Honey, I shrunk the kids (but it was probably worth it)
Anxious parents can take some comfort from two recent reviews that explore the impact of inhaled corticosteroids on the growth of children with mild to moderate persistent asthma. The first, which included 25 trials with more than 8400 children, concluded that steroids reduce growth during the first year of treatment (by about half a centimetre). The reduction is less pronounced in subsequent years, and seems minor compared with the known benefits of these drugs for controlling asthma. The second review, which included data on 3400 children from 22 trials, found that lower doses of corticosteroids have less impact on growth, supporting the “minimal effective dose” approach (doi: 10.1002/14651858.CD009471.pub2; 10.1002/14651858.CD009878.pub2).
Of course, when it comes to obesity, shrinking is desirable. The recently updated review of surgery for weight loss in adults, which now includes 22 trials with 1800 participants, found that compared with no surgery, body mass index was six units lower 1 to 2 years after surgery. This finding extended to improvements in health-related quality of life and aspects of diabetes. The review highlights potentially important differences in surgical procedures; for example, three studies found that gastric bypass achieved greater weight loss than adjustable gastric bands. Given that most trials followed participants for only 1 or 2 years, the long-term effects of surgery remain unclear (doi: 10.1002/14651858.CD003641.pub4).