Obese teens shed weight with combo diet, exercise, therapy and drug program

New research suggests that when combined with a low-calorie diet, exercise and behavioral therapy, treatment with the drug Xenical significantly improves weight management for obese teenagers.

Dr. Jean-Pierre Chanoine and colleagues, from the British Columbia Children's Hospital in Vancouver, found that behavioral modification alone seldom led to sustained weight loss in obese adolescents, and say there is therefore a need for other strategies to promote weight loss.

The drug Xenical, known generically as Orlistat, produces weight loss by vastly reducing fat absorption in the intestines, it has a good safety profile and it is currently approved for use in obese and overweight adults.

In their research Chanoine's team assessed the weight-related outcomes of 539 obese teens who were randomly assigned to treatment with Orlistat or an inactive placebo. All the participants also followed a low-calorie diet, exercised, and got behavioral therapy for a year.

One hundred and seventeen subjects in the placebo group and 232 in the Orlistat group completed the study, but 180 and 348 subjects in the two groups, respectively, were included in the analysis.

Apparently both groups experienced a drop in body mass index (BMI - a measure of weight in relation to height) up to week 12, but after that point, the average BMI held steady in the Orlistat group whereas the BMI of the control group increased to levels higher than at the start of the study.

At one year, BMI had dropped by 0.55 in the Orlistat group, while it had increased by 0.31 in the control group.

The researchers say that the percentage of patients experiencing a reduction in BMI of at least 5 percent or 10 percent was significantly higher in the Orlistat group.

Gastrointestinal side effects, such as passage of fatty or oily stool and abdominal pain, were more common in the Orlistat group, but were usually mild.

Dr. Alain Joffe, from Johns Hopkins University in Baltimore, in an accompanying editorial, says the researchers "have made a valuable contribution" to the topic of adolescent obesity, but much more data are needed on the long-term benefits and risks of Orlistat therapy.

The research is published in the Journal of the American Medical Association, June 15, 2005.