Hope And Despair For The Obese

Separate studies Tuesday reported there's new hope for overweight adults, but overweight children often feel there isn't any hope for them.

An epilepsy drug combined with a reduced-calorie diet may result in significant weight loss for obese adults, according to one of several obesity studies in this week's Journal of the American Medical Association.

Doctors' concern is growing about the nation's obesity epidemic and recent data suggesting 15 percent of U.S. youngsters are severely overweight or obese.

In another study, obese children rated their quality of life with scores as low as those of young cancer patients on chemotherapy, a study found, highlighting the physical and emotional toll of being too fat.

Teasing at school, difficulties playing sports, fatigue, sleep apnea and other obesity-linked problems all severely affect obese youngsters' well-being, that study found.

While the researchers didn't expect to find youngsters mirroring the cliché of the fat, happy child, the dismal scores were far lower than anticipated, said lead author Dr. Jeffrey Schwimmer, a pediatric gastroenterologist at the University of California in San Diego.

"The magnitude... is striking," Schwimmer said. "The likelihood of significant quality-of-life impairment was profound for obese children."

The epilepsy drug research was prompted by reports of unintentional weight loss in epilepsy patients using zonisamide to prevent seizures.

In the Duke University study, participants who took zonisamide daily for 16 weeks lost an average of nearly 13 pounds, compared with about 2 pounds in patients given dummy pills.

Both groups also ate 500 fewer calories daily in a diet monitored by a dietitian, and were encouraged to increase their activity levels. Patients were mostly women, aged 21 to 50, and weighed over 200 pounds on average.

The study was small — just 60 patients — and the results are preliminary, but they suggest the drug could be a promising addition to efforts to control the nation's obesity epidemic, according to a research team led by Duke's Dr. Kishore Gadde.

Some 30 percent of U.S. adults are obese and 60 percent are overweight.

The study was funded by Elan Biopharmaceuticals, makers of zonisamide, which is sold under the brand name Zonegran.

A JAMA editorial notes that Schwimmer's study on children found that severely obese youngsters and adolescents seeking obesity treatment have more than a fivefold increased risk of reporting low quality of life than healthy youngsters.

"It seems clear that one of the most compelling medical challenges of the 21st century is to develop effective strategies to prevent and treat pediatric obesity," Drs. Jack and Susan Yanovski of the National Institutes of Health said in the editorial.

Schwimmer's study involved 106 children aged 5 to 18 who filled out a questionnaire last year used by pediatricians to evaluate quality of life issues. Parents answered the same questionnaires, and their ratings of their children's well-being were even lower than the youngsters' self-ratings.

Girls and boys appeared to be equally adversely affected by obesity.

Youngsters were aged 12 on average, with an average height of 5 feet 1 inch and average weight of 174 pounds. All had a body-mass index that would be considered obese.

Obesity-related ailments were common and included fatty liver disease, obstructive sleep apnea, diabetes and orthopedic problems caused by excess weight.

"Even in the absence of these physical conditions, children and parents reported a low quality of life," Schwimmer said.

Also in Wednesday's JAMA:

  • A Harvard University study of more than 50,000 women bolsters the link between sedentary lifestyles and obesity, finding a 23 percent increased risk of obesity and a 14 percent increased risk of diabetes for every two hours of television watched daily.

    By contrast, watching less than 10 hours of TV weekly and engaging in brisk walking at least half an hour daily reduced the obesity and diabetes risks by 30 percent and 43 percent respectively.

  • The prescription diet drug Meridia helped adolescents lose weight when combined with behavior therapy, but also was linked with increases in pulse rate and blood pressure that have been found in adults.

    The research team led by Dr. Robert Berkowitz of the University of Pennsylvania said the drug should only be used on an experimental basis in adolescents and children "until more safety and efficacy data are available."

  • A research review concluded that any success with low-carbohydrate regimens including the Atkins diet results primarily from restricting calories, not just reducing carbohydrates.

    But evidence on safety and efficacy is insufficient to recommend low-carbohydrate diets, especially for longer than three months or for people older than age 50, said lead researcher Dr. Dena Bravata of Stanford University.

In the zonisamide study, the researchers said "the precise mechanism is not known" for how the drug stimulates weight loss.

Fatigue was the only side effect reported more frequently in the zonisamide patients than in the placebo group. How it would stack up against drugs approved for weight loss is not known.


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