About two months ago, Rafaela Nogueira, known as Rafa, 10 years old, took a trial crossfit class for kids at a gym in Ribeirão Preto (São Paulo state). She liked it so much she invited her schoolmates to try it out. Six classmates started training, according to her mother, Jessica Nogueira, 37.
“When they took the trial class, they really liked it. They talked to their parents, the parents gave permission and they started doing it,” Rafa says.
The workout is the most visible part of a change that began at home. To help her daughter, who had been gaining weight since she was 3, the family changed everyone's diet.
In Ribeirão Preto, nearly four in ten adolescents aged 10 to 19 monitored by the Food and Nutrition Surveillance System (Sisvan) of the Ministry of Health are overweight or obese. In 2026, through September, the rate was 39.3%. In 2008, it was 22.8%.
In the municipal health network, the Childhood Obesity Center (Nobin), opened by the city hall in December 2025, treats children and adolescents with the problem. From January to September of this year, patients missed 161 out of 297 scheduled appointments at the center.
On October 7, the World Health Organization (WHO) released its first guidelines for the treatment of obesity in children and adolescents. For those under 10, the organization recommends a healthy diet, physical activity, and behavioral change, and does not recommend medication or bariatric surgery.
For pediatric endocrinologist Thiago Hirose, a specialist certified by the Hospital das Clínicas of the Ribeirão Preto Medical School (HC-FMRP/USP), the rise in cases “is a general trend, not just in Ribeirão Preto, but also in other locations.”
“The whole house changed”
According to Jessica, Rafa started gaining weight after turning 3, when she spent about a year taking corticosteroids due to a respiratory crisis. The mother believes the medication increased her daughter's appetite. She also mentions family pampering and Rafa's partnerships—she is a digital influencer—with snack bars and pizzerias.
“There were weeks when she practically didn't eat real food at night. One day it was a burger, one day it was pizza, one day it was esfihas, one day it was Japanese food.”
Around age 8, Rafa cried when going out to buy clothes because nothing fit. “And that’s when it clicked for me,” Jessica says. “I can't demand something of her that I'm doing wrong.”
The first treatment attempt didn't go anywhere. Last year, after not being able to make it up a single block on a walk, the girl went back to the doctor. This time, she was the one who wanted to change.
“The whole house changed,” says Jessica, who was also overweight. Today, she prepares meal-prep containers with the right portions for the week. Rafa eats more fruit, but still doesn't like lettuce, tomatoes, and collard greens. “A lot of things, but I try hard,” Rafa says.
“We have to be an example. Kids don't change through pressure. They imitate you, they do what you do,” the mother states.
Rafa works out every day. Since she was traumatized by the scale, the doctor started tracking her progress through measurements, according to her mother. At one of the appointments, the girl had lost 10 centimeters off her waist. Four months later, 4 more. She does not take weight-loss medication and has not undergone surgery.
“Now she's not afraid to go out and buy clothes,” Jessica says. When asked if she feels better, Rafa replies: “Much better.”
On social media, restaurant partnerships have become rare, according to her mother. Today, Rafa trains at the gym in exchange for promotion.
“She's a different girl”
Thalia Leme de Oliveira, 9, has been monitored by Nobin since January. At her home, the change also started with the mother. Rosana de Andrade Leme changed her diet after discovering gestational diabetes and, according to her, lost 30 kilos. That same year, a routine checkup showed her daughter's cholesterol was slightly elevated.
Thalia traded ballet for street dance and now does physical activity all week long. Chocolate and soda have become the exception. “We didn't take her food away. She cut it out little by little,” Rosana says.
According to the mother, Thalia doesn't like missing the Wednesday sessions and is the one who remembers the time. For Rosana, listening to the professionals made a difference: “Kids listen more when it's someone else.”
“My goodness, she's a different girl,” Rosana sums up. Thalia herself recalls: “My clothes used to be super tight, sometimes they wouldn't even fit.” On November 15, she will perform street dance in a theater.
How Nobin works
Nobin receives children and adolescents referred by Basic Health Units (UBSs) when the condition persists for at least six months, according to city hall. The first appointment is with nutrologist Valéria Moro. Afterward, the family attends individual sessions and groups on Wednesday afternoons with nutritionists, a psychologist, and a physical educator, including a support group for parents and guardians.
“There's no way to cover all dimensions of treatment with a single professional,” says nutritionist Gisele, who is part of the team. According to her, 61 patients have gone through the team since the opening.
Why so many families miss appointments
No-shows account for 54% of scheduled appointments from January to September, according to city hall. For follow-ups, it reaches six in ten: 113 out of 186 scheduled appointments. Among new cases, 48 out of 111 patients did not show up for their first appointment.
“Obesity is a serious, chronic, multifactorial disease that is difficult to treat,” Gisele says.
According to her, factors include the lack of someone to bring the child, transportation costs, and school hours. Since the sessions are in the afternoon, those who study in that shift have to leave class to go. “In the end, it all falls on the mother to do everything.”
The spike among adolescents
In Ribeirão Preto, according to Sisvan, the percentage of adolescents who are overweight or obese went from 22.8% in 2008 to 32.4% in 2016 and 37.9% in 2025. In 2026, through September, there were 5,126 adolescents in this condition, or 39.3% of those monitored.
In 2025, the rate was 38.4% in the state of São Paulo and 33.4% in Brazil.
Among children aged 5 to 9 evaluated in 2025 in Ribeirão Preto, 2,301 were overweight and 2,134 were obese, according to the Municipal Health Department.
Sisvan records those who are weighed and measured at SUS (Unified Health System) health units. Therefore, the numbers do not represent the entire city population.
What the WHO says
According to the WHO, 400 million children and adolescents aged 5 to 19 were overweight worldwide in 2024. Of that total, 170 million were obese. Among children under 5, 35 million were overweight.
The organization defines obesity as a chronic and recurring disease. For adolescents aged 10 to 19, the guidelines allow for obesity medications, but only when a supervised habit-change program has failed to produce results. Bariatric surgery may be considered in cases of severe obesity, under strict conditions.
The WHO also recommends treating obesity and mental health together and from an early age. According to the organization, anxiety, depression, and low self-esteem can lead to unhealthy eating habits.
What the expert says
For Thiago Hirose, the Covid-19 pandemic worsened the problem, bringing anxiety, lockdowns, lack of physical activity, and online classes. Today, he says, a combination of habits weighs heavily.
“Children are sleeping less, staying home more, spending more hours in front of screens, and consuming more ultra-processed foods, often while watching television.”
The doctor has seen cases in increasingly younger children. One of the most common complications, according to him, is insulin resistance, which hinders the action of this hormone and can promote high blood pressure, type 2 diabetes, and cholesterol changes. Fatty liver disease, sleep apnea, and puberty disorders are also among the risks.
In addition to weight, he recommends tracking waist circumference, always according to age and with a pediatrician's evaluation. This is the measurement Rafa's family started tracking.
When talking to the child, the doctor advocates treating obesity as a health issue, not just an aesthetic one, using age-appropriate language and avoiding extremism. Involving the child in meal prep and trading screen time for play are among the strategies he suggests.
