Solution to cure obesity in children - Research Paper Example

?Introduction: Obesity or being over weight has become one of the most chronic conditions in the recent decades. The accelerating rate of weight issues in pediatric population has made childhood obesity a critical public health issue worldwide. Globally the prevalence of childhood obesity is 10% with many developed countries reaching 30% (Iughetti et al., 2011). In United States alone, 1 of every 3 children is either exceeding a healthy weight or obese (Perkins et al., 2008). Obesity leads to severe co-morbidities that not only burden the treatment costs annually but also account for approximately 117,000 preventable deaths annually (Perkins et al., 2008) Prevalence of Obesity: According to Stendardo (2011), in U.S. alone 17% of the children and adolescents from 2-19 years are categorized as obese. Similarly, about 9.5% of children up to 2 years are classified as obese. Similarly, 26% of the children and adolescents in Canada are considered obese (Rogovik and Goldman, 2011). Health implications of child hood obesity: 1. Cardio-vascular diseases: 20-30% of obese children reportedly exhibit high blood pressure (Perkins et al., 2008). Similarly, higher cholesterol levels and arterial plaques (Johnson, 2008), hyperlipidemia (Stendardo, 2011) are also exhibited by over-weight children. These obesity related conditions result in childhood or adolescent cardio-vascular diseases. 2. Type II diabetes: Incidence of type II diabetes particularly in obese children is alarmingly high and one of the leading chronic diseases in children. In U.S. about 2 million children, have a pre-diabetic condition i.e. X-syndrome making them susceptible to diabetes, high blood pressure, heart disease and even stroke (Johnson, 2008). Due to rapidly increasing rate of obesity, statistics indicate development of type II diabetes in 1 in every 3 children (Perkins et al., 2008). 3. Attention deficient hyperactivity disorder (ADHD): Excessive consumption of soda, energy drinks and processed food increase hyperactivity and impulsiveness (Johnson, 2008). 4. Respiratory disorders: Common respiratory disorders include sleep apnea, insomnia, asthma and obesity hypoventilation syndrome (Johnson, 2008). 5. Psychological disorders: Psychological conditions such as child autism, depression and mood disorders are commonly seen in obese children (Johnson, 2008). Several studies have indicated that obese children are socially isolated which results in lower self-esteem (Stendardo, 2011). 6. Similarly several other ailments such renal conditions, reproductive disorders, slip disks, bone fractures, chronic inflammation leading to skin lesions and gastro-intestinal hepatic disease, gastro-esophageal reflux are commonly witnessed in obese children (Johnson, 2008). 7. Higher risk for development of certain cancers is also reported in obese children (Stendardo, 2011). Risk factors and diagnosis for child hood obesity: Risk factors for child obesity and overweight include genetic, socio-economic and lifestyle factors (Stendardo, 2011). Body Mass Index (BMI) is used to measure weight status of an individual. BMI is conveniently defined as weight (kg) divided by height (m). A child is considered obese if the BMI is >85 percentile. However, the threshold for being classified as obese is also dependent upon age, gender, social status, general health etc. (Perkins, et al., 2008). Treatment of obesity: According to Stendardo (2011), treatment to obesity should be approached in multiple management practices with emphasis on obesity awareness, prevention and life style changes. 1. Lifestyle interventions: Initial treatment of obesity focuses on behavioral and dietary interventions. Patients are advised to limit the consumption of energy dense, high caloric food, beverages and oily snacks etc. (Rogovik and Goldman, 2011). Diet plans with fresh fruits, juices, cereals etc. less processed and low fat food should be emphasized in obese children. Physical activity of 30 minutes a day, restricted exposure to television and computer (less than 1.5 hours/day) and frequent monitoring of BMI should be done as preliminary measures to control childhood obesity (Stendardo, 2011). 2. Pharmacotherapy/medication: Recent guidelines by health associations suggest pharmacotherapy for obese children only if: a. Child is extremely obese i.e. BMI> 2 units above the 95 percentile and no estimable benefit from 1 year intensive life style and dietary treatment, pharmacotherapy is recommended (Stendardo, 2011; Rogovik and Goldman, 2011). b. Children above 12 years with impaired glucose tolerance/ insulin resistance, stroke, myocardial infarction, family history of diabetes and cardiovascular disease; ovarian hyper-androgenism is strong candidates for pharmacotherapy (Iughetti, 2011). 3. Bariatric Surgery It is recommended for obese children with severe comorbidities who are unable to benefit from lifestyle interventions and pharmacotherapy. However, surgical complications such as shock, post-operative bleeding, hernia, infection and adherence etc. limit the advantage of obesity management (Stendardo, 2011). Medication used for treatment of obesity: 1. Orlistat: Lipase inhibitor orlistat is the only drug that is approved by FDA for management of obesity in children below 12 years of age (Stendardo, 2011) and adolescents (Rogovik and Goldman, 2011). It is the only drug of choice for obese adolescents 12-17 years. Orlistat acts by decreasing and inhibiting the absorption of fat in stomach and is relatively regarded as safe drug. In several trials for treatment of obese children it reduced by 0.5-4.2 kg/m. 2. Sibutramine: A central serotonin and norepinephrine intake inhibitor; it was a drug of choice for obese adolescents 16 and above. However, in 2010 as a result of several controlled studies, which indicate increased risk of cardiovascular events; FDA directed the manufacturer to withdraw this drug from market. These studies represent an average 16% of increased cardiovascular diseases in obese patients prescribed sibutramine thus outweighing the advantage of weight loss (Rogovik and Goldman, 2011). 3. Metformin: It is specifically recommended to obese patients with co-morbid type II diabetes. (Iughetti et al., 2011). Recently, studies indicate that metformin indicated significant reduction in BMI (Stendardo, 2011), fat deposits, waist circumference, fasting insulin and glucose. Also, its major effect as a powerful appetite inhibitor (Iughetti et al., 2011). It is recommended for children 10 years and above. 4. Phentermine: It is approved only for short-term treatment of obesity (up to 3 months) due to absence of long-term researches. In several initial studies it has been proven weight loss in obese patients (average 3.6 kg). Side effects include elevated pulse rate and blood pressure, constipation, dry mouth, restlessness and constipation etc. (Iughetti et al., 2011). 5. Several other drugs such as fluoxetine, octreotide and ephedrine etc. have demonstrated significant results in animal testing. However, pilot and protocol studies in humans are still under way to observe significant results in obese patients (Iughetti et al., 2011). Benefits of pharmacotherapy: The focus of pharmacotherapy should be to reduce co-morbidities, reduce long-term complications and improve quality of life (Freemark, 2007). Theoretically, the epidemic of obesity can be controlled by life style intervention however, in practical only a limited number of patients benefit from life style intervention. Recent studies suggest that medication along with lifestyle alteration is beneficial in treatment of obese children than lifestyle intervention alone (Rogovik and Goldman, 2011; Iughetti et al. 2011). Stendardo (2011) and Iughetti et al (2011), reports weight loss of 2-3 kg, reduced waistline, fat and adipose reduction when medication is combined with lifestyle intervention. However, there are no long-term studies to advocate the beneficial effects of medication in obese children. In short, medication provides moderate to short term weight reduction and its efficacy is highly variable in individuals. Risks involved in using medication: Stendardo (2011), reports modest side effects from orlistat including adverse gastrointestinal effects i.e. oily stools, diarrhea, incontinence, fecal urgency etc. Similarly, clinical trials have shown that the drug sibutramine exhibits serious cardio-vascular effects, insomnia, headache, dizziness, constipation and increased blood pressure (Iughetti et al., 2011). Additionally, the long term effects of weight loss medication in cardio-vascular diseases and malignancy is still under research (Freemark, 2007). Future drugs Novel anti-obesity drugs under clinical progress include agents that affect peripheral and central mechanisms. These include cetilistat, amylin, exendin-4, anti-epilepsy drugs, nor-adrenalin, human GH fragment etc. Careful evaluation and systematic investigation is required for beneficial and toxic effects of these drugs. Also beneficial effects should outweigh the risk factors before prescribing them in population. So far, none of these drugs are being tested on pediatric population (Iughetti et al., 2011; Freemark, 2007). Conclusion: Childhood obesity is an imperative risk factor for development of morbidities and higher mortality rate in adolescents. Obesity directly affects endocrine, gastrointestinal, cardio-vascular systems and psychological health. Obesity is a life long chronic medical condition and pharmacotherapy is short-term solution for this problem. According to Freemark (2007), some researches indicate total weight gain in obese patients within a year of discontinuation. Therefore, it is vital to recommend medication only in selective patients and then maintain low dosage before complete discontinuation. Regulation of life style, behavioral interventions and physical activity is important factor in obesity treatment along with pharmacotherapy. In addition, future research is necessary for the optimum clinical approach to prevention, screening and treatment of obesity. References: Freemark, M. Pharmacotherpay of childhood obesity: An evidence based Conceptual Approach. American Diabetic Association, Diabetic Care. 2007. Vol. 30; no. 2; pp.395-402. Iughetti, L. China, M., Berri, R. and Predieri, B. Pharmacological Treatment of Obesity in Children and Adolescents: Present and Future. Journal of Obesity Vol.  2011 (2011). Hindawi Publishing Corporation. Johnson, C. New Prescription for Childhood Obesity. Fight Childhood obesity with Antioxidants and Phytonutrients. iUniverse Publications. 2008. United States. Pp.32-39. Perkins, R., Newton, D., and Swift, J. Pediatric Hospital Medicine: Textbook of Inpatient Management. 2nd Edition. Lippincott Williams and Wilkins. 2008. United States. Pp. 689-695. Rogovik, A. and Goldman, R. Pharmacological treatment of Pediatric Obesity. Can Fam Physician February 2011; 57(2): 195-197. Stendardo, S. Childhood Obesity, Assessment, Prevention and Treatment. American Academy for Family Physicians. CME Bulletin 2011. Vol. 10, no. 2. Read More