Efforts to fight obesity among children and teens should include strategies to help them think differently about their eating and exercise habits, researchers conclude based on a review of 64 studies of lifestyle "therapy" and drug interventions.

And it's important for parents to get involved, especially for pre-adolescent children, Dr. Hiltje Oude Luttikhuis, of the Beatrix Children's Hospital in Groningen, The Netherlands, and her colleagues say.

The review is published in the Cochrane Library, which is put out by The Cochrane Collaboration, an international group that produces systematic reviews of health care interventions.

The current review is an update of the first one, done in 2003. No direct conclusions could be drawn from the earlier review, Luttikhuis and her team note, because of the small size of many of the studies as well as quality concerns. The new review incorporates randomized, controlled trials published as recently as May 2008, including 12 targeting increased activity; 6 focused on diet; 36 of behavioral treatment; and 10 of drug therapy. The studies included 5,230 children in all.

Participants in many of these studies did lose significant amounts of weight, Luttikhuis and her colleagues report, but differences in the ways the studies were designed and their quality made it difficult to analyze the studies in combination.

While their review couldn't show that one method was better than the others, the researchers add, it does confirm that behavioral lifestyle interventions can help kids lose weight.

One-third of the lifestyle intervention studies included measures of potential adverse effects including disordered eating behavior, growth stunting, and worsening of psychological well-being. None of these potential adverse effects were seen in any of the studies.

The researchers were able to analyze the trials that included treatment with orlistat, a drug that blocks fat absorption, and those that included treatment with sibutramine, an appetite suppressant. Both sets of drug trials showed significant weight loss benefits from these two agents -- along with a number of adverse drug effects. They were unable to discern whether one medication was more effective than another.

"Evidence from this review shows that family-based, lifestyle interventions with a behavioral program aimed at changing diet and physical activity thinking patterns provide significant and clinically meaningful decrease in overweight in both children and adolescents compared to standard care or self-help in the short- and the long-term," the researchers write.

While orlistat and sibutramine should be considered as part of a lifestyle treatment program for obese adolescents, they add, "such therapy needs to be carefully weighed up against the potential for adverse events."

(China Daily via Agencies January 22, 2009)