I’m keeping a bit quiet about this for fear of upsetting some of my little woodland neighbours, but scientists have been Doing Things to mice and have discovered a gene mutation linked to obesity, which they hope may lead to the development of new drugs to help control weight. While we’re waiting for that (and it could be a long wait, as the Cambridge professor of genetics who commented on the research pointed out that study was “entirely in mice” and that the mutation was “very rare” in humans) we would do well to look as what is at our disposal in tackling the current ‘obesity epidemic’.
A Cochrane review of interventions for treating obesity in children and adolescents included 64 randomised controlled trials (RCTs), following a systematic search of relevant databases. The primary outcome was measured height and weight. 54 RCTs (3806 participants) evaluated lifestyle interventions of three types: dietary, physical activity and behavioural (aimed at changing thinking patterns and actions). Ten RCTs (1424 participants) assessed drug treatments (metformin, orlistat and sibutramine). No suitable RCTs on surgical interventions were found.
Here’s what they found:
- Positive outcomes for treating obesity in children were achieved in several studies, including high quality studies
- Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in a) lifestyle interventions involving children (under 12 years) and b) lifestyle interventions in adolescents with or without the addition of the drugs orlistat or sibutramine
- Combining dietary, physical activity and behavioural components appears effective, with parental involvement an important feature of behavioural programs, particularly in pre-adolescent children
- 10 lifestyle studies that reported on measures of disordered eating, did not find any adverse changes. A range of adverse effects was noted in drug RCTs
- The studies varied considerably in intervention design, methods of measuring outcomes and in methodological quality
The authors concluded:
“…combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects.”
BBC News Obesity gene’s role revealed in mice study. 18th March 2012
Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O’Malley C, Stolk RP, Summerbell CD. Interventions for treating obesity in children. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD001872. DOI: 10.1002/14651858.CD001872.pub2.
A Cochrane summary and a podcast of this review are available