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Overweight in older children and adolescents: treatment or prevention?
  1. Caroline M Apovian
  1. Correspondence to Caroline M Apovian, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA; caroline.apovian{at}bmc.org

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In children and adolescents, overweight is defined as a body mass index for age greater than the 95th percentile of a reference population. Between 1980 and 2004 the prevalence of overweight in children and adolescents increased from 6% to 19% in the USA.1 Overweight children and adolescents very often become obese adults.2 Obesity seems to have complex and multiple aetiologies and because of this is very difficult to prevent or treat. Since prevention of this disease in this obesogenic environment has proven to be elusive, much focus has revolved around treatment of overweight and obesity for adults and children. This editorial will briefly comment on the use of antiobesity medicines as well as bariatric surgical procedures in older children or adolescents.

A recent article by Viner et al3 reports on rising antiobesity drug prescription rates in older children in the UK over the period between 1999 and 2006, a time in which childhood and adolescent obesity rates skyrocketed all over the world. At the time, the three medications approved for obesity treatment in adults in the UK were the gastric and pancreatic lipase inhibitor orlistat, the serotonin and noradrenergic reuptake inhibitor sibutramine, and the selective cannabinoid CB1 receptor antagonist rimonabant. In the UK these drugs are not licensed for use in children or adolescents. In the USA, rimonabant did not meet approval requirements by the Food and Drug Administration, and in addition to sibutramine and orlistat, the market includes the older drugs phentermine and diethylproprion, approved in the 1970s for 3-month usage. Orlistat was approved for use in patients aged ⩾12 years and sibutramine for patients aged ⩾16 years. The UK data report that approximately 0.1 in 1000 of those …

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