| Adolescent obesity has become a significant health problem in the United States, nearly tripling in the last thirty years. Aggressive treatment of adolescent obesity is important because the symptoms and co-morbidities are associated with the metabolic syndrome. The purposes of this study are threefold: to determine what components of the metabolic syndrome are present in obese adolescents, to determine what differences exist in the effects of lifestyle intervention verses lifestyle intervention plus pharmacotherapy on weight management and select markers of the metabolic syndrome in obese adolescents, and to determine which factors predict weight loss in obese adolescents treated with lifestyle changes. A retrospective chart review of 68 obese adolescents treated for obesity at the LeBonheur Youth Lifestyle Clinic from January 1, 2000 through June 30, 2005 was performed. The study was a secondary data analysis utilizing existing data from the clinic. Adolescents ages 11 though 18 were included. Lifestyle interventions included diet, exercise, and counseling. Weight loss medications utilized included metformin and phentermine. Outcomes evaluated included Body Mass Index (BMI), Relative Body Mass Index (RBMI), weight, waist and hip circumference, blood pressure, serum lipid levels, fasting plasma glucose, two hour oral glucose tolerance tests, and insulin levels. Changes in mean values between groups were evaluated using the SAS statistical analysis program (version 9.1) Logistic regression was utilized to determine which factors might predict weight loss. The metformin group tended to be heavier, older, and had more components of metabolic syndrome than the nonmetformin group. All components of the metabolic syndrome were present in both groups but metabolic syndrome was more prevalent in the metformin group. Both groups had a downward trend in RBMI, a surrogate marker for weight loss, but the only the metformin group had a significant loss in RBMI points from baseline to end. The only predictors of weight loss were higher RBMI and the absence of Type 2 Diabetes Mellitus (T2DM). While the use of lifestyle changes and lifestyle changes plus pharmacotherapy both produce some degree of weight loss, subjects on metformin in this study lost significantly more RBMI than those on lifestyle changes alone. |
