New review highlights gaps and discrepancies in obesity guidelines for adolescents vs. adults
A new evidence map published in Obesity Reviews has revealed significant discrepancies and gaps in how obesity is diagnosed and managed in adolescents compared to adults.
Drawing on 39 international clinical guidelines, the review outlines where current recommendations diverge - and where they fall short in addressing the unique needs of adolescents, especially during the transition to adult healthcare.
Led by researchers across Germany and Austria, the study synthesised over 1,200 recommendations from guidelines published between 2017 and 2023. It identifies major differences in diagnostic methods, lifestyle and behavioural guidance, pharmacotherapy, and recommendations on metabolic and bariatric surgery (MBS).
While some discrepancies are expected - reflecting differences in physiology, psychology, and care settings - the authors argue that current guidelines do not go far enough to support adolescents, especially during the critical transition from paediatric to adult care.
Key discrepancies and gaps
- Diagnostics: Adolescents are assessed using dynamic BMI percentile curves, while adults rely on fixed BMI thresholds. There are also fewer recommendations for screening comorbidities in youth, including monogenic obesity.
- Lifestyle treatment: Paediatric guidelines tend to offer general nutritional guidance, whereas adult guidelines recommend specific dietary approaches, such as low-carb or very-low-calorie diets. Similarly, adults are more likely to be advised on strength training and behavioural strategies for smoking or alcohol use—areas often missing in youth guidelines.
- Pharmacotherapy and surgery: There is a lack of recommendations for specific medications in adolescents, despite recent approvals for paediatric use. For MBS, most guidelines focus on adults, leaving gaps in peri- and post-operative care guidance for adolescents.
- Reproductive health: Many adult guidelines include recommendations for women of reproductive age, but none address contraception, fertility, or pregnancy for adolescent girls—despite clear clinical relevance.
The transition gap
The transition from paediatric to adult obesity care is a particularly vulnerable time for young people, often marked by changes in care teams, increased independence, and shifting responsibilities. Yet the review found only one guideline with a specific recommendation on how to manage this transition.
The authors call for the development of targeted transition pathways, including age-appropriate therapeutic goals and structured support for young people as they take on greater autonomy in managing their health.
A call for dedicated adolescent guidance
In their conclusion, the authors advocate for the creation of a dedicated transition guideline for adolescents with obesity. They argue that bridging the divide between paediatric and adult care—while addressing overlooked areas like reproductive health and long-term treatment adherence—is essential to improving health outcomes for young people.
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World Obesity publishes four scientific, peer-reviewed journals, each focusing on a different area of obesity research: systematic reviews, pediatrics, clinical treatment, and science and practice.
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