It's hard for these kids to lose weight. It's even harder for them to keep lost weight off. Might drastic measures be called for? A second study suggests that the controversial weight-loss drug Meridia -- combined with intensive behavior therapy -- might help some teens lose some weight. Both studies appear in the April 9 issue of TheJournal of the American Medical Association.
Just how bad is a fat kid's life? Jeffrey B. Schwimmer, MD, works with overweight children and teens as director of the weight and wellness center at Children's Hospital and Health Center, San Diego. Suspecting that these kids are suffering more than most people think, he decided to find out where they stood relative to healthy children -- and to children with cancer. Schwimmer's research team gave a battery of quality-of-life tests to 106 obese children and teens and compared them with findings from healthy kids and kids getting chemotherapy for cancer. The children ranged in age from 5 to 18.
"Kids with cancer report the lowest known quality of life for children," Schwimmer tells WebMD. "We found it surprising that obese children had a quality of life as low as those with cancer and receiving chemotherapy."
It's not just a simple measure of pain. Obese children suffered from physical, emotional, and social problems. Their quality of life was at least as poor as kids with cancer. In some ways it was worse.
|More weight-loss news from a special obesity issue of The Journal of the American Medical Association.|
"For psychosocial health, obese children actually reported worse health than those with cancer," Schwimmer says. "Cancer is a bad thing. Children, parents, teachers, and doctors all understand it is a bad thing. A great deal of sympathy goes to children with cancer and rightfully so. Children who are obese are not sympathized with. In fact, they are stigmatized, yet their quality of life is as bad as that of kids with cancer. This is good evidence that parents and teachers and doctors need to be aware of risk of bad quality of life in obese children. This is a rapidly growing problem."
Rapidly growing indeed. One in seven U.S. children is obese. Obese children have all kinds of health problems -- and these problems continue and worsen as they grow up. And that's not all. Schwimmer found that obese kids miss four times as much school as healthy kids, suggesting a "striking" impact on academic achievement.
Younger children suffered just as much as teens. Race, ethnicity, and cultural factors didn't make any difference. No matter the cultural background, obesity devastated kids' quality of life.
It's not at all clear what to do about childhood obesity. Intensive behavioral therapy can help. Unfortunately, Schwimmer notes, this is the kind of care that insurance companies are least likely to pay for.
"The best treatment includes physicians, dieticians, and mental health professionals working together as a team," he says. "Insurance companies tend not to pay for many of those services. It is a real limiting factor. They pay for complications such as diabetes, orthopedic procedures, liver disease, and sleep apnea. But those are all caused by extra body fat. If that is made better, many other problems will be made better."
Might treatment improve life quality for these kids? Schwimmer is now studying the issue. But there's already some preliminary evidence that it does. Robert I. Berkowitz, MD, is medical director of the University of Pennsylvania's weight and eating disorders program. He's lead researcher of a study that looked at treating obese teens with intensive behavioral therapy, with or without the diet drug Meridia.
"When it comes to body image concerns, these kids have lots of problems," Berkowitz tells WebMD. "We saw that overall, mood and self-esteem improves with this kind of support. Quality of life and body image improves with treatment and may not correlate with weight loss. With a lot of support, teens felt better about themselves. It's not easy to be an overweight teen in our culture. These kids really have it tough. We like to think it is helping the kids' self-esteem as well as their health."
All of the teens in the Berkowitz study got intensive, family-based behavior therapy. Dietitians, psychologists, or psychiatrists lead each session. This state-of-the-art therapy starts with 13 weekly group sessions followed by six every-other-week sessions. After this, treatment tapers off to two more months of biweekly sessions and three monthly sessions. That's not all: Parent groups meet separately on the same schedule.
This helped kids lose some weight. Ranging in age from 13 to 17, the teens started with an average weight of 228 pounds. After six months of behavior therapy, kids lost an average of seven pounds.
But if kids got Meridia as well as behavioral therapy, they lost twice as much weight. And over the next six months they kept most of this weight off. When kids started taking Meridia after six months of behavior therapy alone, they lost another three pounds. Meridia's manufacturer, Abbott Laboratories, provided the Meridia for the study.
"Forty percent of the kids on [Meridia] lost 10% or more of their weight. With behavior therapy alone, only 15% of kids lost 10% or more of their weight," Berkowitz says. "Ninety percent of health benefits come from the first 10% of weight loss. So 10% is a pretty realistic goal, and many of the health benefits are gained there."
Berkowitz concludes that adding drug therapy to behavior therapy makes a powerful combination. The reason? Obese children face toxic environments both inside and outside their bodies.
"Behavior therapy helps kids deal with this toxic outside environment. You get all this junk food coming at you, this television, this sedentary culture, and you teach families to manage that," he says. "The drug targets the kids' internal environment -- the biology of obesity."
Meridia is not by any means a totally safe drug. It's now approved only for adult use -- and many adults who take the drug have dangerous increases in blood pressure and pulse rate. Citing at least 32 patient deaths, the consumer group Public Citizen has called for a ban on Meridia. About 40% of the teens in the Berkowitz study had to have their Meridia dose reduced because of high blood pressure and/or high pulse rate. Doctors have to keep a close watch on patients taking the drug.
"When we did that -- closely monitor the kids -- we could keep blood pressure under control," Berkowitz says. "Their pulse rate did go up. But we saw a doubling in reductions in hunger compared to the placebo group. The drug is working the way we think it is working. ... My own belief is when you follow these guidelines, Meridia is a relatively safe medication. ... Although we had some adverse events, we could put most teens on the right dose and they were quite successful."
Berkowitz has already begun a larger study. Schwimmer agrees with Berkowitz's view that there's a need for more and better treatments for childhood obesity.
"I think we need multiple tools including drug treatment," he says. "There are so many obese children. People are desperate to be able to offer them care. Many doctors will use medications, and it is going to be essential to have trials like the one Berkowitz has done to understand which are effective -- and for whom. It will be one important strategy. It is very important that they used the drug only in combination with behavior therapy."