Management of obesity in adolescents: state of art

Abstract

Increasing prevalence of obesity in children and adolescents might represent an emerging public health issue. Pathogenesis of obesity is multifactorial and involves a complex interplay of genetic and environmental factors. Adolescent obesity has been seen as a cosmetic problem only; nevertheless, a significant increase in cardiovascular risk, probably due to obesity-related metabolic disarrangement has been observed. Consequently, discussion on strategies for treating childhood and adolescent obesity has been promoted worldwide. The proposed treatment triad is life style modification, pharmacological, and surgical treatment. Although lacking definitive data, drug therapy has emerged as an efficacious tool, at least in adolescent obesity. Therefore, sibutramine and orlistat may be good therapeutic options when life style modifications alone do not work. Arq Bras Endocrinol Metab. 2009;53(2):252-261. KeywordsObesity; adolescent; anti-obesity agents; treatment; sibutramine; metformin; orlistat; bariatric surgery resumo O aumento da prevalência de obesidade em crianças e adolescentes pode representar um sério problema de saúde pública nos próximos anos. A patogênese da obesidade é multifatorial e envolve uma complexa interação de fatores genéticos com fatores ambientais. A obesidade na adolescência tem sido vista apenas como um problema estético, entretanto, tem sido observado significativo aumento de fatores de risco cardiovasculares, provavelmente em razão das alterações metabólicas relacionadas ao excesso de peso. Desde então, estratégias de tratamento da obesidade na infância e adolescência têm sido propostas. O tripé proposto para o tratamento é: mudança de estilo de vida, tratamento medicamentoso e cirúrgico. Apesar da falta de evidências definitivas, o tratamento medicamentoso em adolescentes emerge como uma ferramenta eficaz. Sibutramina e orlistat, desse modo, podem ser uma boa opção terapêutica quando as mudanças de estilo de vida, isoladamente, não forem eficazes. Arq Bras Endocrinol Metab. 2009;53(2):252-261. Descritores

Ethical considerations in the treatment of childhood obesity

“…24 Selecting the appropriate treatment option and then implementing it is a complex and at times, difficult process. The use of pharmacotherapy in regard to treating childhood obesity may come with severe consequences and/or side effects if prescribed.…”

“…Providers and families who have attempted family-based weight loss treatment and were unsuccessful may have no option, given the severity of their comorbid health conditions, but to attempt other treatments, such as medications to manage weight loss, some of which have been shown to be effective in managing childhood obesity. 24,25,27 In addition, bariatric surgery comes with risks and benefits as well. Given the relatively recent use of surgical intervention for obese children, only some enduring issues have been discovered thus far, such as substance abuse, eating disorders, and malnutrition.…”

“…24,28 Orlistat blocks fat absorption in the intestine by inhibiting lipase activity. 24 It reduces gastrointestinal absorption of fat by 30%.…”

“…24,28 Orlistat blocks fat absorption in the intestine by inhibiting lipase activity. 24 It reduces gastrointestinal absorption of fat by 30%. 31 Sibutramine conversely, "promotes satiety and enhances energy expenditure by inhibiting the reuptake of the neurotransmitters noradrenaline and serotonin."…”

Artigos publicados em periódicos brasileiros de interesse para a medicina do exercício e do esporte: uma revisão

“…Despite the lack of definite evidence, medication treatment in adolescents comes up as an efficient strategy. Sibutramine and orlistat, hence, may be a ggod therapeutic option when changes in lifestyle alone were not efficient (15) . Harm in glucose transportation stimulated by insulin in the muscle constitutes a crucial flaw for the establishment of glucose intolerance as well as type 2 diabetes.…”