Although improvements in the management of risk factors for surgical wound infection have reduced the rate of these infections considerably, postoperative wound infections still occur and contribute to longer hospital stays and increased medical costs
Barium enema is a common diagnostic procedure used for the evaluation of bowel symptoms and signs, but it requires careful bowel preparation for optimal results. To determine the frequency of and predictors for inadequate barium studies in elderly pat
Varicella (chickenpox) is relatively uncommon in childbearing women, because most are exposed to the disease before adolescence. The incidence of chickenpox in pregnancy is estimated at 0.7 cases per 1,000 pregnancies. When women contract chickenpox i
The only preventive strategy that has been demonstrated to reduce the incidence and mortality of colorectal cancer is adherence to a high-fiber, low-fat diet. Studies have suggested that aspirin and other non-steroidal anti-inflammatory drugs may have
In the countries of the European Community, cigarette smoking is responsible for the deaths of over 106,000 women each year. In these countries, 34 percent of women 15 to 24 years of age are smokers. In several countries, smoking is more prevalent amo
During the past 50 years, the incidence of breast cancer has steadily increased. Although there have been advances in the detection and treatment of breast cancer, mortality rates have remained stable. Excess weight has been associated with a poorer p
Estrogen and calcium are commonly used to treat postmenopausal osteoporosis. Calcitriol has been considered for the treatment of osteoporosis because it increases intestinal calcium absorption, stimulates bone synthesis and decreases bone resorption.
Breath-holding spells represent an involuntary, reflexive action that occurs during active or full expiration. The spells are a dramatic and commonly observed clinical phenomenon in otherwise healthy children. In a review article, DiMario summarizes t
Serum total cholesterol levels are known to vary widely in individuals because of physiologic, dietary and sampling reasons. Hetland and colleagues investigated how accurately a single fasting serum total cholesterol determination reflects long-term c
Although the incidence of retained stones following common bile duct exploration has fallen, 5,000 cases still occur each year in the United States. Because of the high morbidity and mortality associated with reoperation to remove retained stones, int
Author: David Slawson
Date: Oct 15, 2005
Clinical Question: Is orlistat (Xenical) effective for weight management in obese adolescents?
Setting: Outpatient (any)
Study Design: Randomized controlled trial (double-blinded)
Allocation: Concealed
Synopsis: Investigators identified 539 adolescents, 12 to 16 years of age, who met the criteria for obesity (a body mass index [BMI] of more than two units above the 95th percentile for age and sex). Participants were assigned randomly in a double-blind fashion to receive 120 mg of orlistat or placebo three times daily. All patients also received general recommendations for diet, exercise, and behavior modification. Persons blinded to treatment group assignment assessed outcomes. Follow-up for one year occurred for 98 percent of patients. Approximately two thirds of adolescents in each group completed the study.
The investigators performed a modified intention-to-treat analysis that included only patients with a baseline measurement and at least one measurement of effectiveness after baseline. At one year of follow-up, 26.5 percent of adolescents in the treatment group versus 15.7 percent in the placebo group had a 5 percent decrease in BMI, and 13.3 percent in the treatment group versus 4.5 percent in the placebo group had a 10 percent decrease in BMI (number needed to treat = 9; 95% confidence interval, 6 to 31 for both). Weight increased an average of 1.2 pounds with orlistat and 6.9 pounds with placebo (total cost per pound not gained = $374). Overall, BMI decreased by 0.55 in the orlistat group and increased by 0.31 in the placebo group (P = .001). Twelve patients (3.4 percent) taking orlistat and three patients (1.6 percent) taking placebo discontinued treatment because of adverse events, most often problems in the gastrointestinal tract. No major safety issues were reported.
Bottom Line: Orlistat, in combination with diet, exercise, and behavior modification, improves weight management in obese adolescents. No major safety issues were identified after one year, but further follow-up for sustained weight management and safety is important. (Level of Evidence: 1b)
DAVID SLAWSON, M.D.
Study Reference: Chanoine JP, et al. Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA June 15, 2005;293:2873-83.
Used with permission from Slawson D. Orlistat improves weight management in obese adolescents. Accessed online July 25, 2005, at: http://www.InfoPOEMs.com.
COPYRIGHT 2005 American Academy of Family PhysiciansCOPYRIGHT 2005 Gale Group