Obese Kids Have Quality
of Life on Par with Cancer
Excerpt by Charnicia E. Huggins, Reuters Health

Some obese children and teenagers have a health-related quality of life as low as that reported by young cancer patients, researchers reported Tuesday.

The findings suggest that "severely obese children really are suffering in a way that is perhaps greater than people recognize," study author Dr. Jeffrey B. Schwimmer told Reuters Health.

"We need to, as parents, physicians, teachers, be aware of just how bad things are for many of these children, particularly because it's often difficult for them to talk about some of these issues," he said.

One in seven children and adolescents in the U.S. is obese. As one of the most common chronic childhood disorders, obesity is known to affect health-related quality of life, but little information exists on the subject.

To investigate, Schwimmer, an assistant professor of pediatrics at the University of California, San Diego, and his team surveyed 106 children and their parents. The children were aged 5 to 18 and had an average body mass index (BMI) of 34.7. BMI is a measure of weight in relation to height, and a BMI of 25 to 29 is considered overweight, while 30 or more is considered obese.

An individual who is 5 feet tall with a BMI of 34 to 35 would weigh 175 to 180 pounds, for example.

Comparing the results to past surveys of children of normal weight, the researchers found that the study participants were five times as likely as their healthy peers to have impaired physical functioning.

In fact, the obese children's quality-of-life scores were lower than that of their healthy peers in every area assessed, including their physical, psychosocial, emotional, social and school functioning, and their health-related quality of life was similar to that of young cancer patients, the report indicates.

For example, obese children missed an average of four days of school in the month before their evaluation, whereas their healthy peers missed less than one day of school.

About 65 percent of the youngsters in the study had an obesity-related health problem such as diabetes, sleep apnea or elevated cholesterol, and 13 percent had psychiatric problems such as anxiety or depression.

However, neither their physical nor mental problems were responsible for the differences in health-related quality of life, according to the report. Even youngsters without those problems had a poor quality of life compared with peers.

While both obese children and young cancer patients may experience teasing and have trouble keeping up with peers due to their conditions, the authors note, obese children are usually "not exposed to the intense medical interventions" that cancer patients go through.

Thus, their similar health-related quality-of-life scores was "an unexpected and important" finding, Schwimmer and his team write.

The health-related quality-of-life assessment used in the study was copyrighted by one of the study authors, who receives financial compensation from its use. It measured the children's emotional, physical and social well-being in relation to their obesity.

A second study, also published in the April 9th issue of the Journal of the American Medical Association, suggests that certain weight-loss drugs may help treat adolescents with obesity.

Currently, there are no Food and Drug Administration-approved weight-loss agents for children under the age of 16.

Dr. Robert I. Berkowitz, of The Children's Hospital of Philadelphia and the University of Pennsylvania, and his colleagues studied 82 teenagers, ages 13 to 17, with BMIs ranging from 32 to 44. The teens were randomly assigned to receive either behavior therapy and sibutramine (Meridia in the U.S. and Reductil in Europe) or behavior therapy and placebo for six months.

The behavior therapy included 13 weekly and six biweekly group sessions led by dieticians, psychologists or psychiatrists in which the teens and their parents -- who attended separate, although similar, sessions -- were instructed to consume a low-calorie diet and given exercise goals.

The teens who were treated with sibutramine lost an average of 7.8 kilograms (17 pounds), reducing their BMI by almost nine percent. Their peers in the comparison group lost about three kilograms (seven pounds), reducing their BMI by four percent.

Further, the study group continued taking sibutramine and maintained their weight loss for an additional six months, while those who switched from placebo to sibutramine lost an additional 1.3 kilograms (three pounds).

Side effects included increased blood pressure and pulse rate, which led to the drug dosage being reduced in 23 teens and discontinued in 10.

"These findings suggest that weight loss medication may be of benefit to adolescents," the researchers conclude. "Sibutramine, however, must be carefully monitored in adolescents, as in adults, to control increases in blood pressure and pulse rate."

Until more studies are conducted, the authors add, the medication should only be used on an experimental basis.

The study was funded by the National Institutes of Health, The Children's Hospital of Philadelphia and in part by an unrestricted educational grant from Knoll Pharmaceutical Co. and Abbott Laboratories, which provided the sibutramine and placebo.

SOURCE: Journal of the American Medical Association 2003;289:1805-1812,1813-1819.

Reference Source 89

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