Clinical approaches to minimize iatrogenic weight gain in children and adolescents

Abstract

SummaryClinical providers may underestimate the role of management of diseases that can occur with obesity, termed co‐morbid conditions, distinct from disease that arise as a result of obesity, co‐morbidities. Many of these conditions are associated with iatrogenic weight gain, and can interfere with weight loss outcomes in children and adolescents with obesity. Management of co‐morbid conditions, and thoughtful selection of medications associated with weight neutrality or weight loss may increase the effectiveness of obesity treatment strategies. The aim of this commentary is to summarize the literature and discuss considerations for obesity treatment in the context of the more complicated patient, which often requires strategic management of co‐morbid conditions and minimizing iatrogenic weight gain.

Guidelines for treating child and adolescent obesity: A systematic review

“…Improved differentiation is required around how co-morbid diagnoses (e.g., learning difficulty, psychological issue, or respiratory, rheumatology or neurology diagnoses) affect obesity development, progression or treatment, and how the direction of relationships should or could impact treatment decisions ( 83 ). The use of obesogenic pharmacotherapies to treat such conditions is an important consideration for clinical decision-making related to obesity treatment ( 96 ).…”

“…Further clarity is also needed on the use of clinical staging systems and outcomes which go beyond BMI or similar, and which can capture meaningful improvements in health, function, wellbeing, and quality of life. There is also a gap in recommendations for assessing complex obesity, or obesity as a co-morbidity/complication, versus "simple" obesity (96,116). Guidance on screening for this may assist HCPs in identifying the most appropriate 10.3389/fnut.2022.902865 management plan.…”

Evaluation of Agreement of Overweight Screening Criteria in Adolescents: Korean National Health and Nutrition Examination Surveys

“…Other important factors should be considered in addition to evaluating HT and WT, such as birth WT, parents’ HT and WT, family history, and medications being taken. 24 The reason for considering birth WT is that metabolic capacity depends on whether the individual was small for gestational age. 25 , 26 Compared to those who have normal birth WT, low birth WT is associated with low lean mass, which reduces metabolic capacity in adolescence and adulthood.…”

Special considerations for the adolescent with obesity: An obesity medicine association (OMA) clinical practice statement (CPS) 2024

“…For example, an adolescent with picky eating may have increased food acceptability when eating out or traveling; if these activities decrease stress, they may be more important than adding new, healthier food choices. Multifactorial causes of weight gain in the patient with SHCN include picky eating, compulsive behaviors, restrictive eating (often due to texture), dysregulated eating patterns, lack of access to adaptive physical activity, decreased metabolism, and iatrogenic weight gain (especially antipsychotic medication) [ 28 , 35 , 36 ].…”

“…Two common WPM in adolescents with SHCN include atypical antipsychotics (behavioral/mental health management) and steroids used for treatment of uncontrolled asthma. Metformin and topiramate are beneficial in mitigating a medication's weight promoting effects and are used in the setting of obesity management [ 36 ]. Additionally, these weight-mitigating medications can lead to decreased hunger, cravings, and improve the adolescent's ability to implement limits around portions and between meal snacking.…”