Childhood obesity: a hefty challenge

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Childhood obesity has reached epidemic proportions in the United States. Data from the Centers for Disease Control and Prevention showed that 16% of children in the United States are overweight, indicating that the number of overweight children of all races, both sexes, and all socioeconomic groups has tripled since 1980. Although diagnosis of obesity is simple, treatment has been daunting, with lifestyle interventions and medications proving disappointing over the long-term.

In this issue of The Journal, Love-Osborne et al report the results of a study evaluating the efficacy of metformin (vs. placebo) in conjunction with lifestyle intervention in achieving weight loss and improvement in glucose tolerance in a cohort of obese adolescents with insulin resistance at high risk for developing type 2 diabetes. They found that weight loss of more than 5% after 6 months occurred only in those adolescents who were adherent to both metformin and a reduction in calorie intake, measured by decreased portion size. The accompanying editorial by Kasa-Vubu discusses the significance of these findings.

This study underscores the importance of patient motivation as a predictor of weight loss in any program. Lifestyle modification remains the sine qua non of all weight loss programs. Although metformin may improve the chance of weight loss in adolescents who are willing to decrease portion size, medications are not effective in patients who are not sufficiently motivated to decrease calorie intake and increase physical activity. Thus, pediatricians must assess the level of patient motivation before prescribing medication as an adjunct to a lifestyle modification program. No medication will be effective if the adolescent does not consider weight loss as a high priority or achievable. However, as demonstrated in this study, medication in conjunction with lifestyle changes may prove to be more effective than lifestyle changes alone. Working with overweight teens is a time-consuming process. We must choose those patients in whom the investment has a reasonable chance of paying off.