Pharmacotherapy in Childhood Obesity

Abstract

<b><i>Background:</i></b> The increasing number of obese children and adolescence is a major problem in health-care systems. Currently, the gold standard for the treatment of these patients with obesity is a multicomponent lifestyle intervention. Unfortunately, this strategy is not leading to a substantial and long-lasting weight loss in the majority of patients. This is the reason why there is an urgent need to establish new treatment strategies for children and adolescents with obesity to reduce the risk for the development of any comorbidities like cardiovascular diseases or diabetes mellitus type 2. <b><i>Summary:</i></b> In this review, we outline available pharmacological therapeutic options for children and compare the available study data with the outcome of conservative treatment approaches. <b><i>Key Messages:</i></b> We discussed, in detail, how knowledge about underlying molecular mechanisms might support the identification of effective antiobesity drugs in the future and in which way this might modulate current treatment strategies to support children and adolescence with obesity to lose body weight.

Tackling obesity while preventing obesity stigma

“…In adults, weight-loss interventions using reduced-energy diet and exercise are associated with moderate (3–6%) weight loss at 6 months, but weight tends to be regained 25 26. For children and young people with more severe or resistant obesity, there may be a role for adjunctive pharmacotherapy, and even bariatric surgery, particularly in adolescents 23 27–29. Overall, it is difficult to achieve sustained good outcomes, particularly at the more severe end of the paediatric obesity spectrum.…”

Current Treatments for Patients with Genetic Obesity

“…Even though not widely used in practice and often of modest efficacy, some treatments are now approved to treat common obesity ( 41 ). In the future, these treatments could be proposed for use in patients with syndromic or monogenic obesity, but only after careful clinical evaluation.…”

“…PWS has benefited from the most intense therapeutic research among syndromic obesity due to its severity and frequency ( 41 , 54 ). PWS leads to a hypothalamic dysfunction involved in satiety deficiency but also results in impaired oxytocin (OXT) signaling and growth hormone (GH) deficiency ( 55 ).…”

Treatment of hypothalamic obesity in people with hypothalamic injury: new drugs are on the horizon

“…Liraglutide causes dose-dependent and treatment duration-dependent thyroid C-cell tumors in rodent models, at much higher dose exposures than those used in humans. Therefore, even if the relevance for humans of such tumors has not been determined, GLP1RAs are contraindicated in patients with a family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 ( 64 ). Otherwise, gastrointestinal adverse effects are frequent in particular at start of treatment, potentially leading to discontinuation of treatment ( 65 ).…”