Management of Pediatric Obesity

Abstract

pediatric obesity [9]. Some randomized trials were conducted in order to clarify metformin role in nondiabetic overweight/obese pediatric patients, and the majority of them suggest metformin beneficial in terms of weight loss and insulin resistance improvement; metformin has also been well-tolerated and safe, with no severe side effects or fatal events described so far [9,[11][12][13]. Thus, metformin is seen as a promising agent to treat obese pediatric patients with impaired glucose tolerance, although its use remains controversial due to the lack of data, especially at long term basis as there are no trials conducted for more than 12 months [11,12].The increasing incidence of obesity in the pediatric setting, has led to additional investigation on alternative pharmacological therapies to manage this condition. In the past, sibutramine was approved from FDA to treat pediatric obesity due to its capacity to promote satiety and stimulate the energy expenditure [14]. It was regarded as an effective drug and extensively used, demonstrating significant decreases of BMI up to 4 kg/m 2 and improvement of metabolic risk factors when compared to placebo groups [15]. However, issues regarding cardiovascular safety led to sibutramine's withdraw in 2010 [16]. Other experimental drugs have been studied in childhood obesity, such as octreotide, topiramate, growth hormone, leptin but conclusive data or significant trials are not available, therefore those cannot be recommended [5].Ultimately, selected cases of severe pediatric obesity may be considered for bariatric surgery. This approach, highly effective to treat adult obesity, has several potential complications in the pediatric setting. Bariatric surgery may be considered only if the children has BMI>50 kg/m 2 or BMI>40kg/m 2 with comorbidities, if lifestyle modification with or without pharmacological intervention fails and if a pubertal Tanner 4/5 status and final/ near-final adult height was already achieved [5,17].Summarizing, the increasing incidence of pediatric obesity and its cardiometabolic impact, the disappointing effectiveness of lifestyle intervention and the lack of pharmacological EditorialThe prevalence of childhood and adolescent obesity is increasing worldwide and constitutes a major public health concern [1]. Pediatric obesity is defined as body mass index (BMI) equal to or greater than 95 th percentiles adjusted for age and sex; the children or adolescents are considered overweight for BMIs between 85 th to 95 th percentiles [2]. Weight excess in childhood has increased the prevalence of some conditions practically only found in adulthood some years ago, such as impaired glucose tolerance and type 2 diabetes mellitus (T2DM), dyslipidemia, hypertension and liver steatosis [3]. The early development of these conditions is associated with cardiometabolic mordibity and premature death [4]. Intervention may prevent those complications or avoid further deterioration of cardiovascular and metabolic status.The mainstay approach of pediatric obesity is lifest...

Orlistat for obesity management with high levels of TNFα in children

“…Orlistat is a drug approved for the treatment of obesity in adolescents and children by the Food and Drug Administration (FDA) (Dolinsky et al, 2013). Orlistat is a reversible pancreatic lipase inhibitor that limits the absorption of dietary cholesterol by about 30% (Marques, 2015).…”