Treatments and drugs

By Mayo Clinic staff Treatment for childhood obesity is based on your child's age and if he or she has other medical conditions. Treatment usually includes changes in your child's diet and level of physical activity. In certain circumstances, treatment may include medications or weight-loss surgery. Treatment for children under age 7 For children under age 7 who have no other health concerns, the goal of treatment may be weight maintenance rather than weight loss. This strategy allows the child to add inches in height but not pounds, causing BMI-for-age to drop over time into a healthier range. However, for an obese child, maintaining weight while waiting to grow taller may be as difficult as losing weight is for older people. Treatment for children 7 years of age and older Weight loss is typically recommended for children over age 7 or for younger children who have related health concerns. Weight loss should be slow and steady anywhere from 1 pound (about 0.5 kilograms) a week to 1 pound a month, depending on your child's condition. The methods for maintaining your child's current weight or losing weight are the same: Your child needs to eat a healthy diet and increase his or her physical activity. Success depends largely on your commitment to helping your child make these changes. Think of eating habits and exercise habits as two sides of the same coin: When you consider one, you also need to consider the other. Healthy eating Parents are the ones who buy the food, cook the food and decide where the food is eaten. Even small changes can make a big difference in your child's health.

When buying groceries, choose fruits and vegetables. Convenience foods, such as cookies, crackers and prepared meals, are often high in sugar and fat. Always have healthy snacks available. And never use food as a reward or punishment. Limit sweetened beverages, including those containing fruit juice. These drinks provide little nutritional value in exchange for their high calories. They also can make your child feel too full to eat healthier foods. Sit down together for family meals. Make it an event a time to share news and tell stories. Discourage eating in front of a screen, such as a television, computer or video game. This leads to fast eating and lowered awareness of how much you're eating. Limit the number of times you eat out, especially at fast-food restaurants. Many of the menu options are high in fat and calories.

Physical activity A critical part of weight loss, especially for children, is physical activity. It not only burns calories but also builds strong bones and muscles and helps children sleep well at night and stay alert during the day. Such habits established in childhood help adolescents maintain healthy weight despite the hormonal changes, rapid growth and social influences that often lead to overeating. And active children are more likely to become fit adults. To increase your child's activity level:

Limit recreational computer and TV time to no more than 2 hours a day. A surefire way to increase your child's activity levels is to limit the number of hours he or she is allowed to watch television each day. Other sedentary activities playing video and computer games or talking on the phone also should be limited. Don't let your child eat while viewing an electronic screen; it keeps your child from being aware of how much he or she is eating. Emphasize activity, not exercise. Your child's activity doesn't have to be a structured exercise program the object is just to get him or her moving. Free-play activities, such as playing hide-andseek, tag or jump-rope, can be great for burning calories and improving fitness. Find activities your child likes to do. For instance, if your child is artistically inclined, go on a nature hike to collect leaves and rocks that your child can use to make a collage. If your child likes to climb, head for the nearest neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book. If you want an active child, be active yourself. Find fun activities that the whole family can do together. Never make exercise seem a punishment or a chore. Vary the activities. Let each child take a turn choosing the activity of the day or week. Batting practice, bowling and swimming all count. What matters is that you're doing something active.

Weight-loss medication One prescription weight-loss drug is available for adolescents: orlistat (Xenical). Orlistat, which is approved for adolescents older than 12, prevents the absorption of fat in the intestines. The Food and Drug Administration has approved a reduced-strength over-the-counter (nonprescription) version of orlistat (Alli). Though readily available in pharmacies and drugstores, Alli is not approved for children or teenagers under age 18. Prescription weight-loss medication isn't often recommended for adolescents. The risks of taking a medication long term is still unknown, and its effect on weight loss and weight maintenance for adolescents is still questioned. A weight-loss drug doesn't replace the need to adopt a healthy diet and exercise regimen. If your child has high cholesterol, it's possible your doctor may recommend giving your child a statin medication. Statins help lower cholesterol, but their use in children remains controversial, since it's uncertain what long-term side effects they might have. Because of disagreement in the medical community about treating high cholesterol in children, talk to your child's doctor about what's best for your child. Weight-loss surgery Weight-loss surgery can be a safe and effective option for some severely obese adolescents who have been unable to lose weight using conventional weight-loss methods. However, as with any type of surgery, there are potential risks and long-term complications. Also, the long-term effects of weight-loss surgery on a child's future growth and development are largely unknown. Weight-loss surgery in adolescents is uncommon. But your doctor may recommend this surgery if your child's weight poses a greater health threat than do the potential risks of surgery. It is important that a child being considered for weight-loss surgery meet with a team of pediatric specialists, including a pediatric endocrinologist. Even so, surgery isn't the easy answer for weight loss. It doesn't guarantee that your child loses all of his or her excess weight or that your child keeps it off long term. It also doesn't replace the need for following a healthy diet and regular physical activity program.

Treatment for Obesity in Children: Childhood Obesity Programs

Last Modified: August 10, 2010
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Treatment for obesity in children is important in preventing the health complications common in overweight children. The increasing number of childhood obesity programs reflects the medical community's concern with childhood obesity. Successful obesity treatment for children teaches new lifestyle skills to counteract habits that promote weight gain.

The Goals of Childhood Obesity Programs

The goals of childhood obesity programs differ slightly from adult obesity treatment objectives. Weight loss and the maintenance of weight loss are the goals of adult treatments. The focus of childhood treatment for obesity, however, is weight maintenance rather than weight loss. If the child maintains a constant weight, normal growth will restore a proper height/weight ratio. Childhood obesity programs may be necessary for kids who are reaching the end of their growing years or for young children who are severely obese. In these cases, slow, regular weight loss is usually more effective than attempting to lose weight rapidly.

Nutrition for Kids

Children are a prime target for fast food marketing, and parents face an uphill battle limiting their children's exposure to junk food. Proper nutrition for kids should include plenty of fruits, vegetables and healthy snacks while limiting junk food, sweetened drinks and fast food. Promoting good nutrition for kids is the entire family's responsibility. Nutritional changes should affect all family members not just the obese child. Parents have a tremendous influence on nutrition for kids: Most children tend to adopt their parents' eating habits. Here are a few tips for parents who are attempting to prevent obesity in children:

Avoid eating in front of the television or computer screen, which can cause overeating. Avoid using food as a reward or comfort. Eat at a table and use mealtimes as a time to talk and communicate. Limit eating out to once or twice a month. Parents not kids should decide which groceries to buy.

Exercise for Children

Nutrition for kids is only part of childhood obesity programs. Parents should also encourage enough exercise for children. As with nutrition, exercise for children works best if parents set a good example. A parent who insists on exercise for children while living a sedentary lifestyle sends a mixed message that can sabotage treatment for obesity. Here are some suggestions on how to promote exercise for children:

Exercise for kids doesn't have to mean structured activities like sports playing tag, throwing frisbees and walking the family dog all count. Find exercises for children the whole family can enjoy. Limit television and computer time to two hours a day. Staying active as a family encourages children to exercise. Vary exercise activities to keep children interested.

Medical Treatment for Obesity in Children

While weight loss medication or surgery may be prescribed as treatment for obesity in children, these treatments are usually a last resort. Medication carries the risk of serious side effects, and only provides results for as long as the child takes the drugs. Surgical treatment is invasive, irreversible and can cause lifelong complications. Doctors will recommend lifestyle changes, such as proper nutrition for kids and exercise for children, before such serious treatments for obesity in children are even considered.

Resources
Ebbeling, C.; Ludwig, D. & Pawlak, D. (2010). Childhood obesity: Public-health crisis, common sense cure. Retrieved April 13, 2010, from http://www.allhealth.org/briefingmaterials/lancetobesityrev-393.pdf. Ferry, R. (2007). Obesity in children. Retrieved April 13, 2010, from http://www.emedicinehealth.com/obesity_in_children/article_em.htm. Mayo Clinic. (2010). Childhood obesity: Treatments and drugs. Retrieved April 13, 2010, from http://www.mayoclinic.com/health/childhood-obesity/DS00698/DSECTION=treatments-and-drugs.

What about the drug therapy for obesity treatment?

Drug therapy is recommended as a treatment option for persons with: 1) a Body Mass Index (BMI) > 30 with no obesity-related conditions or 2) a BMI of > 27 with two or more obesity-related conditions. Drug treatment should be used with appropriate lifestyle modifications. Drug therapy may be used for weight loss and weight maintenance. Patients should be regularly assessed to determine the effect and continuing safety of a drug. Three weight loss drugs, approved by the US Food and Drug Administration (FDA) for treating obesity, are Orlistat (Xenical), Phentermine, and Sibutramine (Meridia). Orlistat works by blocking about 30 percent of dietary fat from being absorbed, and is the most recently approved weight loss drug. Phentermine, an appetite suppressant, has been available for many years. It is half of the "fen-phen" combination that remains available for use. The use of phentermine alone has not been associated with the adverse health effects of the

fenfluramine-phentermine combination. Sibutramine is an appetite suppressant approved for long-term use. Drugs for weight loss fall into several categories. Drugs that change appetite (sympathomimetic drugs): Sibutramine - Today sibutramine is the only medication approved for long-term use. The drug suppresses your appetite by keeping your nerve endings from taking up the substances norepinephrine and serotonin. Side effects may include dry mouth, inability to sleep, and constipation. You should not take sibutramine if you have a history of heart disease or stoke. NOTE: Maybe you have heard of the Fen-phen combination drug.[fenfluramine and phentermine] Fenfluramine has been pulled out of the marketplace because it had unacceptable side effects causing heart valve and lung problems. Metabolism-changing drugs: Orlistat - Orlistat is the only drug that alters the way your body responds to fat intake. It works by preventing the action of lipases (enzymes that break down fat) produced in your pancreas, a gland behind your stomach. The pancreas secrets lipases into your intestine and block dietary fat digestion. The result, particularly in individuals who eat a high fat meal, are some gastrointestinal side effects, including stomach cramps, gas and a feeling like diarrhea or inability to control your bowels. Drugs that increase the energy you spend: Ephedrine - Ephedrine stimulates weight loss by reducing appetite and perhaps by stimulating your body to produce more heat. One form of this drug is found in the Chinese plant ma huang and is sold without a doctor's prescription. This drug is not proven safe or yet approved for the treatment of obesity. Other substances that cause you to reduce your eating: The following hormones and other substances are still being studied and are not yet approved as drugs for obesity: Leptin is a hormone made in fat tissue. Mice without leptin become very fat, and taking leptin has helped mice and human subjects reduce their food intake and lose weight. High doses of leptin seem to be necessary and still need further testing. Neuropeptide-Y is a substance found in nerve tissue which stimulates eating. Drugs that block the Yreceptors lower food intake. Cholecystokinin plays a key role in facilitating digestion in the small intestine. It stimulates delivery of digestive enzymes and bile from the gall bladder. Melanocortins are a group of pituitary peptide hormones. One of the receptors for these hormones is found in the hypothalamus gland in the brain and the protein that binds to it seems to play an important role in controlling body weight. Glucagon is a protein hormone produced in the pancreas that helps to regulate your body's use of carbohydrates and helps to decrease food intake. A part of the glucagons molecule, glucagon-like peptide 1, also helps to reduce food intake.