Pharmacological Approaches for Management of Child and Adolescent Obesity

Abstract

Overweight and obesity among children and adolescents continue to be a global public health epidemic. Current national data on childhood and adolescent obesity show alarming statistics of overweight and obese children and adolescents. This epidemic runs across various continents and affects various ethnic populations. The current weight management practices involve dietary modification, behavioral change therapies involving exercise, pharmacological therapy and surgical intervention. The purpose of this current review is to focus on pharmacological therapy i.e. role of sibutramine and orlistat in childhood and adolescent weight management. An open search of PUBMED database was made with search 'key words' such as 'orlistat' or 'sibutramine' or "pharmacological approaches" and "child obesity" and "adolescent obesity". This yielded a total of 20 articles. All of these articles have been summarized in the current review. Sibutramine functions by promoting satiety and increases energy expenditure by inhibiting reuptake of noradrenaline and serotonin. Most of the studies, reviews and trials conducted using sibutramine among adolescents and children show limited short-term efficacy. The long-term effects of sibutramine use are not yet studied due to the severity of its side-effects profile. Orlistat was approved by Food and Drug Administration for adolescent weight reduction. Despite its approval, it has a limited role in adolescent and pediatric obesity reduction due to the purported malabsorption of fat soluble vitamins and its side-effect profile. Obesity and adolescent weight management in present times mainly deals with dietary modification with superadded behavioral therapies promoting exercise. There is insufficient evidence as of now if these alone would cause adequate weight reduction and weight maintenance. Pharmacotherapy i.e use of drugs like sibutramine and orlistat has a limited role in the current fight against childhood and adolescent obesity. Extreme side-effects, close monitoring and lack of long-term studies involving these drugs, suggest questionable efficacy in current times. Future research studies involving pharmacological agents need to not only have immense scientific rigor during preliminary analyses but should also translate their efficacy in practical and clinical settings.KeywordsObesity; Overweight; Adolescents; Pharmacological; sibutramine; Orlistat

Adolescent Bariatric Surgery

“…37 In addition, to our knowledge, no study has shown this weight loss to be sustained after stopping the medication. 38,39 Combined behavior, diet, and pharmacotherapy programs in adolescents have demonstrated minimal longitudinal efficacy as well; in 3 recent trials, [40][41][42] BMI decreased by an average of 1.82, and only 71% of patients completed therapy after 1 year.…”

Extemporaneous Formulations of Metformin for Pediatric Endocrinology: Physicochemical Integrity, Cytotoxicity of Sweeteners, and Quantitation of Plasma Levels

“…2,3 For this reason, pharmacologic support using metformin has been implemented in addition to dietary hygiene measures, which are not sufficient to re-establish normoglycemic metabolic markers in a number of cases. [3][4][5] Metformin is an antihyperglycemic drug that maintains decreased blood glucose levels and sensitizes peripheral tissues to insulin's action without causing hypoglycemia. [4][5][6] Excepting the United States and Canada, there is no commercial presentation with customized doses that can be easily administered to children and adolescents.…”

Bariatric surgery in adolescents: What's the rationale? What's rational?

“…Weight loss with the use of medications is limited (typically Ͻ 3 kg more than control subjects) and maintaining the weight loss and long-term effects of pharmacotherapy for obesity in adolescents is largely unknown (Kanekar & Sharma, 2010;Rogovik et al, 2010). Insurance often does not pay for weight loss medication, and cost often prohibits its use.…”

“…Moreover, since the removal of sibutramine (Meridia) from the market in 2010 due to its association with heart disease, the only currently available, long-term pharmacotherapy agent for obesity in adolescents is orlistat (Kanekar & Sharma, 2010;Sarwer & Dilks, 2011). Orlistat (Xenical) is a lipase inhibitor and functions to reduce fat malabsorption by blocking about 30% of dietary fat with the typical 120-mg dose three times a day for adolescents (Greydanus et al, 2011;Rogovik et al, 2010).…”