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Pharmacotherapy in pediatric obesity: current agents and future directions
1Division of Pediatric Endocrinology, UH Rainbow Babies & Children's Hospital, Case Western Reserve University, 11100 Euclid Avenue, RB&C Suite 737, Cleveland, OH 44106, USA.
Insights
Childhood obesity is a growing public health concern. Family-based lifestyle changes are primary treatments, with medications like orlistat, sibutramine, and metformin considered for specific cases when lifestyle changes fail.
Area of Science:
- Pediatric Endocrinology
- Public Health
- Pharmacology
Background:
- Childhood obesity presents a significant public health challenge with severe individual and societal consequences.
- Current primary treatment involves family-based lifestyle interventions, including behavioral modification, diet, and exercise.
Purpose of the Study:
- To review the role of pharmacologic interventions in managing pediatric obesity.
- To discuss current FDA-approved medications and those considered for specific conditions like insulin resistance.
- To highlight gaps in evidence regarding treatment duration and combination therapy with lifestyle interventions.
Main Methods:
- Review of current literature on pharmacologic treatments for pediatric obesity.
- Analysis of FDA-approved medications and off-label considerations.
- Discussion of challenges including insurance coverage, cost, and adverse effects.
Main Results:
- Orlistat and sibutramine are FDA-approved; metformin is considered for insulin resistance.
- Evidence is limited on optimal duration and combination of medical therapy with lifestyle interventions.
- Adverse effects and cost can limit medication adherence and effectiveness.
Conclusions:
- Pharmacologic treatment is a potential adjunct for pediatric obesity in select cases, particularly when lifestyle interventions are insufficient.
- Careful monitoring for adverse effects and consideration of cost are crucial.
- Novel pharmacologic agents hold promise for improved efficacy and safety in managing childhood obesity.
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.
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