An overview of obesity in children with psychiatric disorders taking atypical antipsychotics.
BACKGROUND
Children with psychiatric illness are at greater risk for obesity than those in the general population. In part, this greater risk is due to the escalating use of psychotropic medications. Second-generation antipsychotics effectively treat mental illness but are associated with weight gain. Data for management of obesity in this population is lacking.


METHODS
Articles on obesity, mental illness, and obesity management were reviewed. Keywords included children, adolescents, obesity, weight gain, psychiatric illness, therapy, treatment, and antipsychotic.


RESULTS
For pediatric obesity, educational, nutritional, behavioral, and family-based interventions were identified as nonpharmacological interventions. All nonpharmacological modalities indicate modest to moderate success in weight control or loss. Pharmacological agents, alone or with diet and exercise, appear promising in obesity management.


CONCLUSIONS
Since there are limited intervention studies available for obese children with psychiatric illness, general childhood obesity studies may be referenced for trials in this population. Long-term efficacy and safety of these interventions are not yet available. Methodological constraints of prior studies include small sample sizes and the absence of randomized, placebo-controlled, and longitudinal trials - highlighting the need for further trials addressing these issues. Clinical monitoring and management of medication-induced obesity remains an important public health concern.
Shin
Lauren
L
Harvard Medical School and Cambridge Health Alliance, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Cambridge, MA 02139, USA. lshin@challiance.org
Bregman
Hallie
H
Frazier
Jean
J
Noyes
Nancy
N
D000293:Adolescent; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001067:Appetite Depressants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D004038:Diet, Reducing; D015444:Exercise; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008687:Metformin / Q000627:therapeutic use; D009765:Obesity / Q000139:chemically induced* / Q000628:therapy; D010343:Patient Admission; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D015430:Weight Gain / Q000187:drug effects
D014150:Antipsychotic Agents; D001067:Appetite Depressants; D007004:Hypoglycemic Agents; D008687:Metformin