Treating Obesity

I’ve watched the OTC version of Xenical, Alli, fly off the shelves at Wal-Mart and Costco over the last year, and I marvel at the market for the next “wonder” diet pill. Adults can — and do – mess around with their digestive systems constantly, and although some people have disorders and medications that make losing weight difficult, most of us just don’t take the time to eat right and exercise.

I can vouch for that last point. Between work during the day and classes at night, the only hope that I had for dinner last semester was the Wendy’s drive-through on the way to school. It’s not simple laziness. It’s more a matter of “you get what you can when you can” or go hungry.

This lifestyle has had a trickle-down effect on our kids, who are getting just about as busy (and gaining as much weight) as we are. An estimated third of American children may be fighting the battle of the bulge.

Still, kids are expected to lose weight the old fashioned way: expend more energy than they take in. And they need a well-balanced diet to support their developmental needs, which has been one of the reasons kids have not been a huge part of the “wonder” pill market. To date, I haven’t seen a medical or psychiatric association recommend the use of medical management for childhood obesity.

That’s why I almost choked on my coffee when I read the headlines, “Study suggests caution on new anti-obesity drug in kids,” in MIT online news. The mouse-model study addressed the blockage of cannabinoid receptors and found that it suppressed the adaptive rewiring that normally occurs in juvenile mice. Based on these results, the researchers have said that drugs with this type of mechanism, such as rimonabant, shouldn’t be used to treat obesity in children.

Rimonabant (brand name ACOMPLIA, Sanofi-Aventis) isn’t approved for use in the United States for adults yet. And I didn’t find the drug associated with clinical trials in children on the NIH website. But I have seen discussion presented in CME that suggests study of rimonabant in children is appropriate due to the effects of obesity later on in life - free sign in and password may be required).

There are obvious benefits to keeping children’s weight at healthy levels. But is achieving that goal with lifestyle adjustments more than we can handle? How often have you been petitioned by a parent to provide medical intervention for a child, and what was your response? Give your opinion here.