" (1999) Moran states that it has been demonstrated in many studies that a "familial aggregation f risk factors for obesity exist and the family "provides the child's major social learning environment." (1999)
Surgical and Pharmacological Treatment
There is very little conclusive research in the area of surgical and pharmacological treatment of child and adolescent obesity. These types of treatments are generally considered by HCPs to be "last resorts" (NIHCM, 2004) the use of gastric bypass surgery has been shown to have a lasting effect on weight loss for up to 10 years with an average weight loss of 50 kg being reporting representing around 59% of the "initial excessive weight." (Ibid) Adolescent weight loss was shown to significantly improve hypertension and sleep apnea. The work of Sugarman et al. found that "five to ten years post-surgery, one third of patients had regained most of their weight while the remaining two thirds maintained the loss for up to fourteen years after having had the surgery. The pharmacological therapy has included the following medications:
Phentermine: an appetite suppression (short-term treatment of up to 12-weeks)
Meridia (sibutramine hydrocholoride monohydrate) a neurotransmitter uptake inhibitor that works by manipulating the appetite-control centers in the brain. This drug has caused significant elevation in blood pressure in some people.
Xenical (Orlistat) This drug works in the gastrointestinal track to block the body's absorption of dietary fat. Orlistat also diminishes the absorption of fat-soluble vitamins so daily vitamin supplements must be taken.
Phenylpropanolamine (Acutrim and Dextrim) Available without a prescription, this drug works by increasing the level of a nervous system chemical called catecholamine that increases metabolic rate. Use of this product can increase heart rate, BP, and glucose levels.
Leptin and leptin receptors: Leptin is a hormone produced primarily in adipose tissue that can alter hunger and energy homeostasis. (NIHCM, 2004)
Programs and Intervention
Interventions which have been shown effective in weight loss include the program referred to as "KidShape." The mission of KidShape is "to increase awareness and promote adoption of a health lifestyle, including health eating, physical activity participation and building positive self-esteem for entire families with overweight or obese children." (Ibid) This program was established in 1987 and attempts to meet the needs of families that are diverse through creation of an environment that is supportive with the primary objective being to: (1) increase the awareness of and adopt of healthy eating habits; (2) increase awareness of and participation in regular physical activity; (3) Increase awareness of and self-appreciation of positive aspects of each participant; and (5) set realistic goals and be rewarded for achieving them with the family." (Ibid) This program is an eight-week program for ages 6-14 that is divided into two interdependent four-week modules in both English and Spanish. Also shown to be effective is a program developed by the University of California - San Francisco named SHAPEDOWN. SHAPEDOWN is a family-based intervention in which individuals participate in meetings that are educational in nature and have a design for enhancement of self-esteem and peer relationships and the adoption of healthier habits with genetic and environmental influences being considered. This program last ten weeks with each weekly session lasting 2 1/2 hours. Weight loss is gradual in this program. This program uses integration of cultural economic and ethnic differences in the workbook materials that are inclusive of broad ranges of examples of types of families. A third program named "Committed to Kids" (CTK) was established in 1986. This program uses an individualized approach to weight management and is conducted in an outpatient, group setting. This program was developed by the Louisiana State University Medical Center Department of Pediatrics and uses a "team-based approach including a physician, registered dietician and exercise physiologist, and behavior specialist." (Ibid) the duration of this program is one-year and is delivered in four phases depending on how severely overweight the child is. The participants are given a comprehensive physical, exercise and nutritional evaluation before staring the program. The exercise component is referred to as the MPEP (Modern Intensity Progressive Exercise Program) and is inclusive of aerobic, strength and flexibility training" presentations through use of video and educational materials. This program is inclusive of weekly group meetings which children and families attend for educational session, behavioral discussions and other activities for reinforcement of behavioral change. The SUNY Buffalo Childhood Weight Control Program is another program shown to be effective. This program is a six-month program and is implemented two or three times each year in which the participants attend 1 1/2 hours week session for eight weeks, then attend eight-week bi-weekly sessions and finally attend monthly session. This program includes "individual counseling and group education session that focus on behavioral choice theory." (Ibid) This program uses the Stoplight Diet to assist decrease of the intake of energy dense foods in children ages 6 to 12 years. The Healthworks! Intervention program for obsess children ages five to 10 and adolescents ages 11 to 19 is part of the Heart Center at Cincinnati Children's Hospital Medical Center. In the HealthWorks! Program the participants have to meet certain weight criteria and be referred through a physician to the program. This program uses a team-based management treatment which includes: "...a physician, a registered dietician, a psychological, a nurse, an exercise physiologist, an exercise instructor, the child and the family." (Ibid) the components of the program include: (1) diet modification and individual nutrition counseling; (2) lifestyle physical activity promotion and group exercise sessions; (3) behavioral intervention strategies; (4) parental involvement; (5) comprehensive clinical evaluation (pre-, during and post-screen); and (6) group education for adult family members." (Ibid) Other effective treatment programs include: (1) L.E.S.T.E.R. (Let's Eat Smart Then Exercise Right) This program is one of the University of Alabama at Birmingham (UAB) Department of Clinical Nutrition for children between the ages of 6 and 11 years of age. This is an eight-week program that has two individual and six group session and follow-up at six and twelve months. The treatment team is composed of clinical nutritionists, a child life therapist, and family members. This program components are inclusive of: (1) an instructors' manual; (2) parent and child notebooks, (3) board games; and (4) 12 monthly follow-up newsletters. The LESTER program is unique in that a scholarship bund has been established by the UAB Children's Auxiliary for reduction of the expense of the program.
Treatment and prevention programs also include school programs and community programs. The school environment is considered to be an ideal setting for development and testing of health behavior interventions. One of these interventions is "Healthy Start" which is a comprehensive preschool health curriculum. Another program is the "Take 10" program which was developed by the International Life Sciences Institute Center for Health Promotion. This program is a classroom-based curriculum tool that is an integration of 10 minutes of "...moderate-to-vigorous physical activity with grade-specific academic learning objectives to reinforce required concepts and skills." (Ibid) Three more school programs include: (1) a Coordinated Approach to Child Health: CATCH; (2) Pathways; and (3) the SPARK Programs (Sports, Play and Active Recreation in Kids. All of these programs focus on education, physical activity, and nutritional adjustments. Finally, the Planet Health Program developed at Harvard University through NIH funding is a school-based intervention for students in 6th, 7th and 8th grades. This program integrates health sessions into regular school classes with a focus on 'decreasing television viewing, decreasing consumption of high-fat foods, increasing fruit and vegetable intake, and increasing moderate and vigorous physical activity." (Ibid) Results of the study of Planet Health is stated to have: "demonstrated a reduction in obesity prevalence among girls, but not among boys; reduced television viewing among girls and boys, and increased fruit and vegetable consumption among girls." (Ibid) Community-based approaches to management of weight include inventions that are conducted at worksites and in homes and include as well "...multi-modal community programs in a variety of regional locations." (Ibid) These types of treatment programs have been shown to produce "only modest weight loss." (Ibid)
The work of Sonia Caprio entitled: "Treating Child Obesity and Associated Medical Conditions" states that the first step in treatment is with "a thorough medical exam, an assessment of nutrition and physical activity, an appraisal of the degree of obesity and associated health complications, a family history, and full information about current medicals." (2006) Caprio believes that "for the severe forms of obesity, the future lies in developing new and more effective drugs." (2006) Carprio states that the most effective obesity treatment programs today are those with an approach "that combines a dietary component, behavioral modification, physical activity and parental involvement." (2006) the Medical association, in order to ensure "that pediatricians are well trained in implementing such…