***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT The prevalence of overweight and obesity in children and adolescents is increasing rapidly . In this population , behavioral therapy alone has had limited success in providing meaningful , sustained weight reduction , and pharmacological treatment has not been extensively studied . OBJECTIVE To determine the efficacy and safety of orlistat in weight management of adolescents . DESIGN , SETTING , AND PATIENTS Multicenter , 54-week ( August 2000-October 2002 ) , r and omized , double-blind study of 539 obese adolescents ( aged 12 - 16 years ; body mass index [ BMI ] > or=2 units above the 95th percentile ) at 32 centers in the United States and Canada . INTERVENTIONS A 120-mg dose of orlistat ( n = 357 ) or placebo ( n = 182 ) 3 times daily for 1 year , plus a mildly hypocaloric diet ( 30 % fat calories ) , exercise , and behavioral therapy . MAIN OUTCOME MEASURES Change in BMI ; secondary measures included changes in waist and hip circumference , weight loss , lipid measurements , and glucose and insulin responses to oral glucose challenge . RESULTS There was a decrease in BMI in both treatment groups up to week 12 , thereafter stabilizing with orlistat but increasing beyond baseline with placebo . At the end of the study , BMI had decreased by 0.55 with orlistat but increased by 0.31 with placebo ( P = .001 ) . Compared with 15.7 % of the placebo group , 26.5 % of participants taking orlistat had a 5 % or higher decrease in BMI ( P = .005 ) ; 4.5 % and 13.3 % , respectively , had a 10 % or higher decrease in BMI ( P = .002 ) . At study end , weight had increased 0.53 kg with orlistat and 3.14 kg with placebo ( P<.001 ) . Dual-energy x-ray absorptiometry showed that this difference was explained by changes in fat mass . Waist circumference decreased in the orlistat group but increased in the placebo group ( -1.33 cm vs + 0.12 cm ; P<.05 ) . Generally mild to moderate gastrointestinal tract adverse events occurred in 9 % to 50 % of the orlistat group and in 1 % to 13 % of the placebo group . CONCLUSIONS In combination with diet , exercise , and behavioral modification , orlistat statistically significantly improved weight management in obese adolescents compared with placebo . The use of orlistat for 1 year in this adolescent population did not raise major safety issues although gastrointestinal adverse events were more common in the orlistat group OBJECTIVE To study the safety , tolerability , and potential efficacy of orlistat in adolescents with obesity and its comorbid conditions . RESEARCH METHODS AND PROCEDURES We studied 20 adolescents ( age , 14.6 + /- 2.0 years ; body mass index , 44.1 + /- 12.6 kg/m(2 ) ) . Subjects were evaluated before and after taking orlistat ( 120 mg three times daily ) and a multivitamin for 3 months . Subjects were simultaneously enrolled in a 12-week program emphasizing diet , exercise , and strategies for behavior change . RESULTS Participants who completed treatment ( 85 % ) reported taking 80 % of prescribed medication . Adverse effects were generally mild , limited to gastrointestinal effects observed in adults , and decreased with time . Three subjects required additional vitamin D supplementation despite the prescription of a daily multivitamin containing vitamin D. Weight decreased significantly ( -4.4 + /- 4.6 kg , p < 0.001 ; -3.8 + /- 4.1 % of initial weight ) , as did body mass index ( -1.9 + /- 2.5 kg/m(2 ) ; p < 0.0002 ) . Total cholesterol ( -21.3 + /- 24.7 mg/dL ; p < 0.001 ) , low-density lipoprotein-cholesterol ( -17.3 + /- 15.8 mg/dL ; p < 0.0001 ) , fasting insulin ( -13.7 + /- 19.0 microU/mL ; p < 0.02 ) , and fasting glucose ( -15.4 + /- 7.4 mg/dL ; p < 0.003 ) were also significantly lower after orlistat . Insulin sensitivity , assessed by a frequently sample d intravenous glucose-tolerance test , improved significantly ( p < 0.02 ) . DISCUSSION We conclude that , in adolescents , short-term treatment with orlistat , in the context of a behavioral program , is well-tolerated and has a side-effect profile similar to that observed in adults , but its true benefit versus conventional therapy remains to be determined in placebo-controlled trials OBJECTIVE To evaluate the efficacy of orlistat to enhance weight loss in obese adolescents . METHODS The study was a 6-month r and omized , double-blind , placebo-controlled trial to compare the effects of orlistat ( 120 mg orally 3 times a day ) and placebo on reduction of body mass index ( BMI ) .  Forty adolescents between 14 and 18 years of age with a mean BMI of 40 kg/m2 entered the protocol between December 2002 and February 2003 . Study subjects stayed overnight in the General Clinical Research Center , during which dietary records were review ed and lifestyle recommendations were given . The study participants received either orlistat ( 120 mg orally 3 times a day ) or placebo and were assessed monthly for 6 months . At 0 , 3 , and 6 months , fasting laboratory tests were performed . The primary end point was the change in BMI from baseline to 6 months . Secondary outcomes included changes in weight , lean body mass , and results of blood chemistry studies . RESULTS No statistically significant difference was noted between the 2 study groups for decrease in BMI from baseline to 6 months ( P = 0.39 ) . The decrease in BMI within the orlistat group ( -1.3 + /- 1.6 kg/m2 ; P = 0.04 ) and within the placebo group ( -0.8 + /- 3.0 kg/m2 ; P = 0.02 ) , however , was statistically significant . Laboratory measurements did not differ between the 2 groups . In comparison with the placebo group , the orlistat group had increased adverse events , primarily gastrointestinal symptoms and findings . CONCLUSION In this study of obese adolescents , orlistat did not significantly reduce BMI in comparison with placebo at 6 months BACKGROUND The prevalence of morbid obesity is increasing rapidly . Weight reduction is very difficult using diet restriction and physical activity alone . Sibutramine has been shown to be effective and safe as an adjuvant therapy to diet restrictions . OBJECTIVES To describe our experience using sibutramine in weight reduction treatment of adolescents suffering from morbid obesity . METHODS The study group comprised 20 young persons ( 13 females , mean age 15 years 4 months , range 13 - 18 years ) with morbid obesity ( body mass index above the 95th percentile for age and /or > or = 30 kg/m2 ) who were treated with sibutramine 10 mg once a day for 1 year . RESULTS Mean BMI was 40 + /- 5.6 kg/m2 ( range 30.1 - 49.5 kg/m2 ) at the beginning of treatment . Most patients showed an early weight reduction to mean BMI 39.3 + /- 4.9 and 35.9 + /- 5.7 at 3 and 6 months respectively , but stopped losing weight over the next 6 months . During the follow-up period 17 patients discontinued the treatment . The main reason for dropout was the slow rate of weight reduction after 6 months . Patients suffering from concomitant disorders ( severe asthma , hypertension , sleep obstructive apnea ) showed improvement after weight reduction . Adverse reactions from the treatment were transient , mild and well tolerated . CONCLUSIONS Sibutramine may help in achieving weight reduction for a short period and in improving concomitant health problems , however its long-term effect is limited To investigate the efficacy and tolerability of orlistat in obese adolescents , a prospect i ve , open-label , r and omised , controlled pilot trial was performed . A total of 22 adolescents with exogeneous obesity were started on orlistat ( 120 mg tid ) and a daily multivitamin preparation in addition to conventional treatment which included nutritional and lifestyle modification programmes . The control group consisted of 20 obese adolescents who had similar duration of follow-up under conventional treatment alone .  Of the 22 patients , 7 dropped out within the 1st month of the trial due to side-effects attributable to orlistat . The remaining 15 patients on orlistat were followed for 5–15 months ( average duration of treatment 11.7±3.7 months ) . The control group was similar in age , sex , and duration of follow-up ( 10.2±3.7 months , range 6–17 months ) to the orlistat group . Compared to initial body weight , patients in the orlistat group lost −6.27±5.4 kg , whereas those in the control group gained 4.16±6.45 kg ( P<0.001 ) during the study period . Patients in the orlistat group lost −7.65%±6.5 % of their initial body weight , whereas , those of the control group gained 5.7%±8.3 % ( P<0.001 ) . The body mass index decreased in the orlistat group by −4.09±2.9 kg/m2 while it increased by + 0.11±2.49 kg/m2 in the control group ( P<0.001 ) . Mild gastrointestinal complaints ( frequent stools ) were experienced by all patients in the orlistat group . Conclusion : Orlistat could be a useful adjunct in the treatment of  severe obesity in adolescents ; however , gastrointestinal side-effects limit its usefulness in almost one in three adolescents CONTEXT Childhood obesity is now considered to be an epidemic . Drug therapy in this age group remains a topic of research . OBJECTIVE The objective of this study was to examine the effect of treatment with sibutramine ( 10 mg ) on body composition and energy expenditure in obese adolescents . DESIGN The study was conducted as a r and omized , double-blind , placebo-controlled trial . SETTING The study was set in an obesity research center . PATIENTS The patients were 24 obese adolescents ( age 12 - 17 yr , 11 boys ) ; four patients withdrew . INTERVENTION Intervention was sibutramine ( Meridia ) or placebo in combination with an energy-restricted diet and exercise plan for 12 wk , followed by an identical , but medication-free , treatment period ( follow-up ) . MAIN OUTCOME MEASURE Change in body mass index ( BMI ) sd score ( BMI -SDS ) was the principal measure of efficacy . Body composition and total energy expenditure were measured by stable isotopes and further calculated according to the four-component model , using underwater weighing and dual x-ray absorptiometry . Basal metabolic rate ( BMR ) was measured by ventilated hood and adjusted for sex and body composition ( BMRadj ) . RESULTS After intervention , the decrease in BMI -SDS was comparable in both groups . During follow-up , BMI further decreased in the placebo group but stabilized in the sibutramine group . Changes in the percentage of fat mass were not different between both groups . BMRadj decreased in the placebo group and remained constant in the sibutramine group . During follow-up , BMRadj decreased in the sibutramine group and increased in the placebo group . Changes in total energy expenditure were not significantly different . CONCLUSION The effect of sibutramine on BMI -SDS was not significant . Sibutramine may diminish the decrease in BMRadj associated with energy restriction in obese adolescents This pilot study compared the efficacy of orlistat as an adjunctive treatment for obesity between African American and Caucasian adolescents . Twenty obese adolescents with obesity-related co-morbid conditions underwent measurements of body composition , glucose homeostasis by frequently sample d intravenous glucose tolerance test ( FSIGT ) , and fasting lipids before and after 6 months treatment with orlistat 120 mg tid in conjunction with a comprehensive behavioral program .  Weight ( p < 0.05 ) , BMI ( p < 0.001 ) , total cholesterol ( p < 0.001 ) , LDL cholesterol ( p < 0.001 ) , fasting insulin ( p < 0.02 ) and fasting glucose ( p < 0.003 ) were lower after treatment . Insulin sensitivity , measured during the FSIGT , improved significantly ( p < 0.02 ) , as did fasting indices such as the homeostasis model assessment for insulin resistance ( p < 0.01 ) . African American subjects exhibited significantly less improvement in weight ( p < 0.05 ) , BMI ( p < 0.01 ) , waist circumference ( p = 0.03 ) , and insulin sensitivity ( p = 0.05 ) . Improvements in cholesterol were not significantly different between African Americans and Cau 
    Output:
    
Sibutramine improved waist circumference , triglycerides and high density lipoprotein (HDL)-cholesterol , but raised systolic and diastolic blood pressure and pulse .
Orlistat increased rates of gastrointestinal side-effects .
We conclude that sibutramine  in adolescents produces clinical ly meaningful reductions in BMI and waist circumference of approximately 0.63 SD , with improvements in cardiometabolic risk .
Orlistat modestly reduces BMI ( effect size approximately 0.24 SD ) with a high prevalence of gastrointestinal adverse effects