APA Research Paper (Mirano)
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nThis paper follows the style guidelines in the Publication Manual of the American Psychological Association, 6th ed.
\n(2010).
\nObesity in Children i
\nCan Medication Cure Obesity in Children?
\nA Review of the Literature
\nLuisa Mirano
\nPsychology 107, Section B
\nProfessor Kang
\nOctober 31, 2004
\nShort title and
\npage number for
\nstudent papers.
\nFull title.
\nXXXX
\nMarginal annotations indicate APA-style formatting and effective writing.
\nObesity in Children 1
\nWriter\u2019s name,
\ncourse, section
\nnumber, instructor\u2019s
\nname, and date
\n(all centered).
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nAbstract appears on
\na separate page.
\nObesity in Children 2
\nAbstract
\nIn recent years, policymakers and medical experts have
\nexpressed alarm about the growing problem of childhood obesity
\nin the United States. While most agree that the issue deserves
\nattention, consensus dissolves around how to respond to the
\nproblem. This literature review examines one approach to treating
\nchildhood obesity: medication. The paper compares the
\neffectiveness for adolescents of the only two drugs approved by
\nthe Food and Drug Administration (FDA) for longterm treatment
\nof obesity, sibutramine and orlistat. This examination of
\npharmacological treatments for obesity points out the limitations
\nof medication and suggests the need for a comprehensive solution
\nthat combines medical, social, behavioral, and political approaches
\nto this complex problem.
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nFull title, centered.
\nThe writer uses a
\nfootnote to define
\nan essential term
\nthat would be cumbersome to define
\nwithin the text.
\nThe writer sets
\nup her organization by posing four
\nquestions.
\nThe writer states
\nher thesis.
\nObesity in Children 3
\nCan Medication Cure Obesity in Children?
\nA Review of the Literature
\nIn March 2004, U.S. Surgeon General Richard Carmona
\ncalled attention to a health problem in the United States that,
\nuntil recently, has been overlooked: childhood obesity. Carmona
\nsaid that the \u201castounding\u201d 15% child obesity rate constitutes
\nan \u201cepidemic.\u201d Since the early 1980s, that rate has \u201cdoubled in
\nchildren and tripled in adolescents.\u201d Now more than nine million
\nchildren are classified as obese.1 While the traditional response
\nto a medical epidemic is to hunt for a vaccine or a cure-all pill,
\nchildhood obesity has proven more elusive. The lack of success
\nof recent initiatives suggests that medication might not be the
\nanswer for the escalating problem. This literature review considers
\nwhether the use of medication is a promising approach for solving
\nthe childhood obesity problem by responding to the following
\nquestions:
\n1. What are the implications of childhood obesity?
\n2. Is medication effective at treating childhood obesity?
\n3. Is medication safe for children?
\n4. Is medication the best solution?
\nUnderstanding the limitations of medical treatments for
\nchildren highlights the complexity of the childhood obesity
\nproblem in the United States and underscores the need for
\n1Obesity is measured in terms of body-mass index (BMI):
\nweight in kilograms divided by square of height in meters. A child
\nor an adolescent with a BMI in the 95th percentile for his or her
\nage and gender is considered obese.
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nHeadings, centered,
\nhelp readers follow
\nthe organization.
\nIn a signal phrase,
\nthe word \u201cand\u201d
\nlinks the names of
\ntwo authors; the
\ndate is given in
\nparentheses.
\nBecause the
\nauthor (Carmona)
\nis not named in
\nthe signal phrase,
\nhis name and the
\ndate appear in
\nparentheses.
\nObesity in Children 4
\nphysicians, advocacy groups, and policymakers to search for
\nother solutions.
\nWhat Are the Implications of Childhood Obesity?
\nObesity can be a devastating problem from both an
\nindividual and a societal perspective. Obesity puts children at risk
\nfor a number of medical complications, including type 2 diabetes,
\nhypertension, sleep apnea, and orthopedic problems (Henry J.
\nKaiser Family Foundation, 2004, p. 1). Researchers Hoppin and
\nTaveras (2004) have noted that obesity is often associated with
\npsychological issues such as depression, anxiety, and binge eating
\n(Table 4).
\nObesity also poses serious problems for a society
\nstruggling to cope with rising health care costs. The cost of
\ntreating obesity currently totals $117 billion per year\u2014a price,
\naccording to the surgeon general, \u201csecond only to the cost of
\n[treating] tobacco use\u201d (Carmona, 2004). And as the number of
\nchildren who suffer from obesity grows, long-term costs will
\nonly increase.
\nIs Medication Effective at Treating Childhood Obesity?
\nThe widening scope of the obesity problem has prompted
\nmedical professionals to rethink old conceptions of the disorder
\nand its causes. As researchers Yanovski and Yanovski (2002) have
\nexplained, obesity was once considered \u201ceither a moral failing or
\nevidence of underlying psychopathology\u201d (p. 592). But this view
\nhas shifted: Many medical professionals now consider obesity a
\nbiomedical rather than a moral condition, influenced by both
\ngenetic and environmental factors. Yanovski and Yanovski have
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nEllipsis mark
\nindicates omitted
\nwords.
\nAn ampersand
\nlinks the names of
\ntwo authors in
\nparentheses.
\nThe writer draws
\nattention to an
\nimportant article.
\nObesity in Children 5
\nfurther noted that the development of weight-loss medications in
\nthe early 1990s showed that \u201cobesity should be treated in the
\nsame manner as any other chronic disease . . . through the
\nlong-term use of medication\u201d (p. 592).
\nThe search for the right long-term medication has been
\ncomplicated. Many of the drugs authorized by the Food and
\nDrug Administration (FDA) in the early 1990s proved to be a
\ndisappointment. Two of the medications\u2014fenfluramine and
\ndexfenfluramine\u2014were withdrawn from the market because of
\nsevere side effects (Yanovski & Yanovski, 2002, p. 592), and
\nseveral others were classified by the Drug Enforcement
\nAdministration as having the \u201cpotential for abuse\u201d (Hoppin &
\nTaveras, 2004, Weight-Loss Drugs section, para. 6). Currently only
\ntwo medications have been approved by the FDA for long-term
\ntreatment of obesity: sibutramine (marketed as Meridia) and
\norlistat (marketed as Xenical). This section compares studies on
\nthe effectiveness of each.
\nSibutramine suppresses appetite by blocking the reuptake
\nof the neurotransmitters serotonin and norepinephrine in the
\nbrain. Though the drug won FDA approval in 1998, experiments
\nto test its effectiveness for younger patients came considerably
\nlater. In 2003, University of Pennsylvania researchers
\nBerkowitz, Wadden, Tershakovec, and Cronquist released the
\nfirst double-blind placebo study testing the effect of sibutramine
\non adolescents, aged 13-17, over a 12-month period. Their
\nfindings are summarized in Table 1.
\nAfter 6 mos.:
\nloss of 3.2 kg
\n(7 lb)
\nAfter 12 mos.:
\nloss of 4.5 kg
\n(9.9 lb)
\nAfter 6 mos.:
\nloss of 7.8
\nkg (17.2 lb)
\nAfter 12 mos.:
\nloss of 7.0
\nkg (15.4 lb)
\nGain of 0.67
\nkg (1.5 lb)
\nLoss of 1.3
\nkg (2.9 lb)
\nTable 1
\nEffectiveness of Sibutramine and Orlistat in Adolescents
\nAverage
\nweight
\nMedication Subjects Treatmenta Side effects loss\/gain
\nSibutramine
\nOrlistat
\nControl
\nMedicated
\nControl
\nMedicated
\n0-6 mos.:
\nplacebo
\n6-12 mos.:
\nsibutramine
\n0-12 mos.:
\nsibutramine
\n0-12 mos.:
\nplacebo
\n0-12 mos.:
\norlistat
\nMos. 6-12:
\nincreased
\nblood pressure;
\nincreased pulse
\nrate
\nIncreased
\nblood pressure;
\nincreased pulse
\nrate
\nNone
\nOily spotting;
\nflatulence;
\nabdominal
\ndiscomfort
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nThe writer uses a
\ntable to summarize the findings
\npresented in two
\nsources.
\nA note gives the
\nsource of the data.
\nA content note
\nexplains data
\ncommon to
\nall subjects.
\nNote. The data on sibutramine are adapted from \u201cBehavior Therapy and
\nSibutramine for the Treatment of Adolescent Obesity,\u201d by R. I. Berkowitz,
\nT. A. Wadden, A. M. Tershakovec, & J. L. Cronquist, 2003, Journal of
\nthe American Medical Association, 289, pp. 1807-1809. The data on
\norlistat are adapted from Xenical (Orlistat) Capsules: Complete Product
\nInformation, by Roche Laboratories, December 2003, retrieved from
\nhttp:\/\/www.rocheusa.com\/products\/xenical\/pi.pdf
\naThe medication and\/or placebo were combined with behavioral therapy
\nin all groups over all time periods.
\nObesity in Children 6
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nWhen this article
\nwas first cited, all
\nfour authors were
\nnamed. In subsequent citations of
\na work with three
\nto five authors,
\n\u201cet al.\u201d is used
\nafter the first
\nauthor\u2019s name.
\nObesity in Children 7
\nAfter 6 months, the group receiving medication had lost
\n4.6 kg (about 10 pounds) more than the control group. But
\nduring the second half of the study, when both groups received
\nsibutramine, the results were more ambiguous. In months 6-12,
\nthe group that continued to take sibutramine gained an average
\nof 0.8 kg, or roughly 2 pounds; the control group, which switched
\nfrom placebo to sibutramine, lost 1.3 kg, or roughly 3 pounds
\n(p. 1808). Both groups received behavioral therapy covering diet,
\nexercise, and mental health.
\nThese results paint a murky picture of the effectiveness
\nof the medication: While initial data seemed promising,
\nthe results after one year raised questions about whether
\nmedicationinduced weight loss could be sustained over time.
\nAs Berkowitz et al. (2003) advised, \u201cUntil more extensive
\nsafety and efficacy data are available, . . . weight-loss
\nmedications should be used only on an experimental basis
\nfor adolescents\u201d (p. 1811).
\nA study testing the effectiveness of orlistat in adolescents
\nshowed similarly ambiguous results. The FDA approved orlistat
\nin 1999 but did not authorize it for adolescents until December
\n2003. Roche Laboratories (2003), maker of orlistat, released
\nresults of a one-year study testing the drug on 539 obese
\nadolescents, aged 12-16. The drug, which promotes weight loss by
\nblocking fat absorption in the large intestine, showed some
\neffectiveness in adolescents: an average loss of 1.3 kg, or
\nroughly 3 pounds, for subjects taking orlistat for one year, as
\nopposed to an average gain of 0.67 kg, or 1.5 pounds, for the
\ncontrol group (pp. 8-9). See Table 1.
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nFor a source with
\nsix or more
\nauthors, the first
\nauthor\u2019s name
\nfollowed by \u201cet al.\u201d
\nis used for the first
\nand subsequent
\nreferences.
\nObesity in Children 8
\nShort-term studies of orlistat have shown slightly more
\ndramatic results. Researchers at the National Institute of Child
\nHealth and Human Development tested 20 adolescents, aged
\n12-16, over a three-month period and found that orlistat,
\ncombined with behavioral therapy, produced an average weight
\nloss of 4.4 kg, or 9.7 pounds (McDuffie et al., 2002, p. 646).
\nThe study was not controlled against a placebo group; therefore,
\nthe relative effectiveness of orlistat in this case remains
\nunclear.
\nIs Medication Safe for Children?
\nWhile modest weight loss has been documented for both
\nmedications, each carries risks of certain side effects.
\nSibutramine has been observed to increase blood pressure and
\npulse rate. In 2002, a consumer group claimed that the
\nmedication was related to the deaths of 19 people and filed a
\npetition with the Department of Health and Human Services to
\nban the medication (Hilts, 2002). The sibutramine study by
\nBerkowitz et al. (2003) noted elevated blood pressure as a side
\neffect, and dosages had to be reduced or the medication
\ndiscontinued in 19 of the 43 subjects in the first six months
\n(p. 1809).
\nThe main side effects associated with orlistat were
\nabdominal discomfort, oily spotting, fecal incontinence, and
\nnausea (Roche Laboratories, 2003, p. 13). More serious for
\nlong-term health is the concern that orlistat, being a fatblocker, would affect absorption of fat-soluble vitamins, such
\nas vitamin D. However, the study found that this side effect
\ncan be minimized or eliminated if patients take vitamin
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nThe writer
\ndevelops the
\npaper\u2019s thesis.
\nObesity in Children 9
\nsupplements two hours before or after administration of orlistat
\n(p. 10). With close monitoring of patients taking the medication,
\nmany of the risks can be reduced.
\nIs Medication the Best Solution?
\nThe data on the safety and efficacy of pharmacological
\ntreatments of childhood obesity raise the question of whether
\nmedication is the best solution for the problem. The
\ntreatments have clear costs for individual patients, including
\nunpleasant side effects, little information about long-term use,
\nand uncertainty that they will yield significant weight loss.
\nIn purely financial terms, the drugs cost more than $3 a
\nday on average (Duenwald, 2004). In each of the clinical trials,
\nuse of medication was accompanied by an expensive regime
\nof behavioral therapies, including counseling, nutritional
\neducation, fitness advising, and monitoring. As journalist Greg
\nCritser (2003) noted in his book Fat Land, use of weight-loss
\ndrugs is unlikely to have an effect without the proper \u201csupport
\nsystem\u201d\u2014one that includes doctors, facilities, time, and
\nmoney (p. 3). For some, this level of care is prohibitively
\nexpensive.
\nA third complication is that the studies focused on
\nadolescents aged 12-16, but obesity can begin at a much younger
\nage. Little data exist to establish the safety or efficacy of
\nmedication for treating very young children.
\nWhile the scientific data on the concrete effects of these
\nmedications in children remain somewhat unclear, medication
\nis not the only avenue for addressing the crisis. Both medical
\nexperts and policymakers recognize that solutions might come
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nBrackets indicate
\na word not in the
\noriginal source.
\nA quotation longer
\nthan 40 words is
\nindented without
\nquotation marks.
\nThe writer interprets the evidence;
\nshe doesn\u2019t just
\nreport it.
\nThe tone of the
\nconclusion is
\nobjective.
\nObesity in Children 10
\nnot only from a laboratory but also from policy, education, and
\nadvocacy. Indeed, a handbook designed to educate doctors on
\nobesity recommended a notably nonmedical course of action,
\ncalling for \u201cmajor changes in some aspects of western culture\u201d
\n(Hoppin & Taveras, 2004, Conclusion section, para. 1). Cultural
\nchange may not be the typical realm of medical professionals,
\nbut the handbook urged doctors to be proactive and \u201cfocus
\n[their] energy on public policies and interventions\u201d (Conclusion
\nsection, para. 1).
\nThe solutions proposed by a number of advocacy groups
\nunderscore this interest in political and cultural change. A report
\nby the Henry 3. Kaiser Family Foundation (2004) outlined trends
\nthat may have contributed to the childhood obesity crisis,
\nincluding food advertising for children as well as
\na reduction in physical education classes and after-school
\nathletic programs, an increase in the availability of sodas
\nand snacks in public schools, the growth in the number of
\nfast-food outlets . . . , and the increasing number of
\nhighly processed high-calorie and high-fat grocery
\nproducts. (p. 1)
\nAddressing each of these areas requires more than a doctor
\narmed with a prescription pad; it requires a broad mobilization
\nnot just of doctors and concerned parents but of educators,
\nfood industry executives, advertisers, and media
\nrepresentatives.
\nThe barrage of possible approaches to combating childhood
\nobesity\u2014from scientific research to political lobbying\u2014
\nindicates both the severity and the complexity of the problem.
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nObesity in Children 11
\nWhile none of the medications currently available is a miracle
\ndrug for curing the nation\u2019s nine million obese children, research
\nhas illuminated some of the underlying factors that affect
\nobesity and has shown the need for a comprehensive approach
\nto the problem that includes behavioral, medical, social, and
\npolitical change.
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nList of references
\nbegins on a new
\npage. Heading is
\ncentered.
\nList is alphabetized by authors\u2019
\nlast names. All
\nauthors\u2019 names
\nare inverted.
\nThe first line of
\nan entry is at
\nthe left margin;
\nsubsequent
\nlines indent 1\u20442”.
\nDouble-spacing is
\nused throughout.
\nObesity in Children 12
\nReferences
\nBerkowitz, R. I., Wadden, T. A., Tershakovec, A. M., & Cronquist,
\nJ. L. (2003). Behavior therapy and sibutramine for the
\ntreatment of adolescent obesity. Journal of the American
\nMedical Association, 289, 1805-1812.
\nCarmona, R. H. (2004, March 2). The growing epidemic of
\nchildhood obesity. Testimony before the Subcommittee on
\nCompetition, Foreign Commerce, and Infrastructure of
\nthe U.S. Senate Committee on Commerce, Science, and
\nTransportation. Retrieved from http:\/\/www.hhs.gov\/asl
\n\/testify\/t040302. html
\nCritser, G. (2003). Fat land. Boston, MA: Houghton Mifflin.
\nDuenwald, M. (2004, January 6). Slim pickings: Looking
\nbeyond ephedra. The New York Times, p. F1. Retrieved from
\nhttp:\/\/nytimes.com\/
\nHenry J. Kaiser Family Foundation. (2004, February). The role
\nof media in childhood obesity. Retrieved from http:\/\/www
\n.kff.org\/entmedia\/7030.cfm
\nHilts, P. J. (2002, March 20). Petition asks for removal of diet
\ndrug from market. The New York Times, p. A26. Retrieved
\nfrom http:\/\/nytimes.com\/
\nHoppin, A. G., & Taveras, E. M. (2004, June 25). Assessment
\nand management of childhood and adolescent obesity.
\nClinical Update. Retrieved from http:\/\/www.medscape
\n.com\/viewarticle\/481633
\nMcDuffie, J. R., Calis, K. A., Uwaifo, G. I., Sebring, N. G.,
\nFallon, E. M., Hubbard, V. S., & Yanovski, J. A. (2002).
\nThree month tolerability of orlistat in adolescents with
\nSource: Diana Hacker (Boston: Bedford\/St. Martin\u2019s, 2006).
\nObesity in Children 13
\nobesity-related comorbid conditions. Obesity Research,
\n10, 642-650.
\nRoche Laboratories. (2003, December). Xenical (orlistat)
\ncapsules: Complete product information. Retrieved from
\nhttp:\/\/www.rocheusa.com\/products\/xenical\/pi.pdf
\nYanovski, S. Z., & Yanovski, J. A. (2002). Drug therapy: Obesity.
\nThe New England Journal of Medicine, 346, 591-602.<\/p>\n","protected":false},"excerpt":{"rendered":"
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