Introduction
Overweight in children and adolescents is a problem that requires its further discussion at all social levels in order to prevent increases in obesity rates with the help of combining community and family efforts (Janicke et al., 2014). The current literature related to the problem of pediatric obesity is focused on discussing the role of a medication treatment and healthy lifestyle modifications associated with parents’ education in addressing this health concern (Janicke et al., 2014; Styne et al., 2017). The purpose of this review of the literature on the topic of pediatric obesity in the United States is to examine, analyze, and present recent trends regarding the treatment of this condition with the help of pharmacological therapies and lifestyle interventions which are discussed in studies.
Search Strategy
In order to collect the most recent and appropriate sources for the further review, it is important to search such databases as the PubMed database, the CINAHL database, and the Cochrane Library database. The keywords used for searching sources have been formulated with reference to the proposed research question, and they include “obesity,” “overweight,” “medication,” “pharmacological treatment,” “intervention,” “education,” and “dietary approach” among other words and their combinations. The focus should be on selecting the articles published only during the period of 2013-2017. Thirty-two results have been retrieved, and six articles are chosen for the further review because of their direct relation to the topic of this study.
Prevalent Themes in the Literature
The review of the recent literature on the problem of preventing and treating obesity in children and adolescents has indicated three main themes. These themes are the following ones: changes in prevalence of obesity in the United States, the role of a pharmacological treatment in addressing the problem, and the effectiveness of lifestyle interventions based on educating parents. These themes need to be discussed and analyzed in detail.
Child Obesity in the United States
Pediatric or child obesity is discussed by researchers and healthcare providers as a significant health concern that affects the development and well-being of communities and families in the United States (Halberstadt et al., 2017). Thus, more than one-third of American children are discussed as overweight or suffering from obesity (Ogden et al., 2016; Styne et al., 2017). According to the data provided by Ogden et al. (2016), the number of overweight children in the United States decreased in comparison to the period of 1988-1994 for the age group of 6-11 years old, but for children aged 12-19 years old, the rates of overweight and obesity are still high. Therefore, this health problem remains to be urgent and requiring effective interventions.
In spite of the fact that specialists pay attention to implementing different interventions to prevent obesity among children, the problem still exists, and according to Styne et al. (2017), the number of children who suffer from such effects of overweight as increased glucose levels, a high blood pressure, and comorbidities also grows gradually. The researchers agree that the problem is in the fact that pediatric obesity is difficult to be treated and prevented because treatments usually involve changes in children’s diets, lifestyles, and physical activities (Halberstadt et al., 2017; Janicke et al., 2014).
In this context, much attention should be paid to the role of parents who are responsible for realizing lifestyle and diet modifications for their children (Janicke et al., 2014; Ogden et al., 2016). From this point, those researchers who study the prevalence of pediatric obesity in the United States are inclined to discuss this phenomenon in its association with the interventions applied by healthcare providers and parents.
Pharmacological Treatment of Obesity in Children
Although researchers provide a lot of evidence to support the idea that lifestyle modifications are effective to cope with overweight in children, there are also many proponents of pharmacotherapy for those children and adolescents who suffer from obesity. As it is noted by Sherafat-Kazemzadeh, Yanovski, and Yanovski (2013), positive effects of using medications can be achieved only when the individualized approach to selecting drugs is followed. Still, it is important to note that a pharmacological treatment is proposed by researchers to be used only in combination with modifications of a child’s lifestyle (Styne et al., 2017). Moreover, there is no credible evidence related to the pediatric population regarding the effectiveness of pharmacological interventions when they are used without changes in individuals’ lifestyles (Sherafat-Kazemzadeh et al., 2013; Styne et al., 2017).
However, there are also proponents of using more intensive pharmacological therapies to address the problem of obesity in children and adolescents. According to Boland, Harris, and Harris (2015), young individuals suffering from obesity can significantly benefit from consuming Orlistat as a medication approved by the Food and Drug Administration to be used for children aged 12-19 years old. However, the researchers note that this medication not only contributes to decreasing children’s weight, but it also provokes gastrointestinal diseases. Metformin and Exenatide can also contribute to reducing the body mass index (BMI), but their adverse effects on children’s organisms are minor (Boland et al., 2015).
However, the opponents of using anti-obesity medications for children state that these drugs have many adverse effects on functional and metabolic processes in individuals’ organisms (Halberstadt et al., 2017). In addition, when medications are not used in combination with the physical activity and low-calorie diets, they do not provide long-term effects, and they cannot be discussed as safe for children (Janicke et al., 2014; Styne et al., 2017). Sherafat-Kazemzadeh et al. (2013) also note that pharmacotherapy often does not produce expected outcomes for children suffering from obesity because this condition is complex and multifactorial, and a systematic approach can be more advantageous in order to cope with obesity as a complicated health problem.
Lifestyle Interventions and Parents’ Education
Specific lifestyle modifications to reduce the BMI in those children who suffer from overweight or obesity are viewed by researchers and nutritionists as the most effective interventions to cope with the problem. According to Sherafat-Kazemzadeh et al. (2013), diets and the focus on the physical activity are essential to change behavioral patterns followed in the family in order to help children focus on the principles of a healthy lifestyle and reduce their BMI.
However, in spite of the fact that healthy lifestyle interventions contribute significantly to reducing the BMI in children aged 5-12 years old, these strategies cannot be discussed as effective in all cases because of individual characteristics of children and their parents who can avoid following dietary and lifestyle recommendations (Sherafat-Kazemzadeh et al., 2013). Halberstadt et al. (2017) also support this idea stating that a range of factors can influence the success in coping with obesity as a result of following lifestyle interventions because of differences in environments, available resources, and psychological aspects.
Much attention should also be paid to the role of parents in the process of implementing specific lifestyle modifications and interventions for children with obesity. Thus, Halberstadt et al. (2017) state that parents need to be educated regarding practices and strategies which they can use in order to control the weight of their children. According to Janicke et al. (2014), parents need to become responsible for realizing interventions developed for patients and interact with nutritionists in order to control children and monitor their eating habits and physical activities.
The focus should be on providing the ongoing education for parents in the context of communities regarding effective ways of preventing and addressing obesity. Styne et al. (2017) also support the idea that the effective realization of lifestyle modifications and interventions is possible only when families are provided with adequate education regarding diets, necessary changes in habits, changes in physical activities and exercises, and modifications in healthy behaviors.
Conclusion
The review of the literature on the problem of child obesity in the United States has demonstrated that many studies use the prevalence data in order to conclude about positive or negative trends in the sphere of obesity prevention and treatment. Furthermore, there are also different findings regarding the effectiveness of such popular interventions as a medication therapy and lifestyle modifications. On the one hand, medications are effective to contribute to decreasing the BMI in children. On the other hand, drugs have many adverse effects, the use of medications is limited for children, and higher results are achieved when medications are used as a part of the complex therapy. In addition, the literature review has indicated that even the most efficient lifestyle modifications supported by parents’ education can be inappropriate to be applied to different cases because of a range of factors which can influence positive outcomes for children suffering from obesity.
References
Boland, C. L., Harris, J. B., & Harris, K. B. (2015). Pharmacological management of obesity in pediatric patients. Annals of Pharmacotherapy, 49(2), 220-232. doi:10.1177/1060028014557859
Halberstadt, J., de Vet, E., Nederkoorn, C., Jansen, A., van Weelden, O. H., Eekhout, I.,… Seidell, J. C. (2017). The association of self-regulation with weight loss maintenance after an intensive combined lifestyle intervention for children and adolescents with severe obesity. BMC Obesity, 4(1), 13-25. doi:10.1186/s40608-016-0140-2
Janicke, D. M., Steele, R. G., Gayes, L. A., Lim, C. S., Clifford, L. M., Schneider, E. M.,… Westen, S. (2014). Systematic review and meta-analysis of comprehensive behavioral family lifestyle interventions addressing pediatric obesity. Journal of Pediatric Psychology, 39(8), 809-825. doi:10.1093/jpepsy/jsu023
Ogden, C. L., Carroll, M. D., Lawman, H. G., Fryar, C. D., Kruszon-Moran, D., Kit, B. K., & Flegal, K. M. (2016). Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA: The Journal of the American Medical Association, 315(21), 2292-2299. doi:10.1001/jama.2016.6361
Sherafat-Kazemzadeh, R., Yanovski, S. Z., & Yanovski, J. A. (2013). Pharmacotherapy for childhood obesity: Present and future prospects. International Journal of Obesity, 37(1), 1-15. doi:10.1038/ijo.2012.144
Styne, D. M., Arslanian, S. A., Connor, E. L., Farooqi, I. S., Murad, M. H., Silverstein, J. H., & Yanovski, J. A. (2017). Pediatric obesity – assessment, treatment, and prevention: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(3), 709-757. doi:10.1210/jc.2016-2573