What Constitutes Successful Weight Management in Adolescents?

In this issue, 2 reports address the consequences and treatment of adolescent obesity. In the first study (1), van Dam and colleagues report that an elevated body mass index (BMI) based on recalled weight at age 18 years was associated with increased premature death in women enrolled in the Nurses' Health Study II. Mortality was increased among women who were obese (BMI ≥ 30 kg/m²) and those who were overweight (BMI, 25.0 to 29.9 kg/m²) at 18 years of age. In addition, in contrast with recently published data from the current National Health and Nutrition Examination Surveys (2), mortality was increased among women who were overweight and obese as adults. The impact of overweight and obesity at age 18 years on death persisted after control for various variables that are likely to alter the effect of body weight on death, such as smoking, alcohol use, physical activity, and BMI in adulthood (1). Although the reported effect of overweight on death has been controversial (2–5), few reports dispute the impact of adult obesity on adult diseases, such as diabetes and cardiovascular disease (6), or the increased risks for adult diseases associated with overweight in childhood.

By convention, I will use the term overweight to describe children and adolescents with a BMI in the 95th percentile for age and sex or greater (the 95th percentile in a young adult is equivalent to a BMI of 30 kg/m²). When I use the term obesity, I refer to the definitions used in the 2 studies.

Overweight in childhood is associated with an increased risk for remaining overweight in adulthood (7) and for becoming more severely overweight in adulthood (8). Overweight in adolescence is associated with increased …