Treatment Options for Severe Obesity in the Pediatric Population: Current Limitations and Future Opportunities

Ryder, Justin R.; Fox, Claudia K.; Kelly, Aaron S.

doi:10.1002/oby.22196

Cited by 64 publications

(40 citation statements)

References 101 publications

(119 reference statements)

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“…Severe obesity is present in 5% of children ages 2 to 19 years and is very common among children seeking care for obesity . Tertiary interventions, such as bariatric surgery and some weight control medications, are approved for adolescents but not pre‐adolescents with severe obesity despite similar prevalence rates . Behavior‐based, nonresidential interventions that report specifically on outcomes of children with severe obesity are limited.…”

Section: Discussionmentioning

confidence: 99%

Who benefits from the intervention? Correlates of successful BMI reduction in the Texas Childhood Obesity Demonstration Project (TX‐CORD)

et al. 2020

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Background Many childhood obesity intervention studies report mean outcomes but do not explore the variation in responses and the characteristics of those who respond well. Objective To identify child and family characteristics associated with improvement in the primary outcome, %BMIp95, of the Texas Childhood Obesity Research Demonstration project (TX‐CORD). Methods The 12‐month TX‐CORD secondary prevention study randomized 549 children, ages 2 to 12 years, with BMI ≥85th percentile to the intensive intervention vs. the comparison program, with measurements at baseline, 3‐, and 12‐months. A growth mixture model was used to identify mutually exclusive latent %BMIp95 trajectories. Latent class regression tested associations between baseline characteristics and latent class membership. Results A 2‐class solution emerged after accounting for the effect of intervention randomization. Latent Class 1 participants (86% of sample) were characterized by mild‐to‐moderate obesity and demonstrated a significantly greater response to the intensive intervention between 0 and 3 months (slope‐on‐group = −0.931, p = 0.03). A rebound between 3 and 12 months was not significantly different between arms. Latent Class 2 participants (14%), who had severe obesity, demonstrated no difference in response between intervention groups. Characteristics associated with Class 1 membership included younger age (2–5 years vs. 6–12 years: OR 3.70, p = .035) and lower maternal BMI category (< 35 kg/m2 vs. ≥ 35 kg/m2: OR 7.14, p < .0001). Conclusions The optimal target population for the intensive intervention are children who have milder obesity, are younger, and do not have a mother with severe obesity. Children with severe obesity may require different approaches.

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Section: Discussionmentioning

confidence: 99%

Who benefits from the intervention? Correlates of successful BMI reduction in the Texas Childhood Obesity Demonstration Project (TX‐CORD)

et al. 2020

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“…A total of 36 studies were found that met the search criteria. The majority of studies were reviews ( n = 16, Table ), 8 were observational, 7 were case‐control studies, 3 were quasi‐experimental/case‐control studies, and 2 were RCTs (1 was a methods paper only) (Table ). No studies that tested the combination of pharmacotherapy interventions with MBS were found.…”

Section: Resultsmentioning

confidence: 99%

“…Other reviews included the importance of the preoperative assessment tools and postoperative multidisciplinary teams (e.g., dietitian, social worker, psychologist) , clinical dietary recommendations , and cosmetic (e.g., skin) considerations, but none did so in a theoretical framework or by citing evidence‐based findings from previously successful secondary prevention lifestyle interventions. The three review papers that included pharmacotherapy support interventions highlighted the need for more research focused on combination therapies (MBS, pharmacotherapy, lifestyle) to support precision medicine treatment approaches among adolescents with severe obesity.…”

Section: Resultsmentioning

confidence: 99%

“…Again, although attention was called to the importance of social support (friends or peers, family), psychological health, etc., for supporting long‐term weight loss in MBS patients , none of the articles cited a theoretical framework or foundation. Moreover, a few of the studies addressed healthy lifestyle changes or components (e.g., total daily calories, percent of total diet from fat, increasing exercise) in either the preoperative or the postoperative stage rather than considering healthy lifestyle as integral to the surgical treatment.…”

Section: Resultsmentioning

confidence: 99%

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Partnering Support Interventions with Bariatric Surgery to Maximize Health Outcomes in Adolescents with Severe Obesity

Messiah

Sacher

Yudkin

et al. 2019

Obesity

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Objective Rates of adolescents with severe obesity continue to rise worldwide, with concurrent increases in metabolic and bariatric surgery (MBS) uptake. The gap between support (lifestyle, pharmacotherapy) interventions and MBS as treatment options for adolescents has been understudied. This review, couched in a socio‐ecological framework, investigates how support interventions for adolescents with severe obesity could be combined or sequenced with MBS to optimize health outcomes. Methods A comprehensive search revealed 36 published articles between 1995 and 2019 that included the combination of support interventions and MBS among adolescents. Results There were no studies that specifically reported outcomes or effect sizes for the combination of lifestyle intervention with MBS. Previous studies have reported individual results for either lifestyle intervention or MBS but not for their compound effect. Conclusions As rates of adolescents with severe obesity are on the rise globally, future research should focus on how partnering support interventions with MBS can amplify positive short‐ and long‐term health outcomes and within a socio‐ecological framework. Understanding the sequence of these approaches will be of particular importance. High‐risk and vulnerable populations such as ethnic minorities who have suffered a disproportionate burden of the obesity epidemic must be included in rigorously tested future trials of combination interventions to maximize health outcomes worldwide.

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“…Study designs for lifestyle treatments vary greatly, but regardless of the setting or methodology, they only show a modest effect on long-term weight loss. [3][4][5][6] In addition, it is well documented that children with overweight and obesity have more comorbidities, such as dyslipidaemia, high blood pressure, abnormalities in left ventricular mass or function, abnormalities in endothelial function, hyperinsulinaemia, and insulin resistance compared to children with normal weight. 7 They also present with poorer psychological health and are at increased risk of becoming adults with overweight or obesity when compared to their normal-weight counterparts.…”

Section: Introductionmentioning

confidence: 99%

A randomized, double‐blind, placebo‐controlled, pharmacokinetic and pharmacodynamic study of a fixed‐dose combination of phentermine/topiramate in adolescents with obesity

Hsia

Gosselin

Williams

et al. 2019

Diabetes Obesity Metabolism

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Aims To assess the pharmacokinetic (PK) and pharmacodynamic characteristics of VI‐0521, a fixed‐dose combination of immediate‐release phentermine (PHEN) and extended‐release topiramate (TPM) in adolescents aged 12 to 17 years with obesity, and to report weight loss and adverse events using this drug combination. Materials and methods This was a multicentre, randomized, double‐blind, parallel‐design, placebo‐controlled study in adolescents with obesity. A total of 42 adolescents were randomly assigned in a 1:1:1 ratio to placebo, or to a mid‐dose (PHEN/TPM 7.5 mg/46 mg), or a top‐dose (PHEN/TPM 15 mg/92 mg) of VI‐0521. A total of 26 adolescents were included in the PK analysis (14 from the mid‐dose group and 12 from the top‐dose group). Results On day 56, arithmetic means of terminal elimination half‐life, apparent clearance (CL/F) and apparent central volume of distribution (Vc/F) were consistent across dose levels for both PHEN and TPM. Arithmetic means of CL/F and Vc/F for PHEN and TPM administered as a combination in adolescents with obesity were within 10% to 30% of those previously assessed in adults with obesity enrolled in phase II and III studies. A higher proportion of adolescents in both the mid‐ and top‐dose groups (13.3% and 50.0%, respectively) compared with placebo (0.0%) reached ≥5% weight loss at day 56. The least squares (LS) mean change in systolic blood pressure from baseline to day 56 was −5.2 mmHg for the placebo group, −2.5 mmHg for the mid‐dose group, and − 5.5 mmHg for the top‐dose group. The LS mean change in diastolic blood pressure from baseline to day 56 was −2.4 mmHg for the placebo group, +3.8 mmHg for the mid‐dose group, and + 2.0 mmHg for the top‐dose group. Participants in the top‐dose group had increases in heart rate from baseline of 4.1 bpm, while participants in the mid‐dose group experienced a mean decrease in heart rate of 4.5 bpm at day 56. Both PHEN/TPM dose combinations were safe and well tolerated. Conclusions Treatment of adolescents with obesity using a fixed‐dose combination of PHEN/TPM for 8 weeks resulted in exposure to PHEN and TPM that was comparable to that observed in adults, statistically significant weight loss, and a tolerable safety profile. These data indicate that both mid‐ and top‐dose levels are appropriate for longer‐term safety and efficacy studies in adolescents.

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Treatment Options for Severe Obesity in the Pediatric Population: Current Limitations and Future Opportunities

Abstract: Treating pediatric severe obesity effectively and safely is extremely challenging. Some progress has been made, but substantially more effort and innovation are needed in the future to combat this serious and ongoing medical and public health issue.

Cited by 64 publications

References 101 publications

Who benefits from the intervention? Correlates of successful BMI reduction in the Texas Childhood Obesity Demonstration Project (TX‐CORD)

Who benefits from the intervention? Correlates of successful BMI reduction in the Texas Childhood Obesity Demonstration Project (TX‐CORD)

Partnering Support Interventions with Bariatric Surgery to Maximize Health Outcomes in Adolescents with Severe Obesity

A randomized, double‐blind, placebo‐controlled, pharmacokinetic and pharmacodynamic study of a fixed‐dose combination of phentermine/topiramate in adolescents with obesity

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