Pharmacotherapy in pediatric obesity: Current agents and future directions

Abstract

Childhood obesity is emerging as a major public health threat, with adverse implications on the health of individuals and long-term costs to society. Family-based lifestyle interventions with behavioral modification, diet and exercise form the mainstay of treatment. Pharmacologic treatment may be considered in selected subjects, especially in the presence of significant and severe comorbidities, when lifestyle intervention has failed to achieve weight reduction. Orlistat and sibutramine are FDA-approved for treatment of pediatric obesity; metformin may be considered in the presence of clinically significant insulin resistance. Evidence is lacking on the appropriate duration of medical therapy and optimal combination with lifestyle intervention. Lack of coverage of medications by insurance and high out-of-pocket costs may be limiting factors to some families. Adverse effects necessitate careful monitoring and may lead to discontinuation of medication. Pharmacologic agents with novel mechanisms of action offer hope of improved efficacy, tolerability and safety.

Pharmacotherapy for childhood obesity: present and future prospects

“…Sibutramine was never approved for use in children younger than 16y, 75, 76 but it is one of the best studied weight loss medication in adolescents. Ten reports 38, 77–85 from 8 RCTs 38, 77, 79, 80, 82–85 and 2 open-label studies 78, 81 investigated the efficacy of sibutramine for weight loss in obese adolescents.…”

“…Sibutramine was contraindicated in those individuals with pre-existing psychiatric disorders. 75 Other contraindications included concurrent use of monoamine oxidase inhibitors or selective serotonin reuptake inhibitors 91 .…”

“…227–230 Treatment with recombinant human growth hormone (rHGH) is FDA-approved for children with PWS to increase height velocity. 75 A decrease in fat mass and an increase in lean body mass are observed among both adult and pediatric patients with PWS who are given growth hormone. 231–233 There is, however, no indication to use rHGH for non-syndromic obesity in the absence of growth hormone deficiency.…”

Managing obesity – from childhood and onwards

“…In the pediatric population, weight loss or weight stabilization through family‐based lifestyle intervention should be the goal. Pharmacotherapy could be considered an adjunct therapy to diet, exercise and behavioral modification, especially when lifestyle changes have failed and health risks are present (11,17). However, particular care must be taken, since we lack long‐term data on efficacy and safety of pharmacotherapy in adolescents and children (17,18).…”

Improving metabolic parameters of antipsychotic child treatment (IMPACT) study: rationale, design, and methods

“…Metformin decreases hepatic gluconeogenesis and improves insulin sensitivity in the liver and muscle [41]. Metformin is FDA approved for the treatment of type 2 diabetes in youth ≥10 years old [42]. The potential side effect of hypoglycemia secondary to metformin is rare because metformin does not stimulate insulin production, and there have been no published pediatric cases of lactic acidosis or increase in serum lactic acid associated with therapeutic doses [43].…”