From the Guidelines
Managing a 13-year-old with a BMI of 31 requires a comprehensive, family-based approach focused on sustainable lifestyle changes rather than restrictive dieting, with a specific assessment for comorbidities and a family-centered weight-loss plan. According to the expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents 1, a family-based weight-loss plan with the adolescent as the change agent for behavior modification, energy-balanced diet, and counseling by a registered dietitian is strongly recommended. This approach should also include a prescription for increased moderate-to-vigorous physical activity (MVPA) and decreased sedentary time for 6 months.
The management plan should start by consulting a pediatrician who can rule out medical causes and provide personalized guidance. Implementing gradual dietary improvements by reducing sugary beverages, increasing fruits and vegetables, controlling portion sizes, and limiting processed foods is essential 1. Encouraging at least 60 minutes of daily physical activity through enjoyable activities like sports, swimming, or cycling and limiting screen time to no more than 2 hours daily for entertainment are also crucial.
A balanced macronutrient diet that contains no fewer than 1200 kcal per day is recommended to improve weight status in adolescents aged 13–18 years who are medically monitored 1. Family diet behaviors that are associated with an increased risk of pediatric obesity, such as parental restriction of highly palatable foods, consumption of food away from home, increased meal portion size, and skipping breakfast, should be avoided.
Regular follow-ups with healthcare providers are essential to monitor progress and adjust the approach as needed. This comprehensive approach works because it addresses both energy intake and expenditure while supporting the teen's psychological well-being during this sensitive developmental period. If there is no improvement in BMI percentile, consideration should be given to referring the adolescent to a comprehensive multidisciplinary weight-loss program or initiating medication (orlistat) under the care of an experienced clinician for 6–12 months 1.
From the Research
Managing a 13-year-old with a BMI of 31
To manage a 13-year-old with a BMI of 31, several strategies can be employed:
- Comprehensive weight management (CWM) interventions that include multiple components, such as nutrition, physical activity, and behavioral strategies, have been shown to be effective 2.
- Increased frequency of dietitian visits is associated with improved body mass index outcomes in obese youth participating in a CWM program 2.
- A reduced glycemic load diet or a portion-controlled diet can be introduced, and the effectiveness of different approaches to delivering the nutrition component can be evaluated 2.
- Orlistat, an inhibitor of gastrointestinal lipases, can be used as an adjunct to diet and exercise to achieve weight loss in obese individuals, but it should only be prescribed for individuals who are motivated to adhere to lifestyle modifications, especially dietary fat restriction 3, 4.
- Lifestyle intervention, including diet and exercise, is a crucial component of weight management, and regular physical exercise can enhance the efficiency of diet and help maintain diet-induced weight loss 5, 6.
- Weight reduction can be achieved via different weight loss strategies, including lifestyle intervention, pharmacotherapy, or bariatric surgery, but not all of these strategies are suitable for all patients, and individual needs should be considered 5.
Key Considerations
- The measurement of body composition is strongly recommended, as reduced muscle mass is highly prevalent throughout the BMI range 5.
- Concomitant therapies that may promote additional weight gain and further trigger the deterioration of blood glucose control should be considered 5.
- A balanced diet with a total dietary calorie intake of 800-1500 calories per day, and a balance of macronutrients, vitamins, and minerals, can be an effective dietary plan for weight loss 6.
- Regular physical exercise, such as 150 minutes of moderate-intensity aerobic exercise per week, can help maintain diet-induced weight loss and improve overall health 6.