Annals of Internal Medicine tip sheet, July 18, 2006

July 17, 2006

15.5 Percent of U.S. teens are overweight. Two articles and an editorial in this issue of annals focus on adolescent obesity

1. Adolescent Female Obesity Can Lead to Premature Death as an Adult

A study of 102,400 female nurses found that a higher than normal body mass index (BMI) at age 18 was associated with greater risk for death than a normal BMI, even after statistical adjustment for risk factors such as smoking, alcohol use and physical activity (Article, p. 91).

The participants, who were aged 24 to 44 at the start of the 12-year study, recalled their weight at age 18. A total of 710 participants died.

2. Diet Drug Plus Therapy Helped Very Obese Adolescents Lose Weight

In a 22 center study of 498 severely obese adolescents, those who received the diet drug sibutramine along with behavior therapy lost an average of 14 pounds at the end of one year of treatment, while a group who received a dummy pill (placebo) with the therapy gained about four pounds (Article, p. 81).

The sibutramine group also had improved profiles of several heart risk factors, such as triglyceride levels, high-density lipoprotein cholesterol levels, insulin levels, and insulin sensitivity.

The participants, who were 12 to 16 years old, weighed on average 215 pounds at the beginning of the study.

3. Editorial Writer Says Prevention of Obesity is Best Long-Term Solution

An editorial writer says that the sibutramine study is useful because there have been few randomized trials evaluating drug therapies for overweight adolescents (Editorial, p. 145).

But the writer cautioned that the study does not show what part of the weight loss came from the drug, increased physical activity, or counseling.

Further, for long-term success, and to avoid the risk or premature death identified in the nurses' study above, people must avoid regaining the excess weight lost during treatment. Does this mean that they would have to take the diet drug for life?

"Because drug therapy is likely to have higher lifetime risks and costs than behavioral interventions, physicians should aim for sustained behavior change and reserve drug therapy for the severely overweight adolescent who cannot otherwise lose weight," the writer says.

Finally, preventing overweight should be a high public health priority, according to the editorial writer, who gives nine strategies for preventing weight gain.

American College of Physicians

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