Pharmacotherapy in pediatric obesity: current evidence and landscape

Abstract

Purpose of review Childhood obesity is escalating globally. Lifestyle and behavioral changes, which are the frequently used interventions in clinical practice, lead to only modest improvements in children with established obesity. Bariatric surgery is currently the most effective obesity treatment but has very limited utilization in pediatric obesity and is preferentially used for children with worsening comorbidities. There exists a massive treatment gap for children suffering with obesity especially after the failure of lifestyle modifications. Pharmacotherapy that is an established management tool in adults is very infrequently used in children. Only two medications, Phentermine and Orlistat are approved by the Food and Drug Administration (FDA) for use in adolescent obesity. Herein, we discuss the current landscape and available literature on the use of antiobesity pharmacotherapy in children. Recent findings There are emerging pediatric data about the efficacy of the many weight loss medications that are FDA approved in adults. Moreover, more clinical trials are underway on the rarer, intractable forms of obesity such as monogenic, syndromic, and hypothalamic obesity. Summary Weight loss medications in children, like adults, have variable efficacy and similar side effect profiles. Rigorous research and improved education of providers about weight loss medications may address the huge treatment gap in severe pediatric obesity.

Anti-obesity medication prescriptions by race/ethnicity and use of an interpreter in a pediatric weight management clinic

“…All of these medications are prescribed in our and other pediatric weight management clinics primarily for the indication of obesity and eating behaviors associated with its development, such as hyperphagia and binge eating. 13 Most of these medications are prescribed ‘off label’. Specifically, topiramate, psychostimulants, and naltrexone (± bupropion) are not Food and Drug Administration (FDA)-approved for weight loss for patients of any age.…”

Pharmacological Approaches in Obesity Treatment

“…Uzun dönemli kullanıldığında uygun vitamin takviyesi yapılması gerekebilir. Kronik malabsorbsiyon, kolestaz ve gebelikte kullanımı kontrendikedir (9).…”

“…Bunun yanında kabızlık, diyare ve kusma gibi diğer gastrointestinal etkilere de sebep olabilirler, ancak daha nadirdir (12). Kendisinde veya ailesinde medüller tiroid kanseri veya tip 2 multipl endokrin neoplazi (MEN) hikayesi olanlarda kullanımı kontraendikedir (9).…”

“…Obezitede monoterapi olarak onaylanmamıştır ancak özellikle tip 2 diyabet gibi ko-morbiditesi olan hastalarda tedaviye eklenebilir (14). Metformin hepatik glukoneogenezi inhibe ederken, kas ve karaciğer gibi periferdeki dokularda insülin bağımlı glukoz alımını arttırır (9). Metformin kullanımı ile yağsız dokuda az miktarda değişiklik olurken yağ kütlesinde azalma meydana gelir.…”

Effects of Movement Behaviors on Overall Health and Appetite Control: Current Evidence and Perspectives in Children and Adolescents

“…Twig et al showed that adolescents with obesity had an increased risk of cardiovascular death over a 40-year period, with hazard ratios of 4.9 for death from coronary heart disease, 2.6 for death from stroke, and 3.5 for death from total cardiovascular causes [ 13 ], constituting the need for early intervention in childhood obesity. However, several drugs for the management of obesity have shown limited effectiveness, significant side effects, or are still understudied in younger children and preadolescents [ 14 , 15 , 16 ], and neither dietary nor PA interventions alone have been proven effective [ 17 ••, 18 ]. The combination of enhanced PA and improved nutrition has emerged as the cornerstone of therapy [ 17 ••, 18 , 19 , 20 ].…”