Behavioral modification programs may help obese children manage weight

DHHS report details that treatment for obese children has improved in recent years but significant gaps remain.

Obese school-age children and adolescents can lose weight and prevent further weight gain by participating in medium- to high-intensity behavioral management programs, according to a report released by the Department of Health and Human Services’ Agency for Healthcare Research and Quality.

The report identified trials conducted to evaluate the effects of behavioral and pharmaceutical treatments on weight in overweight and obese children aged 5 to 18 years. The evidence-based report indicated that treatment of obese children has improved in the past decade, but significant gaps remain for obesity treatment in this population.

“Effective prevention is the best way to stem the childhood obesity epidemic, but we also have to find effective and healthy ways of helping our children and teens who already are obese get to a healthier weight. The Agency for Healthcare Research and Quality’s new evidence report helps identify possible solutions,” Carolyn M. Clancy, MD, AHRQ director, said in a press release.

Upon review, the researchers reported effectiveness of medium- to high-intensity behavioral management programs up to one year that include techniques to improve dietary and physical activity habits, such as goal setting, problem solving and relapse prevention. Obese children enrolled in these weight management programs weighed an average 3 lb to 23 lb less than their obese peers at the end of treatment. The AHRQ report also concluded that intensive, health care–based programs generally had greater effects than school-based programs.

The report suggested that the appetite suppressant sibutramine (Meridia, Abbott) and orlistat (Xenical, Hoffman-La Roche), which helps block fat aborption, were effective when added to a behavioral weight management program. Obese children who received these drugs lost more weight compared with healthy peers receiving behavioral weight management and placebo, according to study results. Adverse events included mild increases in heart rate for those assigned to sibutramine and the prevention of small decreases in blood pressure seen in patients assigned to placebo; adverse events associated with orlistat included abdominal pain, oily spotting and fecal incontinence.

The researchers also reviewed the effectiveness of weight-reduction surgery on morbidly obese adolescents who had a BMI of 41 or greater. While the evidence to date is limited, results showed moderate to substantial weight loss, and the surgery may help resolve other weight related medical problems such as sleep apnea and asthma. However, more short-term risks are associated with surgery and few cases have been followed for more than a year.

“Obese children and their families may be discouraged about their weight, but our review found there are programs out there that can help kids to either gain weight more slowly as they grow or, where appropriate, lose weight,” Evelyn Whitlock, MD, MPH, associate director, Oregon Evidence-Based Practice Center, Kaiser Permanente Center for Health Research, Portland, Ore., said in a press release.

For more information:

Agency for Healthcare Research and Quality. Effectiveness of weight management programs in children and adolescents. www.ahrq.gov/clinic/tp/chwghttp.htm. Accessed Oct. 1, 2008.