Pediatric Obesity: Influence on Drug Dosing and Therapeutics

Abstract

Obesity is an ongoing global health concern and has only recently been recognized as a chronic disease of energy homeostasis and fuel partitioning. Obesity afflicts 17% of U.S. children and adolescents. Severe obesity (≥120% of the 95th percentile of body mass index (BMI) for age, or a BMI ≥ 35 kg/m2) is the fastest‐growing subgroup and now approaches 6% of all U.S. youth. Health consequences (eg, type 2 diabetes, coronary heart disease) are related in a dose‐dependent manner to severity of obesity. Because therapeutic interventions are less effective in severe obesity, prevention is a high priority. Treatment plans involving combinations of behavioral therapy, nutrition, and exercise achieve limited success. Only one drug, orlistat, is U.S. Food and Drug Administration approved for long‐term obesity management in adolescents 12 years and older. As part of comprehensive medication management, clinicians should consider the propensity for a given drug to aggravate weight gain and to consider alternatives that minimize weight impact. Medication management must take into account developmental changes as well as the pathophysiology of obesity and comorbidities. Despite expanding insight into obesity pathophysiology, there are gaps in its translation to therapeutic application. The historical construct of obesity as simply a fat‐storage disorder is fundamentally inaccurate. The approach to adjusting doses based solely on body size and extrapolating from therapeutic knowledge of adult obesity may be based on assumptions that are not fully substantiated. Classes of drugs commonly prescribed for comorbidities associated with obesity should be prioritized for clinical research evaluations aimed at optimizing dosing regimens in pediatric obesity.

Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US

“…Despite significant effort to determine reasons for medication discontinuation as part of the manual chart review, it is notable that this reason was unspecified for approximately one-third of patients. Lastly, this study did not account for confounders such as the simultaneous use of other medications associated with weight gain (18), which could be of particular importance given the high rates of anxiety (62.3%) and depression (55.7%) noted.…”

“…The current use of pharmacotherapy for the treatment of obesity in the pediatric population is limited (18). Compared to prescribing patterns for the treatment of other pediatric chronic diseases such as type 2 diabetes mellitus (T2DM), anti-obesity medications (AOMs) are disproportionately underutilized in relation to the disease burden (19), likely due to the lack of current guidelines addressing their use.…”

Dosing Common Medications in Hospitalized Pediatric Patients with Obesity: A Review

“…It is not established, however, that obesity and its natural history are similar in adult and pediatric populations. Like T2D across the age spectrum, there may be distinctions between juvenile‐onset and adult‐onset obesity (80,81). In addition, the underlying disease being treated may differ between age groups, as is the case for thrombotic disease and obesity‐associated asthma in adolescents compared with adults (49,61).…”

Creating a Pharmacotherapy Collaborative Practice Network to Manage Medications for Children and Youth: A Population Health Perspective

“…For example, obesity now affects almost 20% of U.S. children and adolescents. Morbid obesity now affects 6% of all U.S. youth [101]. CMM in this rapidly-rising sub-population should consider for potential for drug-induced weight gain where pharmacists are embedded in the inter-professional ambulatory or community healthcare delivery for pediatric patients.…”