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Background Metformin has been proffered as a therapy for adolescent obesity, although long-term controlled studies have not been reported. Objective To test the hypothesis that 48 weeks of daily metformin hydrochloride extended release (XR) therapy will reduce body mass index (BMI) in obese adolescents, as compared with placebo. Design Multicenter, randomized, double-blind, placebo-controlled clinical trial. Setting The 6 centers of the Glaser Pediatric Research Network from October 2003 to August 2007. Participants Obese (BMI > or = 95th percentile) adolescents (aged 13-18 years) were randomly assigned to the intervention (n = 39) or placebo groups. Intervention Following a 1-month run-in period, subjects following a lifestyle intervention program were randomized 1:1 to 48 weeks' treatment with metformin hydrochloride XR, 2000 mg once daily, or an identical placebo. Subjects were monitored for an additional 48 weeks. Main Outcome Measure Change in BMI, adjusted for site, sex, race, ethnicity, and age and metformin vs placebo. Results After 48 weeks, mean (SE) adjusted BMI increased 0.2 (0.5) in the placebo group and decreased 0.9 (0.5) in the metformin XR group (P = .03). This difference persisted for 12 to 24 weeks after cessation of treatment. No significant effects of metformin on body composition, abdominal fat, or insulin indices were observed. Conclusion Metformin XR caused a small but statistically significant decrease in BMI when added to a lifestyle intervention program. Trial registration clinicaltrials.gov Identifiers: NCT00209482 and NCT00120146.

Sir .—The nonmedical use of anabolic steroids among high school students is an issue that requires better definition. Terney and McLain 1 present data that show that 4.4% of the students in a large Chicago, Ill, high school admit to using anabolic steroids, an incidence that is quite concerning. However, the interpretation of the data is compromised by questions regarding the study design. In my experience, the term anabolic steroid is relatively unfamiliar to many, if not most, school-aged children. None of the survey questions in this study verified that the subjects understand this term, and no mention was made of presurvey education. An unknown percentage of the children will be familiar with the term steroid as used for treatment of asthma, allergies, and other medical conditions and might answer in the affirmative without knowing the meaning of anabolic . Another unknown percentage of the children may have had anabolic