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Adolescent Obesity Linked to Premature Death

But diet pill, not yet approved for children, works for teens, researchers report

MONDAY, July 17, 2006 (HealthDay News) -- Teenage girls who are obese run a three-fold greater risk of premature death in middle age, according to a new study in the Annals of Internal Medicine.

"This study underscores the importance of childhood obesity," said lead researcher Dr. Frank B. Hu, an associate professor of nutrition and epidemiology at the Harvard School of Public Health. "Childhood obesity not only has health consequences for children, but increases the risk for death in adulthood."

But another report, also in the July 18 issue of the journal, found that the diet drug sibutramine -- brand-named Meridia -- along with behavior therapy, helps very obese adolescents lose weight. That study was funded by the makers of Meridia, Abbott Laboratories, Inc.

That finding could prove valuable in the United States, where 15.5 percent of teens are overweight.

In the first study, Hu's team found a link between teenage obesity and premature death among 102,400 women enrolled in the Nurses' Health Study II. The women, who were aged 24 to 44 at the start of the study, were asked to recall their weight when they were 18 years old. During 12 years of follow-up, 710 of the women died.

The researchers found that a higher-than-normal body mass index (BMI, a ratio of weight to height) at age 18 was associated with as much as a three-fold increased risk for death, compared with girls who had a normal BMI.

Hu said excess weight during adolescence can increase the risk for such diseases as heart disease and diabetes, both of which can lead to complications and death in adulthood.

"The link between childhood obesity and premature death is an important public-health issue," Hu said. "Prevention at early ages is an important strategy to combat this problem."

In the second study, researchers assigned 498 very obese teens, 12 to 16 years old, to receive either sibutramine plus behavior therapy, or a placebo. At the beginning of the study, the teens weighed an average of 215 pounds.

"This is the first study to evaluate whether sibutramine in addition to a lifestyle-modification program helps very obese adolescents," said lead author Dr. Robert I. Berkowitz, an associate professor of psychiatry and pediatrics at the University of Pennsylvania School of Medicine, and director of the school's Weight and Eating Disorders Program.

Sibutramine works by increasing the feeling of fullness and reducing hunger, Berkowitz said. "We saw there was a significant difference in weight in the two groups after a year," he said.

Over a year, those teens taking sibutramine lost an average of 14 pounds, while those taking the placebo gained about four pounds. In addition, those taking the diet pill also lowered their risk for heart disease by lowering their cholesterol, triglyceride levels, insulin levels and insulin sensitivity, Berkowitz said.

Berkowitz noted that sibutramine is not currently approved by the U.S. Food and Drug Administration for children under 16 years of age. "We need long-term studies to determine the long-term side effects," he said. "There were small increases in blood pressure and pulse rate in the trial, which have to be monitored."

"Treatment with sibutramine may be helpful under careful monitoring," he added.

But one expert doesn't think pills or surgery are the answer to the obesity epidemic facing today's teens.

"Recent study has shown that gastric bypass works as well, and as safely, in adolescence as it does in adults," said Dr. David L. Katz, an associate professor of public health and director of the Prevention Research Center at Yale University School of Medicine "Now we have the results of a large clinical trial affirming that drug therapy, too, can produce weight loss in teens."

These findings are especially interesting when juxtaposed with those of Hu's study on the impact of adolescent obesity on future mortality, Katz said. "Perhaps the judicious use of weight-control medication could be used to mitigate this threat," he said.

"But relying on drugs, or surgery, to contain the threat that obesity poses to young people is testimony to glaring societal failures," Katz added. "Obesity is preventable by means well understood and at our disposal -- increasing physical activity, and reducing caloric intake. Unlike drugs and surgery, these options enhance overall health, come at low or no cost, and do not impose a risk of complications."

More information

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SOURCES: Frank B. Hu, M.D., associate professor of nutrition and epidemiology, Harvard School of Public Health, Boston; Robert I. Berkowitz, M.D., associate professor of psychiatry and pediatrics, University of Pennsylvania School of Medicine and medical director, Weight and Eating Disorders Program, Philadelphia; David L. Katz, M.D., M.P.H., associate professor of public health, director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; July 18, 2006, Annals of Internal Medicine
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