Orlistat treatment in obese prepubertal children: a pilot study

Norgren, Svante; Danielsson, Pernilla; Jurold, R; Lötborn, M; Marcus, Claude

doi:10.1111/j.1651-2227.2003.tb00596.x

Cited by 70 publications

(31 citation statements)

References 8 publications

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“…While no weight loss medications have been approved by the FDA for use in children under the age of 16 203 , several studies employing medications efficacious in overweight adults have also shown promise for use in adolescents. The research examining the impact of medication on weight loss in overweight children is minimal 208 .…”

Section: Medical Treatments For Obesitymentioning

confidence: 99%

“…Several studies support the use of orlistat to significant reduce weight in overweight children (Norgren et al, 2003) and adolescents [223][224][225] , though one study of 40 overweight adolescents found no difference between teens receiving orlistat and those receiving placebo 226 . Unfortunately, these studies only examined outcomes as far out as 6 months.…”

Section: Medical Treatments For Obesitymentioning

confidence: 99%

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Pediatric Obesity: Parallels with Addiction and Treatment Recommendations

Acosta

Manubay²,

Levin³

2008

Harvard Review of Psychiatry

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Rates of pediatric obesity have increased dramatically over the past decade. This trend is particularly alarming as obesity is associated with significant medical and psychosocial consequences. Obesity may contribute to cardiovascular, metabolic, and hepatic complications, as well as psychiatric difficulties. The development of obesity appears to be influenced by a complex array of genetic, metabolic, and neural frameworks, as well as behavior, eating habits, and physical activity. Numerous parallels exist between obesity and addictive behaviors, including genetic predisposition, personality, environmental risk factors, and common neurobiological pathways in the brain. Typical treatments for pediatric obesity include behavioral interventions targeting diet and/or exercise. Treatments focusing on diet and exercise have yielded mixed results, and typically have been examined in specialty clinic populations, limiting their generalizability. There are limited medication options for overweight children and adolescents, and no approved medical intervention in children younger than 16. Bariatric surgery may be an option for some adolescents, but due to the risks of surgery it is often seen as a last resort. The parallels between addiction and obesity aid in the development of novel interventions for pediatric obesity. Motivational enhancement and cognitive-behavioral strategies used in addiction treatment may serve to be beneficial. KeywordsPediatric obesity; medical co-morbidity; addiction; treatment; review Pediatric obesity has reached epidemic proportions, with a 200-400% increase in the past 10 years [1][2][3] . Alarmingly, routine screening for obesity in children is very low (0.5% in a recent review of 600 pediatric cases), treatment is only provided to a fraction of children identified as overweight, and the most frequently used treatment (general advice) is known to be ineffective 4 . The current article will review some of the correlates of obesity, examine parallels with addictive behaviors, and review treatment recommendations.Due to concerns about stigma, the CDC recommends the term "overweight", rather than obese, when referring to youth 5 . Overweight is a condition where one has excess adipose tissue 6 . Body Mass Index (BMI) is the most accepted parameter for measuring total body fat. A BMI of > 85 th percentile indicates mild to moderate overweight, and a BMI > 95 th percentile indicates a need for intervention. Based on these criteria, more than 20% of US Medical and psychosocial consequences of overweight in children and adolescentsBeing overweight during childhood and adolescence is associated with a myriad of concurrent medical and psychosocial consequences, as well as placing children and teens at higher risk for medical comorbidity and mortality as adults. One of the most widely documented health consequences of overweight is a metabolic syndrome that includes insulin resistance, type 2 diabetes mellitus, polycystic ovary syndrome, dyslipidemia, and hypertension 13 . This syndrome has b...

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Section: Medical Treatments For Obesitymentioning

confidence: 99%

Section: Medical Treatments For Obesitymentioning

confidence: 99%

Pediatric Obesity: Parallels with Addiction and Treatment Recommendations

Acosta

Manubay²,

Levin³

2008

Harvard Review of Psychiatry

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“…The National Childhood Obesity Center, Stockholm, is a referral center for children with severe obesity, the aim of which is to evaluate obesity treatment [13,14,15]. All children and their parents have agreed to continuous treatment for 5 years.…”

Section: Methodsmentioning

confidence: 99%

Importance of Age for 3-Year Continuous Behavioral Obesity Treatment Success and Dropout Rate

et al. 2012

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Objective: To assess whether first year weight loss, age, and socioeconomic background correlate with the success rate of continuous long-term behavioral obesity treatment. Methods: In a 3-year longitudinal study, obese children (n = 684) were divided into three groups based on age at the start of treatment, age 6–9 years, 10–13 years, and 14–16 years. Results: The mean BMI standard deviation score (BMI-SDS) decline was age-dependent (p = 0.001), independently of adjustment for missing data: –1.8 BMI-SDS units in the youngest, –1.3 in the middle age group, and –0.5 in the oldest age group. SES and parental BMI status did not affect the results. 30% of the adolescents remained in treatment at year 3. There was only a weak correlation between BMI-SDS change after 1 and 3 years: r = 0.51 (p < 0.001). Among children with no BMI-SDS reduction during year 1 (n = 46), 40% had a clinically significantly reduced BMI-SDS after year 3. Conclusion: Behavioral treatment should be initiated at an early age to increase the chance for good results. Childhood obesity treatment should be continued for at least 3 years, regardless of the initial change in BMI-SDS.

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“…The nonsystemic mechanism rendered it a good choice for investigation in the pediatric population where long-term safety is a concern. Small pilot studies published the feasibility and tolerability of orlistat in adolescents [11][12][13][14]. In 2003, orlistat was approved by the FDA for the management of obesity in individuals age 12 to 16 years (www.fda.gov/foi/esum/2003/20766se5-018_Orlistat_BP CA_CLINICAL_ltr.pdf).…”

Section: Orlistatmentioning

confidence: 99%

Pharmacotherapy in pediatric obesity: Current agents and future directions

Wald

Uli

2009

Rev Endocr Metab Disord

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Childhood obesity is emerging as a major public health threat, with adverse implications on the health of individuals and long-term costs to society. Family-based lifestyle interventions with behavioral modification, diet and exercise form the mainstay of treatment. Pharmacologic treatment may be considered in selected subjects, especially in the presence of significant and severe comorbidities, when lifestyle intervention has failed to achieve weight reduction. Orlistat and sibutramine are FDA-approved for treatment of pediatric obesity; metformin may be considered in the presence of clinically significant insulin resistance. Evidence is lacking on the appropriate duration of medical therapy and optimal combination with lifestyle intervention. Lack of coverage of medications by insurance and high out-of-pocket costs may be limiting factors to some families. Adverse effects necessitate careful monitoring and may lead to discontinuation of medication. Pharmacologic agents with novel mechanisms of action offer hope of improved efficacy, tolerability and safety.

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Orlistat treatment in obese prepubertal children: a pilot study

Cited by 70 publications

References 8 publications

Pediatric Obesity: Parallels with Addiction and Treatment Recommendations

Pediatric Obesity: Parallels with Addiction and Treatment Recommendations

Importance of Age for 3-Year Continuous Behavioral Obesity Treatment Success and Dropout Rate

Pharmacotherapy in pediatric obesity: Current agents and future directions

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