Abstract
Adolescent obesity is one of the most pressing pediatric public health challenges of this generation, with a near tripling of prevalence over three decades. Most adolescents with obesity have an exogenous cause, but a small proportion harbor pathological causes that warrant timely recognition. The Indian context is distinctive as complications develop at lower BMI thresholds, low birth weight and a family history of type 2 diabetes are key predictors of metabolic risk, and metabolically healthy obesity is observed in around 40% of obese children. Stepwise evaluation distinguishing exogenous from pathological causes, followed by screening for metabolic and mechanical complications, provides cost-effective assessment. Management combines structured lifestyle change with judicious pharmacotherapy and bariatric surgery in carefully selected adolescents. Prevention strategies anchored in early-life nutrition, physical activity, sleep, and screen-time regulation remain the cornerstone of long-term control.