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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