Introduction: The adverse effects of obesity and overweight in adolescence are vast and cover a wide range of physical and mental health problems. Overweight adolescents are at increased risk of developing chronic conditions such as type 2 diabetes, hypertension, cardiovascular disease and musculoskeletal disorders, as well as facing psychosocial challenges such as stigma, low self-esteem and depression. 

Objective: to contribute to a better understanding of the complexity of obesity and overweight in adolescence, as well as to help in the development of effective and comprehensive approaches to preventing and controlling these conditions, aiming to promote the health and well-being of adolescents. 

Methods: This study constitutes a systematic review, classified as exploratory and descriptive. The preparation of the research was a bibliographical search in electronic databases on methods associated with RSL (Systematic Literature Review) and the applications of SMARTER (Simple Multi-Attribute Rating Technique using Exploiting Rankings). 

Results: A comprehensive systematic search of the literature yielded 4125 articles referring to the incidence of obesity and overweight in adolescents, of which 22 articles were eligible to be included in this systematic review. 

Conclusion: By prioritizing nutrition education, promoting regular physical activity and access to healthy foods, we can not only reduce the incidence of obesity and overweight among adolescents, but also improve their quality of life and overall well-being.

The incidence of obesity and overweight among adolescents is an increasingly prevalent and worrying public health problem worldwide (JEBEILE et al., 2022). During recent decades, an alarming increase in the proportion of young people experiencing these conditions has been observed, raising serious concerns about the consequences for the health and well-being of this growing population (WHO, 2022). This complex phenomenon is the result of a varied interaction between genetic, behavioral, social, economic and environmental factors, which converge to influence eating patterns, physical activity levels and lifestyles of adolescents (TONG et al., 2022).

Adolescence is a critical period of development characterized by significant biological, psychological and social changes that can have a lasting impact on health and body weight throughout life. (JOSHI et al., 2023; MOORE HESLIN; MCNULTY, 2023). During this phase, teens face unique challenges, such as the transition to independence in food choices and social pressure to fit into idealized beauty standards, which can contribute to unhealthy eating behaviors and a decrease in physical activity (SHAMS; SHAFIEI; SADREMOMTAZ, 2024).

During adolescence, young people experience rapid physical and hormonal growth, which can directly influence body weight. Some hormonal changes can affect metabolism, appetite and fat distribution in the body, contributing to weight gain (MOUSIKOU; KYRIAKOU; SKORDIS, 2023; SHALITIN; GAT-YABLONSKI, 2022). Furthermore, genetic factors play an important role in susceptibility to overweight and obesity, and these factors often manifest during adolescence (WÓJCIK et al., 2023).

The environment in which adolescents live plays a crucial role in their health and weight (NEUFELD et al., 2022). Socioeconomic factors, such as access to healthy foods and food security, can influence adolescents' food choices (DALY; O'SULLIVAN; KEARNEY, 2022). Furthermore, the availability of high-calorie foods rich in fat and sugar, combined with adverse advertising of unhealthy food products, can lead to harmful food choices during adolescence (BERNARD, 2022).

A sedentary lifestyle is another significant contributing factor to overweight and obesity in adolescence (CARPENA LUCAS et al., 2022; LIU et al., 2022). With the increase in time dedicated to sedentary activities, such as watching television, using computers and playing video games, many adolescents are unable to meet physical activity recommendations, which can lead to the accumulation of body fat (MATEO-ORCAJADA; VAQUERO-CRISTÓBAL; ABENZA -CANO, 2024).

The adverse effects of obesity and overweight in adolescence are vast and cover a wide range of physical, mental and social health problems (CABRAL; SOARES; FARIA, 2023; FÖRSTER et al., 2023). They often face stigmatization and discrimination, which can lead to problems with self-esteem, social isolation and even depression. (LANGFORD et al., 2022; TANAS et al., 2022).

Obesity in adolescence is also associated with a greater risk of persistence into adulthood, increasing the likelihood of developing obesity and its complications throughout life. They have an increased risk of developing chronic conditions such as type 2 diabetes, hypertension, cardiovascular diseases and musculoskeletal disorders (LOPEZ-JIMENEZ et al., 2022; MOHAJAN; MOHAJAN, 2023).

Therefore, effective prevention and management of obesity and overweight during adolescence are crucial to reduce the negative impact on individual and collective health, as well as to reduce the social and economic costs associated with these conditions (TULLY et al., 2022).

Faced with this challenging scenario, it is essential that integrated and comprehensive approaches are adopted, involving interventions at multiple levels, including public policies, school programs, community initiatives and family support. By directing efforts to promote healthy eating habits, encourage regular physical activity and create environments conducive to the well-being of adolescents, we can work towards a future where obesity and overweight in adolescence are less prevalent and their adverse consequences are mitigated.

Considering the above, the objective of this review is to improve understanding of the complexity of obesity and overweight in adolescence, in addition to contributing to the development of comprehensive and effective approaches to prevent and control these conditions, aiming to promote the health and well-being of adolescents.

This study constitutes a systematic review, classified as exploratory and descriptive. The preparation of the research was a bibliographical search in electronic databases on methods associated with RSL (Systematic Literature Review) and the applications of SMARTER (Simple Multi-Attribute Rating Technique using Exploiting Rankings). The work carried out is of a qualitative and quantitative nature. Qualitative data analysis was carried out intuitively and inductively during the survey of the theoretical framework. It is also quantitative through the use of the multi-criteria method. In addition, there is also a numerical experimental study in order to simulate an article selection situation based on the observed criteria. 

The bibliographical research was carried out in the following databases: Web of Science; Science Direct; Wiley; Springer Link; Taylor and Francis; PubMed and EBSCO. In addition, searches were carried out using bibliographical references of studies that relevantly addressed the topic on the Google Scholar search platform.

The search in the databases was carried out using the terminologies registered in the Health Sciences Descriptors created by the Virtual Health Library developed from the Medical Subject Headings of the US National Library of Medicine, which allows the use of common terminology in Portuguese, English and Spanish. The present study sought to investigate the literature on the incidence of obesity and overweight in adolescents. To this end, the descriptors “incidence”, “obesity”, “overweight” and “adolescents” were used, initially in English, and in a complementary way in Spanish and Portuguese.

As a tool to support decision-making in the selection and prioritization of articles, a set of criteria were considered essential to represent the state of the art of the topic under study. This method has the following characteristics: (i) rigorous logic allows the method to be accepted as a decision support tool; (ii) simple to understand and apply with easy-to-interpret results.

References from selected works were also searched for other documents of potential interest. Once qualified for full text in the evaluation, articles were included in the qualitative review if they met the following inclusion criteria: a) they contained data on the incidence of overweight in adolescents; b) contained data on the incidence of obesity in adolescents. Articles were excluded if they were reports, banners or conference abstracts. There was no review of confidential health information and the study was non-interventional. Therefore, ethics committee approval was not necessary. In the end, the result obtained totaled 22 articles that covered the desired characteristics for the study.

Three independent researchers extracted data from articles that met the inclusion criteria and recorded them in a “Data Extraction Form” generated in Microsoft Excel on the incidence of overweight and obesity in adolescents. From this form, the authors and year of publication, objective, type of study (design), study title, sample size (n) and conclusion of the studies were included, which will be demonstrated in the results through table 1

Table 1. Selected studies and their main findings

Source: Authors (2024).

A comprehensive systematic search of the literature yielded 4125 articles referring to the incidence of overweight and obesity in adolescents. Of these, 783 studies were excluded due to data overlap. From this, the SMARTER method (Simple Multi-Attribute Rating Technique using Exploiting Rankings) was chosen and 449 articles were selected that were suitable for full-text screening, of which 135 articles were included for data extraction, of which 113 were excluded by the exclusion criteria, making 22 articles eligible and included for systematic review. In Figure 1, we describe the strategy for selecting articles on the topic in question.

Source: Authors (2024)

Figure 1: Article search strategy

Obesity is a multifactorial condition, influenced by a complex interaction of several factors throughout life, from conception to adulthood. These factors include genetic predisposition, eating habits, physical activity levels, psychosocial and environmental factors. Understanding the factors that influence health-related behaviors, such as diet and physical activity, is critical due to their significant impact on global morbidity and mortality. Changes in these behaviors can have substantial effects on health (SHAMS; SHAFIEI; SADREMOMTAZ, 2024).

Early childhood adversity, whether emotional or physical, is linked to long-term negative effects on physical and mental health. Chronic stress resulting from these adversities can affect growth and well-being throughout life. There is a global increase in the prevalence of obesity in children and adolescents, which can lead to several comorbidities and impact physical and psychological development, including accelerated linear growth and the risk of precocious puberty (MOUSIKOU; KYRIAKOU; SKORDIS, 2023; SHALITIN; GAT-YABLONSKI, 2022).

Obesity is now recognized as a chronic, multifactorial, and treatable neurobehavioral disease characterized by adipose tissue dysfunction and adverse consequences for metabolic, biomechanical, and psychosocial health. It is one of the main causes of increased cardiovascular risk in young adults. Obesity-related hypertension is prevalent among adolescents, highlighting the significant impacts of obesity on cardiovascular health (WÓJCIK et al., 2023).

The study "Substances that interfere with eating habits and human health: sociocultural senses and meanings in the school context" highlights the influence of the school environment on the formation of adolescents' eating habits, highlighting the importance of considering sociocultural aspects in health promotion (BERNARD, 2022).

The need for comprehensive educational programs on nutrition, involving schools, parents and health professionals, is highlighted in light of inadequate eating habits and decreased physical activity among adolescents. Such programs, by emphasizing critical thinking and emotional intelligence, empower teens to make informed choices about lifestyle and diet. The deterioration in diet quality during adolescence is influenced by several individual, social and environmental factors, whose influences increase as adolescents become more independent. This poor nutrition can have immediate and long-term health consequences, such as micronutrient deficiencies and increased risk of overweight, obesity and cardiometabolic risk factors, problems that persist among adolescents, both in Ireland and internationally. (JOSHI et al., 2023; MOORE HESLIN; MCNULTY, 2023).

Diet during adolescence is fundamental to a healthy life, although eating patterns and influencing factors vary among adolescents. More evidence is needed to better understand adolescents' dietary issues and their food choices in order to promote more effective actions. Although concerned about their health, teenagers often relate this to their body image, which can influence their food choices. Factors such as taste, price, and convenience play a significant role in adolescents' food choices, while social influence and social norms become more prominent as they gain independence and interact more with their peers (DALY; O'SULLIVAN; KEARNEY, 2022 ; NEUFELD et al., 2022).

Controlling modifiable risk factors is crucial in the prevention and treatment of excess weight, with genetics being responsible for a small portion of childhood obesity. Environmental and behavioral factors play a significant role in weight. Recent social and cultural changes have amplified the factors involved in obesity, including the increased consumption of ultra-processed foods and the decreased intake of healthy foods. The increasing use of information and communication technologies is associated with a reduction in physical activity among adolescents, contributing to a positive energy balance and associated health problems, such as increased body fat percentage and worse cardiorespiratory performance (CARPENA LUCAS et al., 2022; MATEO-ORCAJADA; VAQUERO-CRISTÓBAL; ABENZA-CANO, 2024).

Adolescent physical fitness is declining globally, with a decrease in aerobic capacity and an increase in body mass index. Studies reveal high rates of below-normal muscular fitness in Czech children and less than half of North American teenagers have healthy levels of physical fitness (TONG et al., 2022).

Before the COVID-19 pandemic, obesity in children and adolescents had stabilized in many rich countries, although severe obesity continued to rise. On the other hand, in low- and middle-income countries, the prevalence of obesity was on the rise. With the advent of the pandemic, there was an increase in weight gain among children and adolescents in several regions (JEBEILE et al., 2022).

Obesity is the main risk factor for disability, contributing to 7% of years lived with disability, and is associated with greater morbidity and mortality from COVID-19. Initial studies from several countries in the Region show an increase in the prevalence of overweight and obesity, as well as in the average body mass index in children and adolescents during the COVID-19 pandemic (WHO, 2022).

In short, obesity during adolescence requires a multidisciplinary approach that takes into account sociocultural, behavioral, nutritional and mental health factors. Effective interventions must be aimed not only at modifying eating and lifestyle habits, but also at promoting a school and social environment that supports healthy choices and the well-being of adolescents.

The incidence of obesity and overweight in adolescents represents a significant public health challenge that requires urgent attention and coordinated action at multiple levels. Analysis of the determining factors and consequences of these conditions reveals the complexity of the problem, highlighting the need for integrated and comprehensive approaches to prevention and intervention.

It is essential to recognize that adolescence is a crucial period of development in which eating behavior and physical activity patterns can be established and have lasting impacts on health throughout life. Therefore, investing in strategies that promote healthy habits from a young age is essential to reduce the risks associated with obesity and overweight.

Furthermore, the implementation of effective public policies, the creation of environments favorable to well-being and the strengthening of family and community support are essential elements to face this challenge in a broad and sustainable way.

By prioritizing nutrition education, promoting regular physical activity and access to healthy foods, we can not only reduce the incidence of obesity and overweight among adolescents, but also improve their quality of life and overall well-being.

By working together to tackle this public health issue, we can build a future where teens grow up healthy, happy and empowered to reach their full potential.