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Aug 1, 2018 Issue
Interventions for Treatment of Overweight and Obese Children [Cochrane for Clinicians]
Interventions that include combinations of diet, physical activity, and behavior changes may reduce weight, body mass index (BMI), and BMI z-score (equivalent to BMI-for-age percentile) in overweight and obese children six to 11 years of age.
In older patients with obesity embarking on a program to improve their health, weight loss accompanied by resistance training and aerobic training resulted in the biggest gains in functional status and physical performance.
Bariatric surgery using Roux-en-Y gastric bypass or sleeve gastrectomy was more effective than intensive medical therapy at improving quality of life and helping patients lose weight and reduce the need for medications. Anemia was more common with sleeve gastrectomy, and approximately 4% of patients in the surgical groups required a second surgery.
Calculating the BMI of children and adolescents in primary care practices and counseling those who are overweight is ineffective to reduce BMI in children over several years of follow-up.
Liraglutide, combined with lifestyle counseling, produces a clinically significant and sustained weight loss that continues as long as it is used. Nausea and vomiting, however, are common adverse effects, and about one in 10 patients will discontinue treatment.
In addition to improving cardiovascular outlook, a Mediterranean diet produced greater sustained weight loss than a low-fat diet and similar weight loss to other diets in patients who were overweight or obese, most of whom had type 2 diabetes mellitus.
Naltrexone/bupropion produces clinically significant weight loss when combined with a diet and exercise program. It decreases body weight in patients with diabetes, but its effect on diabetic outcomes is not known. A significant proportion of patients will experience adverse effects.
More than 40 years ago, Dr. Robert Atkins wrote his first book advocating for a low-carbohydrate diet to cause and sustain weight loss. This study (of mostly women) found that a low-carbohydrate diet—though not as severe a diet as the Atkins approach—caused an average 3.5 kg (7.7 lb) greater weight loss than a low-fat diet.
Lorcaserin, combined with diet and exercise, can be used to produce additional weight loss, although the effect on morbidity and mortality is not known. It should be discontinued in patients who do not lose at least 5% of their body weight in the first 12 weeks because they are unlikely to have any additional weight loss.
Phentermine/topiramate has been shown to be a good option for sustained weight loss in patients who are unable to lose weight with diet and exercise alone. It should not be given to patients with a history of significant heart disease, and women of childbearing age should use contraception and have ...