How Effective is Obesity Treatment in Children?Friday, March 27, 2009
No question – Canada, as many other Western countries is experiencing an unprescedented epidemic of childhood overweight and obesity. Many of these children will need obesity treatment – they are beyond the stage where “prevention” is likely to help.
So do obesity interventions for kids actually work?
This was the topic of a Cochrane review by Oude Luttikhuis and colleagues from the University of Groningen published earlier this year.
The authors analysed all randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy).
The final analysis included 64 RCTs (5230 participants). The studies included varied greatly in intervention design, outcome measurements and methodological quality (the surgical studies were considered to be of too poor quality to include in the analysis).
The authors conclude that although there is not enough data to to recommend one treatment program versus another, there is little doubt that combined behavioural lifestyle interventions are superior to standard care or self-help in producing clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should also be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions.
As they point out, there is a continuing need for high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care.
It appears to me that obesity management in kids is no different than treatment in adults in that it requires multidisciplinary intervention and ongoing monitoring to assure that lost weight is not regained.
Unfortunately, we are far from having the infrastructure, the resources, or the medical expertise to provide adequate obesity interventions to the over 500,000 Canadian kids (and their parents?), who urgently require obesity treatments.