Highlights of the Annual Scientific Meeting of NAASO, The Obesity Society

October 20-24, 2006; Boston, Massachusetts

Heather K. Stein, MD, MPH

Disclosures

January 05, 2007

In This Article

Adolescent Obesity

Rates of childhood and adolescent obesity continue to increase. Robert Berkowitz, MD, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, and Thomas Inge, MD, PhD, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, participated in a symposium about the intensive treatment of obesity during adolescence.[17]

Dr. Berkowitz discussed the use of pharmacotherapy, including orlistat and sibutramine, in adolescents with a BMI of 30-44. He reviewed a 3-month study by McDuffie and colleagues,[18] which showed that patients taking orlistat lost an average of 4.4 kg over the course of the study. In a year-long study by Chanione and colleagues[19] examining the effects of lifestyle intervention combined with orlistat 120 mg 3 times daily vs placebo, adolescent patients taking orlistat had an average -0.55 kg/m2 decrease in BMI, whereas those on placebo increased their BMI by 0.31 kg/m2. In regard to sibutramine, Dr. Berkowitz detailed the results of a randomized controlled clinical trial in which adolescents received behavioral therapy and either 10 mg sibutramine or placebo.[20] After 1 year, patients on sibutramine decreased their BMI by 3.1 kg/m2, whereas those on placebo decreased their BMI by 0.3 kg/m2. Although both orlistat and sibutramine are options for adolescents, Dr. Berkowitz noted that the studies were short in duration and did not clarify the use of these medications on a chronic basis in adolescents.

Dr. Inge discussed the use of bariatric surgery in adolescents, including RYGB and LAGB. RYGB has been performed on teenagers since the 1980s, but LAGB has not been FDA-approved in the United States for adolescents younger than 18 years of age. He reviewed the guidelines for bariatric surgery for adolescents[21]:

  • BMI ≥ 40 with obesity-related medical comorbidities, such as diabetes or sleep apnea, or BMI ≥ 50 with less severe comorbidities, such as hypertension or nonalcoholic steatohepatitis;

  • At least 6 months of organized weight-loss attempts;

  • Attainment of skeletal maturity at approximately age ≥ 13 years for girls and ≥ 15 for boys;

  • Assessment by a multidisciplinary team;

  • Ability to commit to pre- and postoperative follow-up; and

  • Full decisional capacity and ability to provide informed consent.

Dr. Inge discussed a study by Lawson and colleagues,[22] which revealed that 1 year after RYGB, adolescents who had the surgery experienced improvements in BMI, triglycerides, total cholesterol, fasting blood glucose, and fasting insulin compared with adolescents who did not have the surgery. He concluded that although bariatric surgery can be performed safely, many questions remain in regard to risks and outcomes. He further questioned which surgery might be best for adolescents, and whether there are unique benefits for early vs later surgical treatment.

In regard to adolescents with less severe obesity, Lloyd-Richardson and colleagues[23] presented an abstract about the "Freshman 15," or the belief that college students gain an average of 15 pounds during their freshman year. They observed that students gained an average of 3 kg during their first year of college and an additional 1-1.5 kg during the second year. Therefore, the weight gain is not transient, and typically continues at least to the end of the sophomore year.

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