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Calls for more research to determine best treatment for childhood obesity

Researchers at Teesside University have been examining drug interventions for the treatment of childhood obesity and found that, although drugs have been found to aid weight reduction in older children, more work is needed to determine their efficiency and safety.

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Latest figures show that over one fifth of reception children are overweight or obese and in year six the figure rises to over one third.

Treatment for childhood obesity usually involves behaviour change programmes that support families to improve their dietary intake and activity levels, so children with excess weight can grow into a healthy weight. The National Institute for Health and Care Excellence currently do not recommend drug treatment for children younger than 12 years, and in children 12 years and older, drug treatment (orlistat) should only be used in exceptional circumstances, for example if children are suffering from severe illnesses associated with their obesity, such as sleep apnea, problems with their joints, or poor mental health.

Researchers from Teesside University are in the process of completing a series of reviews to examine the effectiveness of different treatments for childhood obesity, including reviews of diet and physical activity, behavioural change, drugs and surgery.

They found that pharmacological interventions such as metformin, sibutramine, orlistat and fluoxetine, may have small effects in reduction in BMI and body weight in obese older children and adolescents. Although many of the drugs reviewed are not licensed for the treatment of obesity in children or have been withdrawn from use in the UK.

Academics at Teesside say there was insufficient evidence to inform future guidelines around the use of drugs in reducing obesity in children and adolescents. However the findings do support the current NICE recommendations in that there is very little evidence to support the use of drugs to treat obesity in children under the age of 12 and that drugs have side effects and therefore should only be considered in exceptional circumstances where the child suffers from severe weight-related morbidity and side effects are closely monitored. And also that it is recommended that drugs are prescribed by a multi-disciplinary team offering support.

The latest study is a continuation of the University’s expertise in obesity. Academics at Teesside have also worked with Public Health England on a report which helped inform the Government’s proposed introduction of sugar tax. The work also contributed to a recent change in regulations to marketing food and drink towards children.

Emma Mead, Research Associate in Teesside University’s School of Health & Social Care, led the latest research which has been published in the Cochrane Library.

She said: 'Childhood obesity can potentially have serious consequences on a child’s health and well-being. It is very important to identify interventions which can treat obesity in both the short and long term.'

The research found an overall BMI reduction of 1.3kg/m2 in favour of drug interventions.

Emma added: 'While this finding suggests that drug interventions can result in a small BMI and weight reduction over the short term, it is not known whether this is sustainable over the longer term, or has any impact on existing or future clinical risk factors or disease. This area would really benefit from more high quality trials.'

The research stresses that drugs should only be considered in exceptional circumstances where the child suffers from severe weight related morbidity. First line treatments should always involve behavioural change programmes that help support families to improve their diet and activity levels.

Dr Louisa Ells, a Reader in Teesside University’s School of Health and Social Care, leads the obesity research programme at Teesside, and is overseeing the review series into the treatment of childhood obesity, which she will present to the World Health Organisation in Geneva later this month.

She said: 'Drug interventions may help children achieve a small reduction in BMI and weight, but the current evidence is not sufficient to make any conclusive recommendations.

'We need to be 100% clear and the evidence from this review doesn’t tell us whether obesity drugs are safe and effective in younger children, or whether the effects seen in older children will last. There is also a lack of information about the side effects of the drugs. It is imperative that further studies are carried out in order to address these questions before any future recommendations about drug treatment for childhood obesity are made.'

20 December 2016