Bariatric surgery shouldn't be one of the first options considered by
very obese children and teens -- but there's a wide gap in effective
treatments between lifestyle intervention and surgery, according to a
scientific statement from the American Heart Association.
Treatment options are currently limited for children with "severe obesity" -- a newly defined class of risk that comprises about 6% of children and adolescents, according to Aaron S. Kelly, PhD, of the University of Minnesota Medical School in Minneapolis, and colleagues.
Further innovation is needed to fill this "unacceptably large" gap between behavior- and drug-based interventions and bariatric surgery for youth with severe obesity, according to the statement published online in Circulation: Journal of the American Heart Association.
"Even highly intensive lifestyle interventions generally have left subjects still markedly obese, albeit with modestly improved cardiovascular and metabolic profiles," Kelly and colleagues noted.
"Alternative approaches are needed for youth who medically qualify for bariatric surgery but are not interested in this option, for youth who lack the family support or emotional maturity for the surgery and resulting change in food intake, and for children too young for surgery but with severe obesity and severe comorbidities," they wrote.
It's important to identify the origin of a child's obesity because it's not always as simple as eating too much, Valentin Fuster, MD, PhD, director of Mount Sinai Heart at The Mount Sinai Medical Center in New York City, told MedPage Today.
There could be environmental factors that play a role, genetic factors, or behavioural factors, Fuster said.
"We also have to identify earlier those children who might be at risk of becoming overweight," he said. "I really believe the school systems should be involved in this."
The authors of the scientific statement defined "severe obesity" in children and adolescents as having a "BMI greater than 120% of the 95th percentile or an absolute BMI greater than 35 kg.m2, which ever is lower based on age or sex."
Kelly and colleagues noted a growing consensus that severe obesity be treated as a chronic problem, but pediatric studies in the area of behavior modification are very limited.
The short-term data (6 to 12 months) tend to suggest that ongoing treatment is associated with better outcomes, but "the feasibility and acceptability of continuing care over longer periods of intervention are not known."
Studies evaluating the efficacy of drug therapy for severely obese children are also sparse, Kelly and colleagues said, even though two new drugs for weight loss were approved last year.
But neither phentermine plus topiramate (Qsymia) nor lorcaserin (Belviq), the two newly approved diet drugs, along with naltrexone with bupropion, which is currently being tested, have been studied in children, Kelly and colleagues said. Orlistat is the only FDA approved weight-loss drug for children over 12.
One of the main risks associated with obesity is heart disease. The writing group said that more longitudinal data are needed tracking such metrics as vascular structure and function, inflammation markers, insulin resistance, and impaired glucose intolerance in severely obese youths.
It's also important to improve utilization of "early-life weight-gain trajectory" data in an effort to better identify those children at risk of developing severe obesity.
In addition, more safety and efficacy data are needed regarding pharmaceutical and surgical interventions.
"The task ahead will be arduous and complicated, but the high prevalence and serious consequences of severe obesity require us to commit time, intellectual capital, and financial resources to address it," they wrote in conclusion.
SOURCE:http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology
Treatment options are currently limited for children with "severe obesity" -- a newly defined class of risk that comprises about 6% of children and adolescents, according to Aaron S. Kelly, PhD, of the University of Minnesota Medical School in Minneapolis, and colleagues.
Further innovation is needed to fill this "unacceptably large" gap between behavior- and drug-based interventions and bariatric surgery for youth with severe obesity, according to the statement published online in Circulation: Journal of the American Heart Association.
"Even highly intensive lifestyle interventions generally have left subjects still markedly obese, albeit with modestly improved cardiovascular and metabolic profiles," Kelly and colleagues noted.
"Alternative approaches are needed for youth who medically qualify for bariatric surgery but are not interested in this option, for youth who lack the family support or emotional maturity for the surgery and resulting change in food intake, and for children too young for surgery but with severe obesity and severe comorbidities," they wrote.
It's important to identify the origin of a child's obesity because it's not always as simple as eating too much, Valentin Fuster, MD, PhD, director of Mount Sinai Heart at The Mount Sinai Medical Center in New York City, told MedPage Today.
There could be environmental factors that play a role, genetic factors, or behavioural factors, Fuster said.
"We also have to identify earlier those children who might be at risk of becoming overweight," he said. "I really believe the school systems should be involved in this."
The authors of the scientific statement defined "severe obesity" in children and adolescents as having a "BMI greater than 120% of the 95th percentile or an absolute BMI greater than 35 kg.m2, which ever is lower based on age or sex."
Kelly and colleagues noted a growing consensus that severe obesity be treated as a chronic problem, but pediatric studies in the area of behavior modification are very limited.
The short-term data (6 to 12 months) tend to suggest that ongoing treatment is associated with better outcomes, but "the feasibility and acceptability of continuing care over longer periods of intervention are not known."
Studies evaluating the efficacy of drug therapy for severely obese children are also sparse, Kelly and colleagues said, even though two new drugs for weight loss were approved last year.
But neither phentermine plus topiramate (Qsymia) nor lorcaserin (Belviq), the two newly approved diet drugs, along with naltrexone with bupropion, which is currently being tested, have been studied in children, Kelly and colleagues said. Orlistat is the only FDA approved weight-loss drug for children over 12.
One of the main risks associated with obesity is heart disease. The writing group said that more longitudinal data are needed tracking such metrics as vascular structure and function, inflammation markers, insulin resistance, and impaired glucose intolerance in severely obese youths.
It's also important to improve utilization of "early-life weight-gain trajectory" data in an effort to better identify those children at risk of developing severe obesity.
In addition, more safety and efficacy data are needed regarding pharmaceutical and surgical interventions.
"The task ahead will be arduous and complicated, but the high prevalence and serious consequences of severe obesity require us to commit time, intellectual capital, and financial resources to address it," they wrote in conclusion.
SOURCE:http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology
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