Tools of Builder

What’s in the Toolbox for Severe Childhood Obesity?

Justin Ryder, Claudia Fox, and Aaron Kelly offer us an excellent overview of the options for treating severe childhood obesity. Unfortunately, for all the talk of urgency about childhood obesity, the options are far too few.

Intense Focus on Lifestyle

The cornerstone of care for youth with severe obesity remains lifestyle interventions. It’s a low risk and low reward option. Ryder et al note that it can be quite effective for a small percentage of youth with severe obesity. But overall, sustainable long-term results are uncommon. Scalability and implementation present real problems. The authors explain:

The limitations of lifestyle modification therapy to produce clinically significant and durable weight loss are grounded in the biology of obesity. While it may be tempting to blame the patient for not adhering to the lifestyle modification therapy and point to poor compliance as the cause for weight management “failure,” it is critical to recognize the biological underpinnings that are at the core of the development and maintenance of obesity.

Banging on about a child’s lifestyle has a limited effect when the real problem lies with potent biological forces. So lifestyle therapy isn’t the best answer. It’s simply the basic tool that clinicians grab first.

Pharmacotherapy Largely Untapped

Ryder et al describe pharmacotherapy for severe childhood obesity as “primordial.” Even the limited options anti-obesity meds in adults simply haven’t been studied much in youth. One exception is orlistat, which has an FDA-approved indication for use in adolescents. Others have been studied, but the data remains incomplete. Studies ongoing with liraglutide in adolescents with obesity offer some hope that this might lead to an approved indication.

But effective and safe anti-obesity meds for severe childhood obesity remain a fairly distant hope. The necessary studies for youth inevitably lag behind the research for adults. The real hope is that success for adults will lead to more intensive efforts for children.

Surgical Devices and Procedures

Undeniably, says Ryder, bariatric surgery is the most effective treatment for severe childhood obesity. Generally, it’s an option only for adolescent patients and relatively few patients receive it. That’s because few adolescents have the capacity for making the mature decisions that this requires. The risks are real, even if the risks of severe obesity are generally even greater. So it’s no panacea.

Medical devices might provide more options. But, again, the data is limited. And we see little indication of investment in the needed research.

One thing is clear. We need better tools to care for children with severe obesity. Sticking with a conservative approach is actually very risky for these children. Without investing money and resources, the lives of five million young people are at risk.

Click here for a deep dive into this subject from Ryder et al. For an early study of liraglutide in adolescents with obesity, click here.

Tools of Builder, etching by Giovanni Battista Piranesi / WikiArt

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May 15, 2018

4 Responses to “What’s in the Toolbox for Severe Childhood Obesity?”

  1. May 15, 2018 at 7:12 am, Allen Browne said:

    Ted,

    Thanks.

    Allen

  2. May 15, 2018 at 8:40 am, John DiTraglia said:

    One good thing about kids is that a sizable minority will outgrow it. The younger you are obese, the more likely you will outgrow it – much higher than the rate of “cure” in adults. Real clues to the mechanisms of obesity is presented by this fact. A real research opportunity is being missed here.

  3. May 17, 2018 at 5:26 pm, Justin Ryder said:

    Thanks for the nice article, Ted.

    To the point made by John. Unfortunately this statement is incorrect, the majority of longitudinal data support the notion that children and adolescents will not grow out of it. Depending on which study you use, there are a few, but 80-90% of children and adolescents with obesity will remain as such into young and mid-adulthood. In the context of severe obesity the numbers are more stark, 85-95% continuing with Class 2 or 3 obesity into adulthood. Treatment outcomes are just as poor in children and adolescents as they are in adults, in some cases worse.

    Hope this clarifies a common misconception.

    Justin Ryder

  4. May 17, 2018 at 6:33 pm, Ted said:

    Thanks for providing good insight, Justin!