By
Dr Zeina AlWahab MD
2015
Clinical Research Project Supervisor in Specific Diseases
Prof Peivand Pirouzi PhD MBA
CHILDHOOD OBESITY A GROWING PROBLEMClinical Research Challenges and Best Practices in
Pediatric Research in Canada
Humber College Toronto Canada
Childhood obesity is a serious medical condition that affects children and adolescents
It occurs when a child is well above the normal weight for his or her age and height
The term overweight rather than obese is often used in children as it is less stigmatizing
At its simplest obesity results from people consuming more calories than their bodies burn but its a more complex problem than that
People didnt decide to become overweight Their weight gain is a consequence of complicated changes in the environment where food is more readily available and opportunities for physical activity are lacking
Childhood Obesity Facts
Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern
With more than 42 million overweight children around the world childhood obesity is increasing worldwide
Since 1980 the number of obese children has doubled in all three North American countries Mexico the United States and Canada
Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years
Childhood Obesity Facts
New data from the 2013 Canadian Community Health Survey show that roughly one in five youths aged 12 to 17 reported height and weight that classified them as overweight or obese
The survey results also show important shifts in the health and behaviour of the Canadian population
552 of Canadians aged 12 and older in 2013 (161 million) they were at least moderately active during their leisure time This was an increase from 539 in 2012
Approximately one in three adults and one in six children are obese
Childhood Obesity Facts
Obesity is epidemic in the United States today and a major cause of death attributable to heart disease cancer and diabetes
The percentage of children aged 6ndash11 years in the United States who were obese increased from 7 in 1980 to nearly 18 in 2012
Similarly the percentage of adolescents aged 12ndash19 years who were obese increased from 5 to nearly 21 over the same period
Sources Statistics Canada Centers for Disease Control and Prevention
Canadian children [2009 to 2011] American children [2009 to 2010]
What causes overweight and obesityOverweight and obesity result from an energy imbalance This involves eating too many calories and not getting enough physical activity
There are a variety of factors that play a role in obesity This makes it a complex health issue to address
Body weight is the result of genes metabolism behavior environment culture and socioeconomic status
Behavior and environment play a large role causing people to be overweight and obese These are the greatest areas for prevention and treatment actions
Genetics
Science shows that genetics plays a role in obesity
A person is more likely to develop obesity if one or both parents are obese Genetics also affect hormones involved in fat regulation
Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome However genes do not always predict future health
Overeating
Overeating leads to weight gain especially if the diet is high in fat
Foods high in fat or sugar (for example fast food fried food and sweets) have high energy density (foods that have a lot of calories in a small amount of food)
A diet high in simple carbohydrates
Carbohydrates increase blood glucose levels which in turn stimulate insulin release by the pancreas and insulin promotes the growth of fat tissue and can cause weight gain
Other Factors
Frequency of eating
Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower andor more stable blood sugar levels than people who eat less frequently (two or three large meals daily)
Physical inactivity
Sedentary people burn fewer calories than people who are active
The National Health and Nutrition Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Childhood obesity is a serious medical condition that affects children and adolescents
It occurs when a child is well above the normal weight for his or her age and height
The term overweight rather than obese is often used in children as it is less stigmatizing
At its simplest obesity results from people consuming more calories than their bodies burn but its a more complex problem than that
People didnt decide to become overweight Their weight gain is a consequence of complicated changes in the environment where food is more readily available and opportunities for physical activity are lacking
Childhood Obesity Facts
Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern
With more than 42 million overweight children around the world childhood obesity is increasing worldwide
Since 1980 the number of obese children has doubled in all three North American countries Mexico the United States and Canada
Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years
Childhood Obesity Facts
New data from the 2013 Canadian Community Health Survey show that roughly one in five youths aged 12 to 17 reported height and weight that classified them as overweight or obese
The survey results also show important shifts in the health and behaviour of the Canadian population
552 of Canadians aged 12 and older in 2013 (161 million) they were at least moderately active during their leisure time This was an increase from 539 in 2012
Approximately one in three adults and one in six children are obese
Childhood Obesity Facts
Obesity is epidemic in the United States today and a major cause of death attributable to heart disease cancer and diabetes
The percentage of children aged 6ndash11 years in the United States who were obese increased from 7 in 1980 to nearly 18 in 2012
Similarly the percentage of adolescents aged 12ndash19 years who were obese increased from 5 to nearly 21 over the same period
Sources Statistics Canada Centers for Disease Control and Prevention
Canadian children [2009 to 2011] American children [2009 to 2010]
What causes overweight and obesityOverweight and obesity result from an energy imbalance This involves eating too many calories and not getting enough physical activity
There are a variety of factors that play a role in obesity This makes it a complex health issue to address
Body weight is the result of genes metabolism behavior environment culture and socioeconomic status
Behavior and environment play a large role causing people to be overweight and obese These are the greatest areas for prevention and treatment actions
Genetics
Science shows that genetics plays a role in obesity
A person is more likely to develop obesity if one or both parents are obese Genetics also affect hormones involved in fat regulation
Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome However genes do not always predict future health
Overeating
Overeating leads to weight gain especially if the diet is high in fat
Foods high in fat or sugar (for example fast food fried food and sweets) have high energy density (foods that have a lot of calories in a small amount of food)
A diet high in simple carbohydrates
Carbohydrates increase blood glucose levels which in turn stimulate insulin release by the pancreas and insulin promotes the growth of fat tissue and can cause weight gain
Other Factors
Frequency of eating
Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower andor more stable blood sugar levels than people who eat less frequently (two or three large meals daily)
Physical inactivity
Sedentary people burn fewer calories than people who are active
The National Health and Nutrition Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
At its simplest obesity results from people consuming more calories than their bodies burn but its a more complex problem than that
People didnt decide to become overweight Their weight gain is a consequence of complicated changes in the environment where food is more readily available and opportunities for physical activity are lacking
Childhood Obesity Facts
Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern
With more than 42 million overweight children around the world childhood obesity is increasing worldwide
Since 1980 the number of obese children has doubled in all three North American countries Mexico the United States and Canada
Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years
Childhood Obesity Facts
New data from the 2013 Canadian Community Health Survey show that roughly one in five youths aged 12 to 17 reported height and weight that classified them as overweight or obese
The survey results also show important shifts in the health and behaviour of the Canadian population
552 of Canadians aged 12 and older in 2013 (161 million) they were at least moderately active during their leisure time This was an increase from 539 in 2012
Approximately one in three adults and one in six children are obese
Childhood Obesity Facts
Obesity is epidemic in the United States today and a major cause of death attributable to heart disease cancer and diabetes
The percentage of children aged 6ndash11 years in the United States who were obese increased from 7 in 1980 to nearly 18 in 2012
Similarly the percentage of adolescents aged 12ndash19 years who were obese increased from 5 to nearly 21 over the same period
Sources Statistics Canada Centers for Disease Control and Prevention
Canadian children [2009 to 2011] American children [2009 to 2010]
What causes overweight and obesityOverweight and obesity result from an energy imbalance This involves eating too many calories and not getting enough physical activity
There are a variety of factors that play a role in obesity This makes it a complex health issue to address
Body weight is the result of genes metabolism behavior environment culture and socioeconomic status
Behavior and environment play a large role causing people to be overweight and obese These are the greatest areas for prevention and treatment actions
Genetics
Science shows that genetics plays a role in obesity
A person is more likely to develop obesity if one or both parents are obese Genetics also affect hormones involved in fat regulation
Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome However genes do not always predict future health
Overeating
Overeating leads to weight gain especially if the diet is high in fat
Foods high in fat or sugar (for example fast food fried food and sweets) have high energy density (foods that have a lot of calories in a small amount of food)
A diet high in simple carbohydrates
Carbohydrates increase blood glucose levels which in turn stimulate insulin release by the pancreas and insulin promotes the growth of fat tissue and can cause weight gain
Other Factors
Frequency of eating
Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower andor more stable blood sugar levels than people who eat less frequently (two or three large meals daily)
Physical inactivity
Sedentary people burn fewer calories than people who are active
The National Health and Nutrition Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Childhood Obesity Facts
Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern
With more than 42 million overweight children around the world childhood obesity is increasing worldwide
Since 1980 the number of obese children has doubled in all three North American countries Mexico the United States and Canada
Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years
Childhood Obesity Facts
New data from the 2013 Canadian Community Health Survey show that roughly one in five youths aged 12 to 17 reported height and weight that classified them as overweight or obese
The survey results also show important shifts in the health and behaviour of the Canadian population
552 of Canadians aged 12 and older in 2013 (161 million) they were at least moderately active during their leisure time This was an increase from 539 in 2012
Approximately one in three adults and one in six children are obese
Childhood Obesity Facts
Obesity is epidemic in the United States today and a major cause of death attributable to heart disease cancer and diabetes
The percentage of children aged 6ndash11 years in the United States who were obese increased from 7 in 1980 to nearly 18 in 2012
Similarly the percentage of adolescents aged 12ndash19 years who were obese increased from 5 to nearly 21 over the same period
Sources Statistics Canada Centers for Disease Control and Prevention
Canadian children [2009 to 2011] American children [2009 to 2010]
What causes overweight and obesityOverweight and obesity result from an energy imbalance This involves eating too many calories and not getting enough physical activity
There are a variety of factors that play a role in obesity This makes it a complex health issue to address
Body weight is the result of genes metabolism behavior environment culture and socioeconomic status
Behavior and environment play a large role causing people to be overweight and obese These are the greatest areas for prevention and treatment actions
Genetics
Science shows that genetics plays a role in obesity
A person is more likely to develop obesity if one or both parents are obese Genetics also affect hormones involved in fat regulation
Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome However genes do not always predict future health
Overeating
Overeating leads to weight gain especially if the diet is high in fat
Foods high in fat or sugar (for example fast food fried food and sweets) have high energy density (foods that have a lot of calories in a small amount of food)
A diet high in simple carbohydrates
Carbohydrates increase blood glucose levels which in turn stimulate insulin release by the pancreas and insulin promotes the growth of fat tissue and can cause weight gain
Other Factors
Frequency of eating
Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower andor more stable blood sugar levels than people who eat less frequently (two or three large meals daily)
Physical inactivity
Sedentary people burn fewer calories than people who are active
The National Health and Nutrition Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Childhood Obesity Facts
New data from the 2013 Canadian Community Health Survey show that roughly one in five youths aged 12 to 17 reported height and weight that classified them as overweight or obese
The survey results also show important shifts in the health and behaviour of the Canadian population
552 of Canadians aged 12 and older in 2013 (161 million) they were at least moderately active during their leisure time This was an increase from 539 in 2012
Approximately one in three adults and one in six children are obese
Childhood Obesity Facts
Obesity is epidemic in the United States today and a major cause of death attributable to heart disease cancer and diabetes
The percentage of children aged 6ndash11 years in the United States who were obese increased from 7 in 1980 to nearly 18 in 2012
Similarly the percentage of adolescents aged 12ndash19 years who were obese increased from 5 to nearly 21 over the same period
Sources Statistics Canada Centers for Disease Control and Prevention
Canadian children [2009 to 2011] American children [2009 to 2010]
What causes overweight and obesityOverweight and obesity result from an energy imbalance This involves eating too many calories and not getting enough physical activity
There are a variety of factors that play a role in obesity This makes it a complex health issue to address
Body weight is the result of genes metabolism behavior environment culture and socioeconomic status
Behavior and environment play a large role causing people to be overweight and obese These are the greatest areas for prevention and treatment actions
Genetics
Science shows that genetics plays a role in obesity
A person is more likely to develop obesity if one or both parents are obese Genetics also affect hormones involved in fat regulation
Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome However genes do not always predict future health
Overeating
Overeating leads to weight gain especially if the diet is high in fat
Foods high in fat or sugar (for example fast food fried food and sweets) have high energy density (foods that have a lot of calories in a small amount of food)
A diet high in simple carbohydrates
Carbohydrates increase blood glucose levels which in turn stimulate insulin release by the pancreas and insulin promotes the growth of fat tissue and can cause weight gain
Other Factors
Frequency of eating
Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower andor more stable blood sugar levels than people who eat less frequently (two or three large meals daily)
Physical inactivity
Sedentary people burn fewer calories than people who are active
The National Health and Nutrition Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Childhood Obesity Facts
Obesity is epidemic in the United States today and a major cause of death attributable to heart disease cancer and diabetes
The percentage of children aged 6ndash11 years in the United States who were obese increased from 7 in 1980 to nearly 18 in 2012
Similarly the percentage of adolescents aged 12ndash19 years who were obese increased from 5 to nearly 21 over the same period
Sources Statistics Canada Centers for Disease Control and Prevention
Canadian children [2009 to 2011] American children [2009 to 2010]
What causes overweight and obesityOverweight and obesity result from an energy imbalance This involves eating too many calories and not getting enough physical activity
There are a variety of factors that play a role in obesity This makes it a complex health issue to address
Body weight is the result of genes metabolism behavior environment culture and socioeconomic status
Behavior and environment play a large role causing people to be overweight and obese These are the greatest areas for prevention and treatment actions
Genetics
Science shows that genetics plays a role in obesity
A person is more likely to develop obesity if one or both parents are obese Genetics also affect hormones involved in fat regulation
Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome However genes do not always predict future health
Overeating
Overeating leads to weight gain especially if the diet is high in fat
Foods high in fat or sugar (for example fast food fried food and sweets) have high energy density (foods that have a lot of calories in a small amount of food)
A diet high in simple carbohydrates
Carbohydrates increase blood glucose levels which in turn stimulate insulin release by the pancreas and insulin promotes the growth of fat tissue and can cause weight gain
Other Factors
Frequency of eating
Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower andor more stable blood sugar levels than people who eat less frequently (two or three large meals daily)
Physical inactivity
Sedentary people burn fewer calories than people who are active
The National Health and Nutrition Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Sources Statistics Canada Centers for Disease Control and Prevention
Canadian children [2009 to 2011] American children [2009 to 2010]
What causes overweight and obesityOverweight and obesity result from an energy imbalance This involves eating too many calories and not getting enough physical activity
There are a variety of factors that play a role in obesity This makes it a complex health issue to address
Body weight is the result of genes metabolism behavior environment culture and socioeconomic status
Behavior and environment play a large role causing people to be overweight and obese These are the greatest areas for prevention and treatment actions
Genetics
Science shows that genetics plays a role in obesity
A person is more likely to develop obesity if one or both parents are obese Genetics also affect hormones involved in fat regulation
Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome However genes do not always predict future health
Overeating
Overeating leads to weight gain especially if the diet is high in fat
Foods high in fat or sugar (for example fast food fried food and sweets) have high energy density (foods that have a lot of calories in a small amount of food)
A diet high in simple carbohydrates
Carbohydrates increase blood glucose levels which in turn stimulate insulin release by the pancreas and insulin promotes the growth of fat tissue and can cause weight gain
Other Factors
Frequency of eating
Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower andor more stable blood sugar levels than people who eat less frequently (two or three large meals daily)
Physical inactivity
Sedentary people burn fewer calories than people who are active
The National Health and Nutrition Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
What causes overweight and obesityOverweight and obesity result from an energy imbalance This involves eating too many calories and not getting enough physical activity
There are a variety of factors that play a role in obesity This makes it a complex health issue to address
Body weight is the result of genes metabolism behavior environment culture and socioeconomic status
Behavior and environment play a large role causing people to be overweight and obese These are the greatest areas for prevention and treatment actions
Genetics
Science shows that genetics plays a role in obesity
A person is more likely to develop obesity if one or both parents are obese Genetics also affect hormones involved in fat regulation
Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome However genes do not always predict future health
Overeating
Overeating leads to weight gain especially if the diet is high in fat
Foods high in fat or sugar (for example fast food fried food and sweets) have high energy density (foods that have a lot of calories in a small amount of food)
A diet high in simple carbohydrates
Carbohydrates increase blood glucose levels which in turn stimulate insulin release by the pancreas and insulin promotes the growth of fat tissue and can cause weight gain
Other Factors
Frequency of eating
Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower andor more stable blood sugar levels than people who eat less frequently (two or three large meals daily)
Physical inactivity
Sedentary people burn fewer calories than people who are active
The National Health and Nutrition Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Genetics
Science shows that genetics plays a role in obesity
A person is more likely to develop obesity if one or both parents are obese Genetics also affect hormones involved in fat regulation
Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome However genes do not always predict future health
Overeating
Overeating leads to weight gain especially if the diet is high in fat
Foods high in fat or sugar (for example fast food fried food and sweets) have high energy density (foods that have a lot of calories in a small amount of food)
A diet high in simple carbohydrates
Carbohydrates increase blood glucose levels which in turn stimulate insulin release by the pancreas and insulin promotes the growth of fat tissue and can cause weight gain
Other Factors
Frequency of eating
Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower andor more stable blood sugar levels than people who eat less frequently (two or three large meals daily)
Physical inactivity
Sedentary people burn fewer calories than people who are active
The National Health and Nutrition Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Overeating
Overeating leads to weight gain especially if the diet is high in fat
Foods high in fat or sugar (for example fast food fried food and sweets) have high energy density (foods that have a lot of calories in a small amount of food)
A diet high in simple carbohydrates
Carbohydrates increase blood glucose levels which in turn stimulate insulin release by the pancreas and insulin promotes the growth of fat tissue and can cause weight gain
Other Factors
Frequency of eating
Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower andor more stable blood sugar levels than people who eat less frequently (two or three large meals daily)
Physical inactivity
Sedentary people burn fewer calories than people who are active
The National Health and Nutrition Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Other Factors
Frequency of eating
Scientists have observed that people who eat small meals four or five times daily have lower cholesterol levels and lower andor more stable blood sugar levels than people who eat less frequently (two or three large meals daily)
Physical inactivity
Sedentary people burn fewer calories than people who are active
The National Health and Nutrition Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Psychological factors
For some people emotions influence eating habits Many people eat excessively in response to emotions such as boredom sadness stress or anger
Medications
Medications associated with weight gain include certain antidepressants anticonvulsants diabetes medications certain hormones such as oral contraceptives and most corticosteroids such as prednisone
Diseases
such as Hypothroidism Insulin resistance Polycystic ovary syndrome and Cushingrsquos syndrome are also contributors to obesity
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
What are the consequences of overweight and obesityCoronary heart disease
Type 2 diabetes
Cancers (endometrial breast and colon)
Hypertension (high blood pressure)
Dyslipidemia (for example high total cholesterol or high levels of triglycerides)
Stroke
Liver and Gallbladder disease
Sleep apnea and respiratory problems
Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
Gynecological problems (abnormal menses infertility)
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Initial assessments The degree of investigation is dependent on the patients age and severity of obesity
Taking a careful history
Family history of obesity and weight-related health problems such as diabetes
childs eating habits
childs activity level
Other health conditions child may have
Physical examination
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Initial assessments BMI
Body Mass Index (BMI) which is calculated by dividing weight in kilograms by height in metressquared
BMI= Weight Height 2
An estimate of body fat and its a good gauge of your risk for diseases that occur with more body fat
BMI plotted on a BMI-for-age chart
BMI-for-age between 85th and 94th percentiles mdash overweight
BMI-for-age 95th percentile or above mdash obesity
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Initial assessments Blood tests
These tests include
A cholesterol test
A blood sugar test (fasting blood glucose)
Other blood tests to check for hormone imbalances that could affect your childs weight
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Treatment Modalities for Childhood ObesityTreatment for childhood obesity is based on childs age and if he or she has other medical conditions
Treatment for overweight or mildly obese children
For children and teens who are overweight or mildly obese with no other health concerns the goal of treatment may be weight maintenance rather than weight loss
Treatment for obese children
Weight loss is typically recommended for obese children and teens and for children younger than 6 who have obesity-related health concerns
Weight loss should be slow and steady anywhere from 2 pounds (about 09 kilograms) a week to 1 pound a month depending on childs condition
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Behavioral Lifestyle Modification
Healthy eating
When buying groceries choose fruits and vegetables
Limit sweetened beverages
Sit down together for family meals
Limit the number of times you eat out
Serve appropriate portion sizes
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Physical activity
Limit recreational computer and TV time to no more than 2 hours a day
Emphasize activity not exercise
Find activities the child likes to do
If you want an active child be active yourself
Vary the activities
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Pharmacotherapy
which may have a role in a select group of overweight adolescents
The main drugs currently considered for treatment of pediatric obesity are Orlistat (Xenical) and Metformin
Orlistat can be useful as an adjunct to lifestyle changes in severely obese adolescents
Metformin can be used in older children and adolescents with clinical insulin resistance
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Bariatric Surgery
In 2015 the European Society for Pediatric Gastroenterology Hepatology and Nutrition released the following guidelines on bariatric surgery in children and adolescents
Consider bariatric surgery in ldquocarefully selectedrdquo patients with a body mass index (BMI) gt40 kgm 2 who have severe comorbidities such as nonalcoholic fatty liver disease (NAFLD) or in those with a BMI gt 50kgm 2 who have milder comorbidities
Additional factors to consider in deciding whether a child or adolescent should undergo bariatric surgery include physical and psychological maturity personal desire to undergo the procedure previous attempts at weight loss and ability to adhere to follow-up care
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
The Roux-en-Y gastric bypass laparoscopic adjustable gastric band and sleeve gastrectomy are the most widely used procedures in pediatric obesity but their use is associated with subsequent nutritional deficiencies
Current evidence suggests that bariatric surgery can decrease the grade of steatosis hepatic inflammation and fibrosis in NAFLD
Uncomplicated NAFLD is not an indication for bariatric surgery
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents as long as appropriate long-term follow-up is provided
Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational
Sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults still need to be considered investigational
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Prevention
Healthy lifestyle habits including healthy eating and physical activity can lower the risk of becoming obese and developing related diseases
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society including families communities schools child care settings medical care providers faith-based institutions government agencies the media and the food and beverage industries and entertainment industries
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors
Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Clinical trialsgovcaEffect of Orlistat on Weight and Body Composition in Obese Adolescents
A Randomized Controlled Trial
Jean-Pierre Chanoine MD PhD Sarah Hampl MD FAAP Craig Jensen MD Mark Boldrin MS Jonathan Hauptman MD
JAMA 2005293(23)2873-2883 doi101001jama293232873
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Objective
To determine the efficacy and safety of orlistat in weight management of adolescents
Interventions
A 120-mg dose of orlistat (n = 357) or placebo (n = 182) 3 times daily for 1 year plus a mildly hypocaloric diet (30 fat calories) exercise and behavioral therapy
Study Design
A 54-week multicenter placebo-controlled study from August 2000 to October 2002 at 32 centers located in the United States and Canada
General guidelines for diet exercise and behavioral modification were supplied to all centers involved in the study
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Main Outcome Measures
Change in BMI secondary measures included changes in waist and hip circumference weight loss lipid measurements and glucose and insulin responses to oral glucose challenge
Participants
Inclusion criteria
Adolescents (aged 12-16 years)
BMI ranged from 285 in boys and 295 in girls at 12 years to 318 and 319 respectively at 16 years
Had a parent or guardian prepared to attend study visits with them
Were willing to be actively involved in behavioral modification
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Exclusion criteria
BMI of 44 or higher (to increase homogeneity of the group)
Body weight of 130 kg or higher or less than 55 kg
Weight loss of 3 kg or higher within 3 months prior to screening
Diabetes requiring antidiabetic medication
Obesity associated with genetic disorders
History or presence of psychiatric disease
Use of dexamphetamine or methylphenidate
Active gastrointestinal tract disorders
Ongoing bulimia or laxative abuse
Use of anorexiants or weight-reduction treatments during the 3 months before randomization
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Results
There was a decrease in BMI in both treatment groups up to week 12 thereafter stabilizing with orlistat but increasing beyond baseline with placebo
At the end of the study BMI had decreased by 055 with orlistat but increased by 031 with placebo (P = 001)
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
Conclusions
In combination with diet exercise and behavioral modification orlistat statistically significantly improved weight management in obese adolescents compared with placebo
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
Nat Rev Gastroenterol Hepatol 2011 Oct 48(11)635-45 doi 101038nrgastro2011165 Assessment and management of obesity in childhood and adolescence Baur LA1 Hazelton B Shrewsbury VA
Indian J Pediatr 2013 Mar80 Suppl 1S48-54 doi 101007s12098-012-0766-0 Epub 2012 Jun 7 The clinical treatment of childhood obesity Dolinsky DH1 Armstrong SC Kinra S
referencesOgden CL Carroll MD Kit BK Flegal KM Prevalence of childhood and adult obesity in the United States 2011-2012 Journal of the American Medical Association 2014311(8)806-814
Barlow SE and the Expert Committee Expert committee recommendations regarding the prevention assessment and treatment of child and adolescent overweight and obesity summary report Pediatrics 2007120 Supplement December 2007S164mdashS192
Pediatr Endocrinol Rev 2009 Dec7(2)3-14
Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity an overview Gogakos A1 Tzotzas TC Krassas GE
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