New drug policy in childhood obesity

Molnár, Denés

doi:10.1038/sj.ijo.0803084

Cited by 8 publications

(7 citation statements)

References 36 publications

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“…82 Sibutramine is a serotonin reuptake inhibitor that increased weight loss for adolescents who were in a diet and exercise program, compared with diet and exercise alone. Adolescents who received medication lost ϳ3 kg more than did those in the control group.…”

Section: Medicationsmentioning

confidence: 99%

Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

2007

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To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child's obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient's age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.www.pediatrics.org/cgi

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Section: Medicationsmentioning

confidence: 99%

Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

2007

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“…Although orlistat and sibutramine have shown significant but limited benefits for weight reduction and have reported good tolerability in a small number of randomized placebo-controlled trials, evidence for their effectiveness in large populations of young people is largely lacking [16]. NICE and FDA guidelines on the use of sibutramine and orlistat have been based upon very limited effectiveness data.…”

Section: Figurementioning

confidence: 99%

“…Although we do not have data on reasons for discontinuation, we believe that this is likely to reflect either poor therapeutic efficacy of the drug in the general population, or poor patient education and preparation before prescription. This poor preparation is likely to be both in terms of high levels of side-effects due to excessive intake of dietary fat [16] or, alternatively, unrealistic expectations of rapid major weight loss, leading to discontinuation when this is not achieved. Although we have no data on reasons for discontinuation in our study, our data suggest that both orlistat and sibutramine are more poorly tolerated and more rapidly discontinued in use in the general population than in highly selected, motivated and supported clinical trial populations.…”

Section: Comparison With the Literaturementioning

confidence: 99%

Rise in antiobesity drug prescribing for children and adolescents in the UK: a population‐based study

Viner

Hsia

Neubert

et al. 2009

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The antiobesity drugs sibutramine and orlistat are not licensed for use in children and adolescents in the UK or USA.• Clinical trials suggest antiobesity drugs are effective and well‐tolerated in obese adolescents. WHAT THIS STUDY ADDS • Prescribing of unlicensed antiobesity drugs in children and adolescents has increased significantly in the past 8 years.• Most prescribed antiobesity drugs in children and adolescents are rapidly discontinued before patients can see clinical benefit, suggesting they are poorly tolerated or poorly efficacious.AIMS The international childhood obesity epidemic has driven increased use of unlicensed antiobesity drugs, whose efficacy and safety are poorly studied in children and adolescents. We investigated the use of unlicensed antiobesity drugs (orlistat, sibutramine and rimonabant) in children and adolescents (0–18 years) in the UK.METHODS Population‐based prescribing data from the UK General Practice Research Database between 1 January 1999 and 31 December 2006.RESULTS A total of 452 subjects received 1334 prescriptions during the study period. The annual prevalence of antiobesity drug prescriptions rose significantly from 0.006 per 1000 [95% confidence interval (CI) 0.0007, 0.0113] in 1999 to 0.091 per 1000 (95% CI 0.07, 0.11) in 2006, a 15‐fold increase, with similar increases seen in both genders. The majority of prescriptions were made to those ≥14 years old, although 25 prescriptions were made for children <12 years old. Orlistat accounted for 78.4% of all prescriptions; only one patient was prescribed rimonabant. However, approximately 45% of the patients ceased orlistat and 25% ceased sibutramine after only 1 month. The estimated mean treatment durations for orlistat and sibutramine were 3 and 4 months, respectively.CONCLUSIONS Prescribing of unlicensed antiobesity drugs in children and adolescents has dramatically increased in the past 8 years. The majority are rapidly discontinued before patients can see weight benefit, suggesting they are poorly tolerated or poorly efficacious when used in the general population. Further research into the effectiveness and safety of antiobesity drugs in clinical populations of children and adolescents is needed.

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“…These drugs are needed in subjects that are morbidly obese with associated cardiovascular risk factors. 51 For the moment, orlistat has been approved for children in the US and a similar approval is expected in Europe. Both the safety data and the efficacy data are not impressive.…”

Section: Treatmentmentioning

confidence: 99%

“…Pharmacology treatment is raising expectations, in particular, in morbidly obese subjects resistant/reluctant to 'conventional' weight loss programs. Molnar,51 in his minireview analyzed the pharmacology treatments available in pediatric subjects and also presented data on new antiobesity agents that are under development. He concluded that it is fundamental to pursue double-blind placebo-controlled long-term studies in order to investigate efficacy and side effects of the new and promising drugs not only in adults but also in adolescents.…”

Section: Treatmentmentioning

confidence: 99%

From birth to adolescence: Vienna 2005 European Childhood Obesity Group International Workshop

et al. 2005

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BACKGROUND:In the last 15 y there has been a tremendous increase in the number of studies on pediatric obesity looking at epidemiology, health-related risks, etiology, methodology and treatment. During the early 1990s, the European Childhood Obesity Group (ECOG) was born as a group of scientists' expert in the field of pediatric obesity. ECOG this year celebrates the approach to early maturity with an excited and omni-comprehensive program developing through eight different tracks. METHODS: Comments on different 'key' papers in each of the eight tracks. RESULTS: The eight tracks were (1) Nutrition requirements and food habits, (2) physical activity, (3) prevention and political actions/strategies, (4) diabetes, (5) metabolism, (6) psychology, (7) pathology, and (8) treatment with emphasis on drugs. CONCLUSION: Looking at the overall picture of the ECOG workshop we could conclude that despite the fact that childhood obesity is a crisis facing worldwide youth, it is necessary that action to control it must be taken now. All the six relevant levels (ie, family, schools, health professionals, government, industry and media) could be involved in prevention of child and adolescent obesity.

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New drug policy in childhood obesity

Cited by 8 publications

References 36 publications

Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

Rise in antiobesity drug prescribing for children and adolescents in the UK: a population‐based study

From birth to adolescence: Vienna 2005 European Childhood Obesity Group International Workshop

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