Treatment and Prevention of Pediatric Obesity
Abstract
Obesity disorder is characterized by excess fat in the body and is measured by the percentage of body mass index (BMI) on a growth chart. Child obesity is a top health issue affecting characterized by mortality and morbidity rates. Therefore, effective prevention and treatment for childhood obesity are paramount. Lifestyle change interventions are the most used prevention and treatment approaches for obesity. However, childhood obesity has persistently increased with a considerable number of children struggling with overweight and comorbidities associated with obesity. A combination of lifestyle modifications and pharmacotherapy is needed treatment of childhood obesity. Clinical studies have shown different medications with promising results in the treatment of overweight and obesity in a family history of obesity and those with obese related comorbidities. The study recommends using orlistat and metformin to complement lifestyle interventions in treating pediatric obesity.
Introduction
Pediatric obesity is a growing public health problem in need of urgent attention from health care stakeholders. Obesity disorder is characterized by excess fat in the body and is measured by the percentage of body mass index (BMI) on a growth chart. A person with a BMI of 85-95% or 25-29.9 kg/m2 is overweight, whereas a person with a BMI of over 95% or BMI >30 kg/m2 is obese. Child obesity is a top health issue affecting characterized by mortality and morbidity rates. Obesity affects 34% of American children and accounts for over about 40 percent of the national healthcare budget (Udod, & Wagner, 2018). Obesity has more than doubled in children and tripled in adolescents over the past three decades. The consumption of high-sugar foods and fatty diets, tobacco smoking, and lack of physical exercise are the main contributing factors for childhood obesity.
Obesity in children is a risk factor for various illnesses, including cardiovascular, type II diabetes, high blood pressure, sleep apnea, asthma, hepatic steatosis, and depression. The long term risks include adult obesity, specific cancer, ischemic stroke, coronary heart illness, and joint diseases, among other chronic disorders. Obesity is also associated with low self-esteem and social problems, including social discrimination, and delayed social and academic functioning. With a rising number of obese children in the country, health professionals are searching for effective methods for preventing and treating child obesity (Udod, & Wagner, 2018). Therefore, prevention and treatment for childhood obesity are paramount for the current and future health and well-being of the population. Lifestyle change involving physical exercise, behavioral, and dietary modifications is the most used prevention and treatment approaches for obesity. Besides diet and physical exercise, reducing time children spend on sedentary activities like online chatting, playing video games, watching television shows and motion movies, and using computers for recreation is imperative in preventing pediatric obesity rates.
Problem Statement
Extensive lifestyle modification interventions and support from a health care professional can address the problem of childhood obesity. However, child obesity has persistently increased, with a considerable number of children struggling with overweight and associated comorbidities (Pandita et al., 2016). The current interventions have failed to address the problem of obesity in American children and adolescents. Therefore, a combination of lifestyle modification and pharmacotherapy can treat childhood obesity. However, medications can only be applied for overweight children with severe and persistent comorbidities despite the use of lifestyle change interventions. It can also be applied to obese children with a history of cardiovascular and type II diabetes risk factors. The article addresses the worsening problem of childhood obesity through a combination of lifestyle change interventions and pharmacotherapy. It reviews the safety and effectiveness of current medication for treating obesity in children and adolescents.
Hypothesis
- The study hypothesized that a combination of pharmacotherapy and lifestyle medication generates better health outcomes for treating overweight and obese American children’s comorbidities and family history of obesity-related disorders than lifestyle change interventions alone.
- The study hypothesized that a combination of pharmacotherapy with lifestyle medication have better health outcomes for treating overweight and obese American children comorbidities and family history of obesity-related disorders than medication alone.
Methods
A literature search was performed on online library including Medline, PubMed, and Cochrane databases. The search was limited to peer-reviewed qualitative and quantitative journals published in the English language between 2000 and 2020 on child obesity. The search terms used in the literature search include child obesity, pediatric obesity, child overweight, obesity prevention, obesity treatment, obesity medications, orlistat, metformin, octreotide, growth hormone, and topiramate. Ideally, the article sought to determine effective methods for preventing and treating childhood through a combination of lifestyle change intervention and medications. Therefore, only studies assessing the effects of medicines in obese and overweight children and adolescents were included. However, studies that did not assess the effects of pharmacological treatment on child obesity were excluded from the literature evaluation.
Results
The use of lifestyle interventions such as a healthy diet and physical exercise have failed to contain the growing cases of pediatric obesity effectively. Therefore, a combination of lifestyle modification and pharmacological therapies are examined. The study assessed the effectiveness of using drug prescription drugs to complement lifestyle modifications approaches in treating pediatric diabetes. Clinical studies have shown different medications with promising results in the treatment of overweight and obesity in children with a family history of obesity and those with obesity-related comorbidities.
Lifestyle modification
According to reviewed literature, lifestyle changes and nutrition can reduce weight gain and deposition of fats in children and adolescents. These interventions can delay the onset or deter the long-term risk of obesity, such as type II diabetes. However, the success of lifestyle modifications and nutrition program is compromised by some factors. For instance, these interventions need to be extensive and continue to be effective, which is hard to maintain for children and adolescents (Gerritsen, Wall, & Morton, 2017). For example, there is a need to restrict calorie intake, family, and individual counseling, and daily physical exercise. Therefore, combining lifestyle intervention with pharmacological therapy can improve the prevention and treatment of pediatric obesity.
Pharmaceutical Interventions
Orlistat
Orlistat is an FDA approved medication for the treatment of obesity and overweight in children. The 120 mg drug is administered a day thrice and works by limiting the absorption of dietary cholesterol by about 30% (Danne et al., 2017). By reducing caloric intake, this medication alters the balance of energy to improve the management of weight. The drug can complicate the growth and development of adolescents by lowering the level of plasma fat-soluble, hence should concomitantly be administered with a daily multivitamin. Orlistat was used with a daily multivitamin as an adjunct to behavioral programs for weight among children with obesity-related comorbidities (Crerand, Wadden, & Berkowitz, 2016). The study found a significant decline in the weight of children three months after administering orlistat medication. Plasma lipids also improved significantly as measured by low-density lipoprotein cholesterol, total cholesterol, and fasting glucose concentration (Crerand, Wadden, & Berkowitz, 2016; Danne et al., 2017).
A similar study by Patni, Quittner, and Garg (2018) focused on orlistat medications on severely obese children revealed positive psychological health and well-being on the children. However, it found no significant changes in triglycerides or serum cholesterol during treatment. Randomized control trials assessed the tolerability and efficacy of this medication on obese health adolescents. The drug was used in combination with lifestyle change and dietary interventions and resulted in a significant loss in weight in the experimental group than the control group (Ryder et al., 2019). A randomized control trial by Buckley, Bessesen, and Zeitler (2020) also found a significant decline in BMI but without changes in the level of serum cholesterol, high and low-density lipoprotein. Based on these studies, Orlistat drugs are a safe and effective adjunct to nutrition and lifestyle behavioral modification in treating pediatric overweight and obesity in children aged over eight years.
Metformin
Metformin is used in treating type II diabetes in people aged over ten years. Excess fat in the body is linked to insulin resistance, a predictor of diabetes mellitus in adults, and metabolic syndrome in children. The medication works by activating adenosine monophosphate kinase protein, reducing hepatic glucose production, and reducing intestinal absorption of glucose. These mechanisms increase the sensitivity of insulin by improving the uptake and utilization of peripheral glucose. The drug also prohibits lipogenesis of fat cell and reduce the intake of food by enhancing a glucogen-like peptide. Most clinical trials on the efficacy and safety of metformin in reducing overweight and obesity in adolescents and children yielded promising results. For instance, Van der et al. (2016) found beneficial treatment effects for fasting glucose. A similar study on the efficacy of metformin and a multivitamin administration observed a significant decline in BMI for obese in insulin-resistant children (Sun et al., 2019). Other studies evaluated the effects of metformin and Placebo on weight reduction, insulin sensitivity, and lipid on morbidly obese, hyperinsulinemic children. The study found a significant weight loss and enhanced insulin sensitivity in metformin subjects than placebo therapy adolescents. A study by (Khokhar et al., 2017) further noted a considerable decline in the level of cholesterol, free fatty acids, and triglycerides among metformin adolescents. On the contrary, the authors observed an increase in BMI and fasting glucose levels in the placebo group subjects, but no changes were found in the insulin level. Still, both groups noted a decline in serum lipids. A similar study combining metformin and lifestyle modification in obese adolescents with comorbidity (metabolic syndrome – high blood pressure, insulin resistance, and dyslipidemia) found a decline in BMI and level of cholesterol serum, triglycerides, and blood pressure. These studies point to the robust efficacy and effectiveness of metformin in reducing the bodyweight of children and adolescents. However, a 1-2 g per day for several weeks is effective than Placebo in reducing BMI and weight for morbidly obese children and adolescents. The length of treatment was a contributing factor to the effectiveness of metformin medications, with more significant effects observed after 3-4 months. Finally, a follow-up study indicates that lifestyle modifications and nutrition are influential on long term goals.
Other pharmacological Agents
The growing interest in pharmacological treatment options to support dietary and behavior change interventions. The use of sibutramine was formerly considered a potential weight reduction therapy in adolescents and children. The drug can stimulate energy expenditure and promote early satiety via thermogenic effects. Even though clinical trials reported a 1 -4 kg reduction in BMI with daily doses of 5-15 g daily, there were concerns of increased cardiovascular events (Crerand et al., 2016). The FDA withdrew the drugs because the risks of cardiovascular events far outweigh the potential benefits if weight loss; hence it is no longer used in treating pediatric obesity. The benefits of octreotide agents on BMI, weight loss, and suppression of insulin in children with hypothalamic obesity have been documented (Crerand et al., 2016). The growth hormone is associated with a decline in weight loss and body fats in children, but adult studies are yet to demonstrate the effects of these agents. A proposal to use of anticonvulsant topiramate to induce insulin sensitivity in adipocytes is hampered by high incidences of adverse effects and lack of pediatric data (Crerand et al., 2016). In conclusion, these agents can only be considered experimental until the large scale is conducted in children and adolescents.
Conclusion and Recommendations
Pediatric obesity is a growing public health problem in need of urgent attention from health care stakeholders. Child obesity is the top health affecting characterized by mortality and morbidity rates. Obesity in children is a risk factor for various illnesses, including cardiovascular, type II diabetes, high blood pressure, sleep apnea, asthma, hepatic steatosis, and depression. Prevention and treatment for childhood obesity are paramount for the current and future health and well-being of the population. Lifestyle change involving physical exercise, behavioral, and dietary modifications is the most used prevention and treatment approaches for pediatric obesity. However, child obesity has persistently increased, with many children struggling with overweight and associated comorbidities. Therefore, combining lifestyle modifications and pharmacotherapy can prove effective intervention to mitigate the problem of childhood obesity.
The analysis has noted lifestyle and nutrition interventions can delay the onset of long term risk of obesity, such as type II diabetes. However, the success of lifestyle modifications and nutrition program is compromised by the need to be extensive and continue to be effective, which is hard to maintain for children and adolescents. Several pharmacological therapies were assessed for their effectiveness; these include orlistat, metformin, octreotide, growth hormone, and topiramate. The study recommends using orlistat and metformin to complement lifestyle interventions in treating pediatric obesity. Accordingly, Orlistat drugs are a safe and effective adjunct to nutrition and lifestyle behavioral modification in treating pediatric overweight and obesity in children aged over eight years. Metformin is safe and effective in reducing BMI and weight for morbidly obese children and adolescents. However, metformin should be administered daily for an extended period of 3-4 months.
References
Buckley, L. L., Bessesen, D. H., & Zeitler, P. S. (2020). Weight Loss Medications in Adolescents. In Insulin Resistance (pp. 325-333). Humana, Cham.
Crerand, C. E., Wadden, T. A., & Berkowitz, R. I. (2016). 17 Pharmacologic Treatment of Adolescent Obesity. PEDIATRIC OBESITY, 211.
Danne, T., Biester, T., Kapitzke, K., Jacobsen, S. H., Jacobsen, L. V., Petri, K. C. C., … & Kordonouri, O. (2017). Liraglutide in an adolescent population with obesity: a randomized, double-blind, placebo-controlled 5-week trial to assess safety, tolerability, and pharmacokinetics of liraglutide in adolescents aged 12-17 years. The Journal of pediatrics, 181, 146-153.
Gerritsen, S., Wall, C., & Morton, S. (2017, April). Exploring the obesity prevention potential of early childhood education services. In World Congress on Public Health.
Khokhar, A., Umpaichitra, V., Chin, V. L., & Perez-Colon, S. (2017). Metformin use in children and adolescents with prediabetes. Pediatric Clinics, 64(6), 1341-1353.
Pandita, A., Sharma, D., Pandita, D., Pawar, S., Tariq, M., & Kaul, A. (2016). Childhood obesity: prevention is better than cure. Diabetes, metabolic syndrome and obesity: targets and therapy, 9, 83.
Patni, N., Quittner, C., & Garg, A. (2018). Orlistat therapy for children with type 1 hyperlipoproteinemia: a randomized clinical trial. The Journal of Clinical Endocrinology & Metabolism, 103(6), 2403-2407.
Ryder, J. R., Kaizer, A. M., Jenkins, T. M., Kelly, A. S., Inge, T. H., & Shaibi, G. Q. (2019). Heterogeneity in response to treatment of adolescents with severe obesity: the need for precision obesity medicine. Obesity, 27(2), 288-294.
Sun, J., Wang, Y., Zhang, X., & He, H. (2019). The effects of metformin on insulin resistance in overweight or obese children and adolescents: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine, 98(4).
Udod, S., & Wagner, J. (2018). Common Change Theories and Application to Different Nursing Situations. Leadership and Influencing Change in Nursing.
Van der Aa, M. P., Elst, M. A. J., Van De Garde, E. M. W., Van Mil, E. G. A. H., Knibbe, C. A. J., & Van der Vorst, M. M. J. (2016). Long-term treatment with metformin in obese, insulin-resistant adolescents: results of a randomized double-blinded placebo-controlled trial. Nutrition & diabetes, 6(8), e228-e228.