Pharmacological Management of Obesity in Pediatric Patients

Boland, Cassie; Harris, John Brock; Harris, Kira B.

doi:10.1177/1060028014557859

Cited by 44 publications

(51 citation statements)

References 63 publications

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“…The weight‐lowering drugs approved for use in the United States work by reducing appetite through enhanced neurotransmission in the central nervous system (i.e., the 5HT2C agonist lorcaserin, phentermine/topiramate extended release, and naltrexone/bupropion) or by decreasing intestinal fat absorption (orlistat) and should be used only as an adjunct to lifestyle interventions . Orlistat is also approved for pediatric patients . Compliance is reduced by gastrointestinal adverse effects and increased risk of nephrolithiasis and liver failure for orlistat; headache, dizziness, and increased risk of serotonin syndrome for lorcaserin; and insomnia, irritability, anxiety, and disturbance of attention for phentermine/topiramate; and nausea, constipation, xerostomia, amnesia, seizures, and hepatotoxicity for naltrexone/bupropion .…”

Section: Resultsmentioning

confidence: 99%

Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management

Manu

Dima

Shulman

et al. 2015

Acta Psychiatr Scand

236

125

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Section: Resultsmentioning

confidence: 99%

Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management

Manu

Dima

Shulman

et al. 2015

Acta Psychiatr Scand

236

125

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“…Metformin is the first-line oral therapy for Type 2 Diabetes (T2D) [1], and is also approved for use or used off-label in a variety of other diseases, such as polycystic ovary syndrome [2], gestational diabetes [3], pediatric obesity [4] and cancer [5,6]. Side effects of metformin are mainly gastrointestinal in 20% to 30% of patients, and in very rare cases include lactic acidosis [7].…”

Section: Introductionmentioning

confidence: 99%

Genomic Characterization of Metformin Hepatic Response

et al. 2016

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Metformin is used as a first-line therapy for type 2 diabetes (T2D) and prescribed for numerous other diseases. However, its mechanism of action in the liver has yet to be characterized in a systematic manner. To comprehensively identify genes and regulatory elements associated with metformin treatment, we carried out RNA-seq and ChIP-seq (H3K27ac, H3K27me3) on primary human hepatocytes from the same donor treated with vehicle control, metformin or metformin and compound C, an AMP-activated protein kinase (AMPK) inhibitor (allowing to identify AMPK-independent pathways). We identified thousands of metformin responsive AMPK-dependent and AMPK-independent differentially expressed genes and regulatory elements. We functionally validated several elements for metformin-induced promoter and enhancer activity. These include an enhancer in an ataxia telangiectasia mutated (ATM) intron that has SNPs in linkage disequilibrium with a metformin treatment response GWAS lead SNP (rs11212617) that showed increased enhancer activity for the associated haplotype. Expression quantitative trait locus (eQTL) liver analysis and CRISPR activation suggest that this enhancer could be regulating ATM, which has a known role in AMPK activation, and potentially also EXPH5 and DDX10, its neighboring genes. Using ChIP-seq and siRNA knockdown, we further show that activating transcription factor 3 (ATF3), our top metformin upregulated AMPK-dependent gene, could have an important role in gluconeogenesis repression. Our findings provide a genome-wide representation of metformin hepatic response, highlight important sequences that could be associated with interindividual variability in glycemic response to metformin and identify novel T2D treatment candidates.

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“…Compared to children with overweight or obesity, lifestyle approaches and standard behavioral interventions have been shown to be less effective; more intensive treatments are recommended to improve both obesity (e.g., BMI percentile) and health metrics (e.g., blood glucose) (Danielsson, Kowalski, Ekblom, & Marcus, 2012; Johnston et al, 2011). Traditionally, interventions for severe obesity have included intensive family-based treatment (sometimes as an inpatient) (Luca et al, 2015; Taylor, Peterson, Garland, & Hastings, 2016; van der Baan-Slootweg, Benninga, Beelen, et al, 2014), bariatric surgery (Nobili et al, 2015; Schmitt et al, 2016; Thakkar & Michalsky, 2015), medication (Boland, Harris, & Harris, 2015), and/or long-term treatment using a chronic care model (Rijks et al, 2015). Therefore, school-based interventions for children with severe obesity must be coupled with more intensive treatment to lead to clinically meaningful decreases in body measures.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a School Nurse-led Intervention for Children With Severe Obesity in New York City Schools

Schroeder

Jia

Wang

et al. 2017

Journal of Pediatric Nursing

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Purpose The Healthy Options and Physical Activity Program (HOP) is a school nurse-led intervention for children with severe obesity. HOP was developed by experts at the New York City Department of Health and Mental Hygiene and implemented in New York City schools beginning in 2012. The purpose of this study was to evaluate HOP implementation with the goal of informing HOP refinement and potential future HOP dissemination. Design and Methods This study entailed a retrospective analysis of secondary data. Analytic methods included descriptive statistics, Wilcoxon rank sum and Chi square tests, and multivariate logistic regression. Results During the 2012–2013 school year, 20,518 children were eligible for HOP. Of these, 1054 (5.1%) were enrolled in the program. On average, enrolled children attended one HOP session during the school year. Parent participation was low (3.2% of HOP sessions). Low nurse workload, low school poverty, higher grade level, higher BMI percentile, and chronic illness diagnosis were associated with student enrollment in HOP. Conclusions As currently delivered, HOP is not likely to be efficacious. Lessons learned from this evaluation are applicable to future nurse-led obesity interventions. Practice Implications Prior to implementing a school nurse-led obesity intervention, nursing workload and available support must be carefully considered. Interventions should be designed to facilitate (and possibly require) parent involvement. Nurses who deliver obesity interventions may require additional training in obesity treatment. With attention to these lessons learned, evidence-based school nurse-led obesity interventions can be developed.

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Pharmacological Management of Obesity in Pediatric Patients

Cited by 44 publications

References 63 publications

Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management

Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management

Genomic Characterization of Metformin Hepatic Response

Implementation of a School Nurse-led Intervention for Children With Severe Obesity in New York City Schools

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