Progress in pediatric obesity: new and advanced therapies

Abstract

Purpose of reviewIn this review, we discuss new medical and surgical options for the treatment of children and adolescents with obesity. We review the impact of COVID-19 on this vulnerable population. We also discuss the recent availability of screening tests for rare genetic causes of obesity.Recent findingsCOVID-19 increased the prevalence of obesity among children and adolescents. This population is at increased risk for severe disease. The field of pediatric obesity has benefited from the approval of two new antiobesity medications: liraglutide and setmelanotide. We discuss indications for their use. New guidelines for surgical options for the treatment of children and adolescents with obesity are reviewed. These options are increasingly used as part of the comprehensive care for these children.SummaryThe epidemic of childhood obesity continues. COVID-19 and the associated isolation contributed to the problem. However, promising new medical and surgical therapies and screening tests for rare genetic causes of obesity are available. These new diagnostic and therapeutic options bring renewed enthusiasm to the treatment of children and adolescents with obesity and increased recognition that obesity is a chronic disease starting in childhood deserving intervention to prevent consequences.

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

“…A recent systematic review and meta-analysis of 53 studies (8942 participants) found that 75.27 % of children with type 2 diabetes mellitus (T2DM) had obesity, and 77.24 % had obesity at T2DM diagnosis [ 8 ]. Pediatric patients who develop T2DM have at least a 50 % chance the disease will progress despite treatment [ [9] , [10] , [11] ].Assessment is critical for medical conditions that worsen obesity including nonalcoholic fatty liver disease, obstructive sleep apnea, gastroesophageal reflux disease, cholelithiasis, polycystic ovary syndrome (PCOS) and orthopedic conditions (Blount's disease and slipped capital femoral epiphysis) [ 12 , 13 ].…”

Medication-induced weight gain and advanced therapies for the child with overweight and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement 2022

“…Setmelanotide can also be utilized for patients with variants in POMC, PCSK1, LEPR, or BBS genes considered pathogenic, likely pathogenic, or of uncertain significance (compound heterozygous) [ 89 ]. Clinical trials are ongoing for other rare genetic disorders associated with obesity, including POMC epigenetic disorders and other melanocortin 4 receptor (MC4R) pathway heterozygous deficiency-related obesity [ 90 , 91 ].…”

“…A prospective study collecting data from 31 pediatric weight management programs across the US showed that early BMI reduction in the first month of treatment was found to be significantly associated with greater long-term reduction of BMI at 6 and 12 months (defined as a >5% BMI reduction from baseline) in adolescents with obesity [ 145 ]. To meet the goal of improvement of the child's health, at least a 5% reduction in BMI percent of the 95th percentile is recommended [ 90 ]. Published literature finds that this percentage reduction is rarely achieved with lifestyle therapy alone [ 12 , 149 , 150 ].…”

Setmelanotide: a promising advancement for pediatric patients with rare forms of genetic obesity

“…Setmelanotide continues to be studied in ongoing clinical trials for those with other alterations in the MC4R pathway, as well as those with deletions on chromosome 16p11.2. The goal of these trials has been to investigate the efficacy and safety of Setmelanotide for individuals with various heterozygous genetic mutations in the MC4R pathway [ 26 ] ( https://clinicaltrials.gov/ct2/show/NCT04963231 ).…”