Efficacy of weight loss drugs on obesity and cardiovascular risk factors in obese adolescents: a meta‐analysis of randomized controlled trials

Abstract

Weight loss drugs have been developed to reduce the comorbidities associated with excess weight. We conducted a meta-analysis of the efficacy of orlistat and sibutramine on weight, body mass index, waist circumference and cardiovascular risk factors in overweight adolescents. MEDLINE and the Cochrane Library were searched for relevant articles using MESH terms and keywords. Studies were included if they had reported quantitative estimates and standard deviations of the association between each weight loss drug and weight, with information on at least one cardiovascular risk factor. A total of eight trials (three orlistat and five sibutramine) with information on 1391 individuals was included in the present analysis. The mean decrease in weight between the intervention and control groups was 5.25 kg (95% confidence interval: 3.03-7.48) after a minimum follow-up of 6 months. There was evidence of statistical heterogeneity between the studies (I(2) = 76%) that was no longer apparent after exclusion of trials of orlistat (mean weight decrease = 5.32 kg; I(2) = 38%). There was little evidence that treatment was associated with adverse effects on cardiovascular risk factors but this requires verification from future large trials with longer study follow-up.

Metabolic syndrome in children and adolescents

“…Pharmacological therapy for obesity are becoming increasingly common, particularly among those who do not respond to behavioral therapy alone (60). The US Food and Drug Administration (FDA) has approved pharmacotherapy for children or adolescents with obesity, which is to be considered after a formal program of intensive lifestyle modification has failed to help with weight reduction or for management of comorbidities.…”

“…Discontinuation of the medications and reevaluation should be considered in those who are unable to achieve >4% BMI/ BMI Z-score reduction following 12 weeks of treatment with the use of medication's full dosage (47). Overall, there is limited evidence in adolescents regarding the safety and efficacy of pharmacological agents specifically in the long term (60). Orlistat (a gastrointestinal lipase inhibitor) is the only obesity medication approved for the use in adolescents over 12 years of age (47,62).…”

Cardiovascular Risk-Benefit Profile of Sibutramine

“…[60] A total of eight trials (three orlistat and five sibutramine) with information on 1391 individuals was included in another meta-analysis. [61] The mean decrease in weight between the sibutramine and control groups was 5.32 kg and there was little evidence that sibutramine treatment was associated with adverse effects on CVD risk factors. However, this requires verification from large trials with longer follow-up such as SCOUT (see below).…”

National Trends in Beverage Consumption in Children from Birth to 5 Years: Analysis of NHANES Across Three Decades

“…A recent meta-analysis of available data in children points out that the drug leads to 5 kg weight loss and 5 cm reduction in weight circumference after at least 6 months of therapy compared with placebo, but no improvement in the lipid profile nor insulin level was observed [210]. An open-label 3-month trial in adults consisting of a calorierestricted diet and 120 mg of orlistat could not demonstrate a significant improvement in FMD [211].…”