Adolescent obesity and risky sexual behavior.

To the Editor:

The recent supplement to the American Journal of Preventive Medicine—Addressing Latino Childhood Obesity Through Research and Policy: Findings from the Salud America! Experience[1]—was exciting and interesting to read. It is a constant reminder of the racial and ethnic disparities that exist in health outcomes that can be seen early in life. It has become clear that treating obesity requires a multifactorial approach. It is also becoming more apparent, and suggested by many of the reports in this supplement, that obesity can be difficult to treat and requires an approach with many different points of contact, including medical providers, parents, and community.

We would like to highlight an additional concern in the treatment of obesity not often considered among obese youth but potentially important to treatment. Concomitant unhealthy behaviors can create barriers to treating obesity. Risky sexual behavior and its related health-compromising outcomes—for example, sexually transmitted infections (STIs), unintended pregnancy—greatly affect Latino youth,[2,3] presumably many of the same youth who are affected by obesity. Risky sexual behavior has been defined most commonly in the literature as unprotected sexual acts that have a high probability of leading to unintended pregnancy; acquisition of an STI, including HIV/AIDS; or other negative outcomes.

In our recent review of the literature on the relationship between risky sexual behavior and obesity among sexually active youth there were only two studies that we found[4,5] addressing this issue and they suggest that obesity increases the likelihood of engaging in risky sexual behaviors such as using alcohol and drugs and not using a condom. According to the CDC, 47.4% of high school students nationwide have ever had sexual intercourse, and 33.7% report having had sex with at least one person in the 3 months prior to the survey.[2] Adolescents who are obese and participating in risky sexual behavior add another layer of complexity to obesity treatment campaigns since both pregnancy and STIs can add additional complications to successful weight management. Excessive weight gain during pregnancy is common[6] and weight loss post-partum is difficult for new mothers.[7] Further, research suggests that HIV infection can make obesity-related complications difficult to treat.[8]

Despite the prevalence of obesity and sexual risk behavior among adolescents, there are few studies that investigate how these conditions may be related. Obese adolescents are a vulnerable population that can benefit from an integrated approach to intervention and treatment. As suggested by many of the studies of this supplement,[1] it is important to pay attention to the whole child in the context of the many environments in which they live—including family, school, and community—when designing interventions that have the potential for sustainable success.