Authors' objectives:

To assess the safety, effectiveness, and cost implications of management of obesity in childhood.

Authors' results and conclusions: Prevention programme: There is some evidence that multifaceted school based programmes that promote physical activity, modification of dietary intake, and targeting sedentary behavior may help children lose weight. Screening methods: There is sufficient evidence to conclude that BMI has high sensitivity and specificity detecting overweight but not for detecting obesity. There is insufficient evidence that the use of hydrodensitometry or air displacement plethysomography is effective in detecting body fat percentage. With respect to MRI, there is evidence that MRI gives the best prediction of total body fat volume as well as patterns of intra-abdominal and subcutaneous fat distribution but the high cost of this procedure limits its use mainly to the research setting. There is some evidence that Bioelectrical impedance (BIA) is suitable for population screening especially for measuring fat free mass in children aged 10-19 years. The evidence on the effectiveness of dual energy x-ray absorptiometry (DEXA) is inconclusive. However, there is evidence that waist circumference is a simple and effective measure for trunk fat mass. There is also some evidence that skin fold thickness measurement, especially of the triceps, is effective in the screening for obesity. Treatment: There is evidence that surgery is a safe and effective treatment for morbidly obese children to induce weight loss and also reduction in obesity together with related comorbidity. With respect to pharmacological treatment, appetite suppressants and thermogenic drugs have not been approved for use in children. Digestive inhibitors like lipase inhibitors and fat substitutes are being used off label. There is some evidence suggesting that Orlistat may assist with weight loss in obese children, but insufficient evidence on the efficacy of Sibutramine. There also insufficient evidence to suggest dietary education, physical activity or a combination of both improves weight control.

Authors' recommendations: Prevention: There is insufficient evidence to recommend in favour of or against community-based obesity prevention programs. However, in view of the major health risk associated with obesity, and the limited long-term effectiveness of weight-reduction methods, the prevention of obesity should be a high priority for health care providers. Screening methods: BMI is recommended for detecting overweight, while skin fold thickness measurements, especially of the triceps, may be considered for screening for obesity. Treatment: There is insufficient evidence to recommend in favour of or against weight-reduction therapy because of a lack of evidence supporting the long-term effectiveness of weight-reduction methods. However, surgery is recommended for treatment of morbidly obese children.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.moh.gov.my/

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment Unit

Contact Address: Health Technology Assessment Unit, Medical Development Division, Ministry of Health Malaysia, Level 21, PERKIM Building, Jalan Ipoh, 51200 Kuala Lumpur, Malaysia. Tel: 603 4045 7781, Fax: 603 4045 77 40

Copyright: Malaysian Health Technology Assessment Unit (MHTAU)