The challenges of adolescent obesity
In the quest to find new, more effective and long-term ways to address America’s obesity epidemic, it often seems like we’re losing more ground than pounds. Roughly one-third of U.S. adults are obese, with some researchers suggesting that percentage might climb to 44 percent by 2030.
Perhaps worse, the prevalence of obesity in American children is approximately 17 percent, with 3 to 5 percent considered to be severely obese. The vast majority of these children will become obese adults, likely beset by a host of obesity-related ailments and premature death.
The obstacles to discovering and developing new weight loss drugs for obese adults are huge. Successes have been few and relatively modest in effect. Indeed, the Food and Drug Administration only recently approved two new prescription anti-obesity drugs, Belviq and Qsymia, the first such approvals in more than a decade.
The task is even more difficult for treating obese children. Writing in the journal JAMA Pediatrics, Jeffrey B. Schwimmer, MD, professor of clinical pediatrics at UC San Diego and director of the Weight and Wellness Center at Rady Children’s Hospital-San Diego outlines the state of clinical trials for adolescent obesity, current challenges and what needs to be done.
First and foremost, he notes that assessing the outcomes of pediatric obesity trials, which have been relatively far and few between, is a work-in-progress. There are no universally accepted criteria for defining successful weight loss in children, whose gender, growth and development confound adult-based standards.
For example, does a change in body mass index (a common measure of weight loss in adults) mean the same thing in boys and girls?
“A 13-year-old who has a large increase in height will have a considerable advantage with respect to BMI change compared with a 16-year-old girl for whom only weight loss will yield a decrease in BMI,” Schwimmer writes.
Schwimmer observes that some researchers and some studies have tried to overcome the limitations of simple BMI measurements with more complex formulations, but that the relative scarcity of adolescent subjects, clinical trials and subsequent data limits their current usefulness, though this may be changing as the number of adolescent trials—current and planned – is growing.
Other challenges involve simply working with the targeted group. It’s hard enough to create effective, yet practical, interventions for adults, let alone weight loss programs that will work for children.
And there’s the language of weight management itself, which contributes to a negative orientation toward obese patients. Echoing the FDA, Schwimmer says weight management efforts need to move toward emphasizing better health and away from simply being “The Biggest Loser.”