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Keys to Teen Weight Loss: Diet, Exercise...and Drugs?

June 12, 2005—Overweight teenagers who exercise and limit what they eat may better control their weight if they also take the diet drug Xenical, a new study shows. As the number of obese teens continues to rise, researchers have struggled to find a weight loss strategy that consistently keeps heavyset kids from becoming overweight adults.

Jean-Pierre Chanoine, MD, a diabetes specialist at the British Colombia Children’s Hospital and lead author of the study, said that Xenical is not "a magic pill."

"By itself, it’s not going to do it." he said. But as part of a broader weight loss effort, Xenical and other drugs might provide much needed help to a notoriously difficult to manage age group.

"It is very hard to change teenage behavior." said Chanoine, "They can be very independent."

For the study, which was published today in the Journal of the American Medical Association, Chanoine and colleagues placed 530 severely obese boys and girls on a comprehensive weight loss program. The teenagers, who ranged from 12 to 16 years of age, were told to exercise and cut back on calories. They were then counseled on how to maintain a healthier weight, such as by keeping a food diary and paying close attention to the triggers that may cause them to overeat.

Nearly 350 of the young volunteers also received Xenical, a prescription weight loss treatment that was approved for adults in 1999 and for teens in 2003. The drug works by blocking a portion of fat from being absorbed by the body, limiting the amount of fatty calories that are consumed. The other teenagers in the study were given a placebo.

Both groups lost weight initially. After a year, the teens who took Xenical gained some of their weight back, but they still had a slightly lower body mass index (BMI). This measurement accounts for height and weight to show whether teens are growing taller, rather than just heavier. Those who followed diet and exercise plans alone gained about nine pounds and ended up with a higher BMI.

The weight differences between the two groups were not all that much after a year, but some of the teenagers who took the drug saw their body fat drop by as much as 5 to 10 percent. "Those who respond in the first three months do best." said Chanoine. The reasons why some respond better than others is unclear, he said.

Still, identifying a candidate that will respond to the drug can be important, since Xenical is linked with unpleasant side effects. In blocking fat, the drug can cause various stomach problems, ranging from embarrassing gas to fecal incontinence. Cutting back on fatty foods can offset such troubles, but Chanoine said, "if a young person does not respond to the drug in three months, I would take them off it."

Dr. Holly Wyatt, the program director of the Centers for Obesity and Research and Education in Colorado, said that weight loss drugs may be an imperfect way to lose weight, but they are here to stay.

"I think we’re going to see more medications." she said, "We’re just at the beginning." Meridia, the only other prescription weight loss drug on the market, has also been found to help teens lose weight. But the drug is associated with increased blood pressure and heart rate.

Despite the promise of losing weight from a simple pill, both Meridia and Xenical have failed to generate a large following. The drugs must be taken continually, which may be especially tough for those who face many years of treatment.

"If you stop taking the medication, you are most likely going to regain the weight, unless something else changes." Wyatt said. Chanoine and Wyatt point out that exercise and a proper diet should be encouraged first and foremost, a message that seems to get lost in the daily routine of teenagers.

"They would rather play video games and eat pizza." said Chanoine.

Wyatt said she pushes teens to become more physically active in their daily lives. "Anything is better than being sedentary." she said, "This can prevent them from continuing to gain weight."