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 23 February 2018

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Intervention for weight management in children and adolescents

This week's issue of the Journal of the American Medical Association examines interventions for weight management in children and adolescents.

News image

Obesity is common in children and adolescents in the United States, is associated with negative health effects, and increases the likelihood of obesity in adulthood.

Dr Elizabeth O’Connor and colleagues systematically reviewed the benefits and harms of screening and treatment for obesity and overweight in children and adolescents to inform the US Preventive Services Task Force.

MEDLINE, PubMed, PsycINFO, Cochrane Collaboration Registry of Controlled Trials, and the Education Resources Information Center were searched through 2016.

The team identified English-language trials of benefits or harms of screening or treatment for overweight or obesity in children aged 2 through 18 years, conducted in or recruited from health care settings.

There were 2 investigators that independently reviewed abstracts and full-text articles, then extracted data from fair- and good-quality trials.

The use of metformin was associated with BMI reductions of −0.86
Journal of the American Medical Association

Random-effects meta-analysis was used to estimate the benefits of lifestyle-based programs and metformin.

The researchers' main outcomes included weight or excess weight, cardiometabolic outcomes, quality of life, other health outcomes, harms.

There was no direct evidence on the benefits or harms of screening children and adolescents for excess weight.

Among 42 trials of lifestyle-based interventions to reduce excess weight, those with an estimated 26 hours or more of contact consistently demonstrated mean reductions in excess weight compared with usual care or other control groups after 6 to 12 months, with no evidence of causing harm.

The research team found that intervention groups showed absolute reductions in BMI z score of 0.20 or more, and maintained their baseline weight within a mean of approximately 5 lb, while control groups showed small increases or no change in BMI z score, typically gaining a mean of 5 to 17 lb.

The team noted that only 3 of 26 interventions with fewer contact hours showed a benefit in weight reduction.

The research team found that the use of metformin and orlistat were associated with greater BMI reductions compared with placebo: −0.86 for metformin and −0.50 to −0.94 for orlistat.

Groups receiving lifestyle-based interventions offering 52 or more hours of contact showed greater improvements in blood pressure than control groups: −6.4 mm Hg for systolic blood pressure and −4.0 mm Hg for diastolic blood pressure.

The researchers observed mixed findings for insulin or glucose measures and no benefit for lipids.

Medications showed small or no benefit for cardiometabolic outcomes, including fasting glucose level.

The team noted that nonserious harms were common with medication use, although discontinuation due to adverse effects was usually less than 5%.

Dr O’Connor's team comments, "Lifestyle-based weight loss interventions with 26 or more hours of intervention contact are likely to help reduce excess weight in children and adolescents."

"The clinical significance of the small benefit of medication use is unclear."

JAMA 2017;317(23):2427-2444
29 June 2017

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