Support After Adolescent Behavioral Weight Loss Treatment During the Transition Into Emerging Adulthood: Qualitative Study.

Approximately 21 million US adolescents and emerging adults, defined as individuals in their late teens through the mid-to-late twenties (aged 15‐24 y), are classified as having overweight (BMI>85th percentile) or obesity (BMI>95th percentile) [,]. Persistent racial, ethnic, and socioeconomic disparities are observed, with adolescents from racial or ethnic minority groups (ie, Black and Latine) and lower socioeconomic backgrounds at disproportionately high risk for disease []. Moreover, obesity rates increased during the COVID-19 pandemic and have since remained persistently elevated []. Obesity is a complex and multifactorial chronic disease that commonly persists into adulthood and is associated with significant lifelong morbidity and mortality [-]. Intensive health behavior and lifestyle treatment (IHBLT) is a first-line evidence-based behavioral intervention and the most effective known treatment []; however, current treatment models are generally short-term, resource-intensive, and not well aligned with the chronicity of obesity or the transition from adolescence to adulthood [-]. For example, only one adolescent trial has examined 2-year treatment effects, and because the sample was predominantly White [], the findings may not generalize to groups experiencing health disparities. For some adolescents, management of obesity involves a multimodal approach, including medications and metabolic and bariatric surgery, but behavioral treatment continues to serve as a foundational part of care [,]. There is limited evidence regarding how adolescents fare after treatment or what support is needed as they transition into emerging adulthood. Although modest short-term weight losses are typically observed in adolescent IHBLT [], relapse is common, and to date, there are no established processes to support adolescents after treatment and to help them sustain weight losses, particularly as they transition into emerging adulthood. Indeed, a systematic review found “no evidence internationally of empirical research on the transition of adolescents with obesity from pediatric to adult weight management treatment,” and only a handful of clinical guidelines contained brief recommendations regarding this transition [,]. Current treatment approaches and guidelines do not align with the chronicity of obesity, highlighting an opportunity to better understand what support adolescents need as they transition into emerging adulthood. A recent study emphasizes that, without adequate support, adolescents are at risk of losing continuity in health care, which may increase the likelihood of complications []. The clinical practice guideline from the American Academy of Pediatrics underscores the importance of a structured, individualized care plan for adolescents, including coordinated collaboration between primary care providers, pediatric specialists, and the adult health care professionals who will assume their care as they transition into adulthood []. There is a need to determine how to best stage interventions in the context of chronic care and to identify what posttreatment supports are needed to mitigate health risks during the transition into emerging adulthood []. Furthermore, given the unique developmental stage of emerging adulthood [,], it is important to understand how to prepare adolescents to manage their health in this transitional life stage. Emerging adulthood is marked by instability and multiple life transitions across physical and interpersonal environments [,,]. The need for independence increases and reliance on parents and caregivers decreases, as adolescents assume primary responsibility for their health while also navigating these life transitions []. Numerous unhealthy weight-related behaviors [-] (eg, alcohol use and high levels of sedentary behavior) and disordered eating behaviors (eg, binge eating) peak during these years, and significant weight gains are commonly observed, with the largest gains among those with overweight or obesity [,]. Alarmingly, more than 40% of emerging adults have overweight or obesity [] and continuous obesity from adolescence to emerging adulthood intensifies health risks []. Despite the need, emerging adults are vastly underrepresented in adult IHBLT trials [], clinical settings [], and commercial weight management programs []. Further, very few IHBLT trials have been designed for this age group specifically [-], and to our knowledge, no programs have been designed to support adolescents in maintaining weight loss during this developmental transition.