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Surveys note a prevalence of over 20% in the United States, England, other European countries, China, and other areas (55-57). Obesity is one of the most important health problems of children, adolescents, and adults in the world, with major negative health implications on physical and psychological health (58). Obesity prevalence among Americans aged 18 to 29 is 14% and increases to 21% if they have spent time in a college or university; perhaps 25% of American college students are overweight (59-60). An obese young teen is 20 times more likely than a teen of normal weight to become an overweight adult; 80% of overweight adolescents become overweight adults (61).

The causes of obesity are implicated in the reduction in physical activity and increase in fatty foods noted in children and adolescents of the last part of the 20th century and the early part of the 21st century. The reduction in physical activity over the past 30 years has been seen as more adolescents forsake exercise for time spent sitting while playing or working at computers, attending movies, and other sedentary activities (60,61). Pregnancy factors are noted, such as limited nutrition during the first trimester and smoking by the pregnant mother (9). Thus, obesity has become a lifestyle disorder that leads to depression, poor self-image, and poor adjustment in the school or work environment for many overweight or obese youth (61-64). It also leads to various medical conditions, including type 2 diabetes mellitus, arthritis, cardiovascular disorders, and various cancers in adolescent or adult years (61,65,66). Any successful management must include improvement in nutrition intake as well as physical activity (66,67).

Management of overweight or obesity starts with a careful look at underlying causes. In less than 5% of cases, there will be an underlying endocrine cause, such as polycystic ovary syndrome, Prader-Willi syndrome, congenital adrenal hyperplasia. As noted, genetics and lifestyle are the main factors in most cases of overweight or obese youth. The precise role of behavioral modification, pharmacologic agents, and bariatric surgery remain unclear at this time and are not appropriate for most youth (61,68,69). Most appropriate in the care of these patients is a vigorous attempt by clinicians to prevent major weight gain by measures to improve poor nutrition and increase physical activity through organized and unorganized sports activity (66,70,71). Any type of physical activity is good if the youth enjoys the sport. Water-based sports may be the best choice for many overtly obese youth, but nearly any type of activity is important. The key to effective physical activities is that the youth enjoys them, and the clinician should not be surprised if choices change from time to time. The key principle is to use sports as a way of encouraging adolescents to make regular physical exertion a part of their lives as children, adolescents, and adults.

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