Weight: Overweight and obesity and gynecologic conditions

Obesity among adolescent girls is a significant public health problem and addressing obesity in clinical practice is a national health priority. The consequences of obesity include physical, psychological, and reproductive health sequelae. The obese adolescent girl presents a unique challenge for providers of reproductive health services, and a knowledgeable and sensitive approach to patient care is required. Eating disorders are prevalent in adolescent females, and may present to the gynecologist or primary clinician with menstrual irregularities and not necessarily with weight concerns. This chapter will describe the diagnostic criteria, signs and symptoms, medical assessment, and treatment of three major groups of eating disorders in adolescents: anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. In an adolescent presenting with amenorrhea or menstrual irregularities, there should be a high index of suspicion for an underlying eating disorder. If an eating disorder is suspected, appropriate referral should be made. Use of oral contraceptives to regulate menses and improve bone mineral density in adolescents with eating disorders is not recommended.