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The role of medications in treatment of obesity in childhood and adolescence
Invited Speakers Abstracts Psychosocial co morbidities of adult obesity Melissa J. Hayden Centre for Obesity Research and Education, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Adult obesity is continually rising in prevalence, as are psychosocial comorbidities in these individuals. Some of the most common psychological effects of obesity are mood disorders, poor self-esteem and body image, decreased quality of life and disordered eating. Over the past 30 years psychological factors of obesity have been studied extensively; however the relationship between obesity and psychological health remains unclear. It has been consistently noted that the complexity of the relationship often inhibits successful weight loss and weight loss maintenance. The current presentation will discuss these comorbidities in surgical and nonsurgical cohorts. The prevalence of AXIS I disorders has been reported to be considerably higher in obese individuals, with rates ranging from 5% to 23% in general population studies and from 6% to 66% in surgical groups. Our own research suggests that this rate in bariatric surgery candidates is as high as 44%, with presence of a mood disorder in 27% of candidates and anxiety in 18%. An important factor contributing to the psychological and social consequences of obesity may be weight stigma. Research has shown that obese individuals suffer from stigmatisation and discrimination because of their weight with prior research indicating that the obese are targets of negative attitudes, stereotyping and discrimination. Perceived weight based discrimination and stigmatization is reported in many aspects of everyday life including the workplace, personal life, education, medical care and obese individuals tend to have an increase in ‘‘general negative experiences’’. The impact of these factors on weight loss and changes following weight loss will be discussed.
S7 The role of medications in treatment of obesity in childhood and adolescence Louise A. Baur Discipline of Paediatrics & Child Health, and Sydney School of Public Health, University of Sydney; Weight Management Services, The Children’s Hospital at Westmead; Sydney, Australia While behavioural programs for weight management are the mainstay of obesity treatment in childhood and adolescence, there is a role for drug therapy in more severely obese adolescents, and in those with clinical insulin resistance. In the 2009 Cochrane Review on childhood obesity treatment, pooled meta-analysis in 579 participants from two separate studies, found an additional effect of or list at over placebo on absolute BMI at 6 months follow up, when given in combination with a lifestyle intervention (−0.76 kg/m2 , 95% CI: −1.07 to −0.44, P < 0.00001) [1]. Reported adverse events were largely in relation to the expected gastrointestinal side-effects of the therapy. Anecdotal experience suggests adolescents find it difficult to adhere to this therapy. Sibutramine is now withdrawn from the market. Metformin has been used in obese older children and adolescents with clinical insulin resistance. A 2010 systematic review [2] and a subsequent RCT [3] comparing the effect of 6 months of metformin with placebo, showed that metformin results in improvements in measures of insulin action, with modest although significant reductions in BMI. Mild gastrointestinal symptoms were reported in about 1/5th of participants. Research into the pharmacotherapy of obesity in adolescence is important, although challenging. Longer-term trials, with a range of outcomes (e.g. weight loss, weight maintenance, comorbidities) are required. Consideration should be given as to the expected duration of treatment (life-long?), strategies for adherence, and applicability of therapy developed for use in adults in the adolescent age group.
doi:10.1016/j.orcp.2011.08.064
References [1] Oude Luttikhuis H, et al. Cochrane Database of Systematic Reviews 2009;1. Art. No: CD001872. [2] Quinn S, et al. Obesity Reviews 2010;11:722—30. [3] Yanovski JA, et al. Diabetes 2011;60:477—845.
doi:10.1016/j.orcp.2011.08.065
S7 The role of medications in treatment of obesity in childhood and adolescence Louise A. Baur Discipline of Paediatrics & Child Health, and Sydney School of Public Health, University of Sydney; Weight Management Services, The Children’s Hospital at Westmead; Sydney, Australia While behavioural programs for weight management are the mainstay of obesity treatment in childhood and adolescence, there is a role for drug therapy in more severely obese adolescents, and in those with clinical insulin resistance. In the 2009 Cochrane Review on childhood obesity treatment, pooled meta-analysis in 579 participants from two separate studies, found an additional effect of or list at over placebo on absolute BMI at 6 months follow up, when given in combination with a lifestyle intervention (−0.76 kg/m2 , 95% CI: −1.07 to −0.44, P < 0.00001) [1]. Reported adverse events were largely in relation to the expected gastrointestinal side-effects of the therapy. Anecdotal experience suggests adolescents find it difficult to adhere to this therapy. Sibutramine is now withdrawn from the market. Metformin has been used in obese older children and adolescents with clinical insulin resistance. A 2010 systematic review [2] and a subsequent RCT [3] comparing the effect of 6 months of metformin with placebo, showed that metformin results in improvements in measures of insulin action, with modest although significant reductions in BMI. Mild gastrointestinal symptoms were reported in about 1/5th of participants. Research into the pharmacotherapy of obesity in adolescence is important, although challenging. Longer-term trials, with a range of outcomes (e.g. weight loss, weight maintenance, comorbidities) are required. Consideration should be given as to the expected duration of treatment (life-long?), strategies for adherence, and applicability of therapy developed for use in adults in the adolescent age group.
doi:10.1016/j.orcp.2011.08.064
References [1] Oude Luttikhuis H, et al. Cochrane Database of Systematic Reviews 2009;1. Art. No: CD001872. [2] Quinn S, et al. Obesity Reviews 2010;11:722—30. [3] Yanovski JA, et al. Diabetes 2011;60:477—845.
doi:10.1016/j.orcp.2011.08.065