Drugs for Childhood Obesity?

Obesity in children is still a rapidly growing public health concern. Nearly one in every five children (aged 6 to 9) is now considered obese with almost 10% of adolescents (aged 10 to 19) falling into the severe obesity category.¹ Childhood obesity is linked to poor health and social outcomes in life in addition to shortening the lifespan due to several obesity-related medical problems, such as type 2 diabetes, non-alcoholic fatty liver disease, and heart disease.¹ 

Childhood obesity dramatically impacts a child’s quality of life and obese children are more vulnerable to social stigmatization. Furthermore, they are more likely to suffer from anxiety and depression, possessing negative consequences that extend into adulthood.¹ Treating obesity early and properly can prevent a decline in health and other negative consequences. As a result, childhood obesity requires active therapy to address its long-lasting effects on children and their families. It is for these reasons that drugs for childhood obesity are being explored as an adjunct therapy or prevention tool. 

Lifestyle modifications

Body mass index (BMI) predicts a person’s risk for weight-related diseases and is used for classifying individuals into risk categories.² To manage BMI and obesity, lifestyle changes have always been the initial treatment choice. Lifestyle changes include 

However, studies have displayed limited evidence that lifestyle changes are sufficient to positively impact BMI and obesity.¹ 

Medical treatment

While perceived as risky and not an ideal solution for children, weight loss surgeries and some adult drugs are used to treat childhood obesity. Currently, only two weight-loss medications are approved by the U.S. Food and Drug Administration (FDA) for use specific to childhood obesity (on-label use).¹  

Often, doctors are required to use medications approved for weight loss for adults but not children; this is called off-label use and is reserved for extreme cases.¹

On-label medications

Orlistat

Orlistat is commonly known as Xenical and acts to limit the absorption of dietary fats. Prior clinical trials have demonstrated that Orlistat has effectively reduced weight and obesity-related diseases in adults.³ As a result, clinical trials were conducted to see if Orlistat can also help overweight children at risk of obesity. Results in children demonstrated that Orlistat was effective in assisting children to lose weight.³ Orlistat is now commonly used as a weight loss medication for children.

Phentermine

Phentermine is commonly sold under the name Lomaira or Adipex-P and is a prescription medication used to regulate mood, attention, and arousal. It functions by inhibiting the reuptake of norepinephrine by nerve cells, ultimately allowing more of these substances to be used by the body. 

This medication is also used to suppress appetite in adults and has recently been proposed alongside lifestyle modifications for children suffering from severe obesity.⁵ Studies revealed that when combined with lifestyle modifications, phentermine enhanced weight loss in adolescents with obesity.⁵

Off-label medications

Topiramate

Topiramate, commonly recognized by its brand name Topamax, is traditionally used to treat epilepsy in adults.⁴ Studies have shown that it has also been used to treat obesity in adults alongside lifestyle modifications. This sparked an interest in scientists to see if the drug could increase weight reduction in children or adolescents. 

Studies revealed that combining topiramate with lifestyle changes may be a promising and safe treatment option for severe obesity in children as there was a reduction of BMI in adolescents with severe obesity. However, clinical trials are needed to evaluate its effectiveness and safety in children.

Metformin

Metformin is the first line of medication for treatment and controlling high blood sugar levels in treating type 2 diabetes.⁶ Studies have shown that metformin can be an effective weight loss treatment for children and adolescents, resulting in a notable decrease in weight over 6 to 12 months.⁶ Further evaluation and clinical studies are needed to ensure the effectiveness and safety of metformin for weight loss in adolescents and children.

A new drug on the block 

Recently, the FDA has approved Mounjaro (tirzepatide) to improve blood sugar control in adults alongside dietary modifications and exercise.⁷ Research during the clinical trials resulted in obese subjects experiencing blood sugar control and weight loss.⁷

When taking the recommended dose, patients treated with Mounjaro lost an average of 15 pounds more than patients who took a placebo.⁷ Mounjaro as a weight loss medication could be a promising development for obese children and adolescents. Further studies are needed to determine the effects of Mounjaro to fully understand the potential benefits and risks in this population.  

The future of treating childhood obesity

The long-lasting consequences of childhood obesity can lead to poor quality of life and increased risk for medical problems which overall emphasizes the importance of early and effective treatment. Lifestyle modifications have always been the first line of treatment, however, this has proven to be insufficient. Additional interventions such as the use of medications have been proven to display promising results in treating childhood obesity. Addressing childhood obesity requires a multidisciplinary approach involving lifestyle changes, medication use and active involvement from families and healthcare practitioners.

References

1. Singhal V, Stella AC, Malhorta S. Pharmacotherapy in pediatric obesity: current evidence and landscape. Curr Opin Endocrinol Diabetes Obes. 2021;28(1):55-63. https://doi.org/10.1097/MED.0000000000000587

2. Khanna D, Peltzer C, Kahar P, Parmar MS. Body mass index (BMI): A screening tool analysis. Cureus (Palo Alto, CA). 2022;14:e22119-e22119. https://doi.org/10.7759/cureus.22119

3. U.S National Library of Medicine. Safety and efficacy of Xenical in children and adolescents with obesity-related diseases. ClinicalTrials.gov. Updated December 18, 2012. Accessed January 20, 2023, from https://clinicaltrials.gov/ct2/show/record/NCT00001723?view=record

4. Fox CK, Marlatt KL, Rudser KD, Kelly AS. Topiramate for weight reduction in adolescents with severe obesity. Clin Pediatr (Phila). 2015;54(1):19-24. doi:10.1177/0009922814542481

5. Ryder JR, Kaizer A, Rudser KD, Gross A, Kelly AS, Fox CK. Effect of phentermine on weight reduction in a pediatric weight management clinic. Int J Obes (Lond). 2017;41(1):90-93. doi:10.1038/ijo.2016.185

6. Pilitsi E, Farr OM, Polyzos SA, et al. Pharmacotherapy of obesity: Available medications and drugs under investigation. Metabolism. 2019;92:170-192. doi:10.1016/j.metabol.2018.10.010

7. U.S. Food & Drug Administration. FDA approves novel, dual-targeted treatment for type 2 diabetes. May 13, 2022. Accessed January 21, 2022. https://www.fda.gov/news-events/press-announcements/fda-approves-novel-dual-targeted-treatment-type-2-diabetes

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