Systematic Review of the Benefits and Risks of Metformin in Treating Obesity in Children Aged 18 Years and Younger

McDonagh, Marian; Selph, Shelley; Ozpinar, Alp; Foley, Carolyn

doi:10.1001/jamapediatrics.2013.4200

Cited by 139 publications

(122 citation statements)

References 29 publications

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“…It has been known for many years that metformin causes only a modest reduction in body weight in diabetic patients [36], though it appears to be at least as effective as orlistat at reducing waist circumference [37]. Recently, there have been reports of its effect on body weight in non-diabetic patients, including children [38]. Children are unlikely to be a niche market for a novel obesity drug, but metformin has also been studied in patients with mood disorders [39] and schizophrenia [40].…”

Section: Metformin and Anti-psychotic Drug-induced Weight Gainmentioning

confidence: 99%

“…The body weight benefits achieved in some of these studies have been markedly greater than in type 2 diabetic patients. Thus a meta-analysis of fourteen studies in children showed a 1.38% decrease in BMI over 6 months compared to placebo [38], and a meta-analysis of twelve studies in olanzapine-treated patients showed a 5.02 kg difference in body weight gain between those treated with metformin and placebo [41].…”

Section: Metformin and Anti-psychotic Drug-induced Weight Gainmentioning

confidence: 99%

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Horizons in the Pharmacotherapy of Obesity

Arch

2015

Curr Obes Rep

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Abstract:Obesity drugs have had a chequered history. In the recent past, only the low efficacy, pancreatic lipase inhibitor orlistat was available worldwide and it was little used. The 5HT2C agonist lorcaserin, and two combinations of old drugs have been approved in the United States but not in Europe. The diabetes drug liraglutide has been approved in both the US and Europe and seems likely to be most widely accepted. In view of regulators' caution in approving obesity drugs, some (like beloranib) may initially be progressed for niche obesity markets. New drug targets have been identified in brown adipose tissue with the aim of not only activating thermogenesis but also increasing the capacity for thermogenesis in this tissue. Attempts are being made to match the efficacy of bariatric surgery by mimicking multiple gut hormones. Unapproved pharmacotherapies are tempting for some patients. Others remain optimistic about more conventional routes to pharmacotherapy.3

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Section: Metformin and Anti-psychotic Drug-induced Weight Gainmentioning

confidence: 99%

Section: Metformin and Anti-psychotic Drug-induced Weight Gainmentioning

confidence: 99%

Horizons in the Pharmacotherapy of Obesity

Arch

2015

Curr Obes Rep

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“…Pooling the available data together, 120 mg of orlistat three times daily combined with lifestyle intervention may significantly decrease BMI from 0.5 to 4.09 kg/m 2 . The frequent gastrointestinal side effects, occurring in 65 to 100% of the patients under orlistat, may limit therapy adherence and efficacy [7].Metformin stimulates AMP-activated protein kinase, reducing hepatic glucose production, decreasing intestinal glucose absorption and improving the peripheral insulin sensitivity [9,10]. This drug, well-established and FDA-approved for T2DM in children older than 10 years of age, has been used off label in …”

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confidence: 99%

“…Some randomized trials were conducted in order to clarify metformin role in nondiabetic overweight/obese pediatric patients, and the majority of them suggest metformin beneficial in terms of weight loss and insulin resistance improvement; metformin has also been well-tolerated and safe, with no severe side effects or fatal events described so far [9,[11][12][13]. Thus, metformin is seen as a promising agent to treat obese pediatric patients with impaired glucose tolerance, although its use remains controversial due to the lack of data, especially at long term basis as there are no trials conducted for more than 12 months [11,12].…”

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Management of Pediatric Obesity

Marques¹

2015

JDMDC

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pediatric obesity [9]. Some randomized trials were conducted in order to clarify metformin role in nondiabetic overweight/obese pediatric patients, and the majority of them suggest metformin beneficial in terms of weight loss and insulin resistance improvement; metformin has also been well-tolerated and safe, with no severe side effects or fatal events described so far [9,[11][12][13]. Thus, metformin is seen as a promising agent to treat obese pediatric patients with impaired glucose tolerance, although its use remains controversial due to the lack of data, especially at long term basis as there are no trials conducted for more than 12 months [11,12].The increasing incidence of obesity in the pediatric setting, has led to additional investigation on alternative pharmacological therapies to manage this condition. In the past, sibutramine was approved from FDA to treat pediatric obesity due to its capacity to promote satiety and stimulate the energy expenditure [14]. It was regarded as an effective drug and extensively used, demonstrating significant decreases of BMI up to 4 kg/m 2 and improvement of metabolic risk factors when compared to placebo groups [15]. However, issues regarding cardiovascular safety led to sibutramine's withdraw in 2010 [16]. Other experimental drugs have been studied in childhood obesity, such as octreotide, topiramate, growth hormone, leptin but conclusive data or significant trials are not available, therefore those cannot be recommended [5].Ultimately, selected cases of severe pediatric obesity may be considered for bariatric surgery. This approach, highly effective to treat adult obesity, has several potential complications in the pediatric setting. Bariatric surgery may be considered only if the children has BMI>50 kg/m 2 or BMI>40kg/m 2 with comorbidities, if lifestyle modification with or without pharmacological intervention fails and if a pubertal Tanner 4/5 status and final/ near-final adult height was already achieved [5,17].Summarizing, the increasing incidence of pediatric obesity and its cardiometabolic impact, the disappointing effectiveness of lifestyle intervention and the lack of pharmacological EditorialThe prevalence of childhood and adolescent obesity is increasing worldwide and constitutes a major public health concern [1]. Pediatric obesity is defined as body mass index (BMI) equal to or greater than 95 th percentiles adjusted for age and sex; the children or adolescents are considered overweight for BMIs between 85 th to 95 th percentiles [2]. Weight excess in childhood has increased the prevalence of some conditions practically only found in adulthood some years ago, such as impaired glucose tolerance and type 2 diabetes mellitus (T2DM), dyslipidemia, hypertension and liver steatosis [3]. The early development of these conditions is associated with cardiometabolic mordibity and premature death [4]. Intervention may prevent those complications or avoid further deterioration of cardiovascular and metabolic status.The mainstay approach of pediatric obesity is lifest...

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