Limited quality data to recommend one treatment program over another, but combined behavioural lifestyle interventions appear to be better than “standard care” or self-help. Mean benefit of 0.3 Z score in children under 6.
Poor evidence for “parent only” interventions. Poor evidence that interventions to change behaviour of health professionals or the organisation of care (dietician, doctor, combined etc) makes any difference!
In obese adolescents, orlistat, metformin, and sibutramine should be considered as an adjunct to lifestyle interventions, but balance against potential for adverse effects. Average BMI benefit of 1.3, high drop out rate (25%) although only 5% due to adverse effects. [Cochrane 2016]
Surgery produced mean loss of 34.6kg in adolescents in Australia. 28% required further revisional surgery. Only 1 RCT! At 2 years, only benefit in 2 of 8 QOL measures. [Cochrane 2015]
Research needed into psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care.