Pediatric Weight Management

PWM: Adjunct Therapies (2006)

Pediatric Weight Management: Adjunct Therapies

Adjunct therapies are medical interventions that fall outside the scope of practice of the dietitian. However, because dietitians are a critical part of the health care team, it is important that dietitians be aware of the evidence regarding these treatments.

Weight Loss Medications in Treating Pediatric Obesity

We reviewed the evidence on the following medications used as part of a pediatric obesity treatment program:

• orlistat (a gastrointestinal lipase inhibitor)
• sibutramine (in clinical trials, but not approved by FDA)

Note: Only evidence on the use of these medications in adolescents was analyzed.

• Intervention
  What is the effectiveness of using orlistat as part of a childhood obesity treatment program?

  • Conclusion

    Orlistat, an oral medication (a gastrointestinal lipase inhibitor), may be moderately effective in promoting improved adiposity (up to 12 months) as part of a comprehensive weight-management program in adolescents. However, application is limited by the common gastrointestinal adverse events.

    Long-term efficacy and tolerability of orlistat as part of a comprehensive behavioral treatment program for adolescents has not been studied. Orlistat has not been studied in children younger than 12 years.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
  • Evidence Summary: Use of Orlistat in the Treatment of Childhood Obesity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Chanoine J-P, Hampl S, Jansen C, Boldrin M, Hauptman J. Effect of orlistat on weight and body composition in obese adolescents. A randomized controlled trial. JAMA 2005;293:2873-2883.
      • Maahs D, de Serna DG, Kolotkin RL, Ralston S, Sandate J, Qualls C, Schade DS. Randomized, double-blind, placebo-controlled trial of orlistat for weight loss in adolescents. Endocr Pract 2006;12:18-28.
      • McDuffie JR, Callis KA, Uwalo NG, Fallon EM, Frazier TE, Hubbard VS, Yanovski JA. Efficacy of orlistat as an adjunct to behavioral treatment in overweight African-American and Caucasian adolescents with obesity-related co-morbid conditions. J Pediatr Endocrinol Medab 2004;17:307-319.
      • McDuffie JR, Calis KA, Uswaifo GI, Sebring NG, Fallon EM, Hubbard VS, Yanovski JA. Three-month tolerability of orlistat in adolescents with obesity-related comorbidities. Obes Res 2002;10:642-650. 
      • Ozkan B, Berekey A, Turan S, Keskin S. Addition of orlistat to conventional treatment in adolescents with severe obesity. Eur J Pediatr 2004;163:738-741.
  • Search Plan and Results: Nutrition Support: Use of Drugs to Treat Childhood Overweight 2006
     
  What is the effectiveness of using sibutramine as part of a childhood obesity treatment program?

  • Conclusion

    The addition of sibutramine in the treatment of adolescents with obesity within a multi-component pediatric weight-management program may be helpful in achieving short-term (six months or less months) reductions in weight and BMI.

    No studies were found using sibutramine in children under 13 years of age.

    Longer-term efficacy and safety have not been thoroughly addressed.

    The use of sibutramine to treat overweight is being studied in clinical trials, but it has not been approved by the FDA for pediatric use.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
  • Evidence Summary: Use of Sibutramine in the Treatment of Adolescent Obesity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Berkowitz RI, Wadden TA, Tershakovec AM, Cronquist JL. Behavior therapy and sibutramine for the treatment of adolescent obesity. JAMA. 2003;289:1805-1812.
      • Godoy-Matos A, Carraro L, Vieira A, Oliveira J, Guedes EP, Mattos L, Rangel C, Moreira RO, Coutinho W, Appolinario JC. Treatment of obese adolescents with sibutramine: a randomized, double-blind, controlled study. J Clin Endocrinol Metab. 2005;90:1460-1465.
      • Reisler G, Tauber T, Afriat R, Bortnik O, Goldman M. Sibutramine as an adjuvant therapy in adolescents suffering from morbid obesity. Isr Med Assoc J. 2006 Jan;8(1):30-2.
        
  • Search Plan and Results: Nutrition Support: Use of Drugs to Treat Childhood Overweight 2006