Challenges in the management of obesity and comorbidities in an adolescent patient

Background: Obesity is a common condition, especially among adolescents. In the United States, the Center of Disease Control states that as of 2019, 18.5% of adolescents are considered overweight. Case Information: 15-year-old female presents to a Weight Center for severe obesity. The patient had an uncomplicated gestation and was adopted at one month. No biological family history is available, except for a grandmother known to be overweight. Despite similar environmental factors, like dietary patterns and nutrition, her BMI at age 3 rose to the 97th percentile, unlike her siblings. After enrollment to a monthly weight control program, at age 8 on physical exam she appeared overweight with mild acanthosis nigricans of the neck. Upon a 15 kg weight increase from age 10 to 11, her pediatrician enrolled her in another weight control program. At age 13, she was diagnosed with obstructive sleep apnea and nocturnal somnambulation. At age 14, following menarche, she began to experience irregular menstrual cycles accompanied with worsening fatigue and rebound weight gain 20 kg. At age 15, severe acanthosis nigricans was noted on her neck and axillae with an android pattern hair growth. After numerous efforts and programs, a bariatric surgery was performed at 19 resulting in a 13 kg weight decrease and improvements of her acanthosis nigricans on her wrists and ankles, except for her neck. Conclusions: This case illustrates a unique presentation of severe pediatric obesity and the significant effect of biological determinants in comparison to developmental and environmental factors.