Lifestyle intervention continues to be first-line treatment for pediatric obesity but for young patients who are severely obese, pharmacological intervention may be beneficial, says a new study published in the journal Annals of Pharmacotherapy. The authors did a literature search identifying studies where pharmacological agents were shown to benefit weight loss in young patients. Orlistat is the only FDA-approved drug that can be used in adolescent patients; in clinical trials in patients ages 12–16 years old, the profile of adverse reactions was generally similar to that observed in adults. However, gastrointestinal side effects may limit its use. Three new therapies have been recently approved for adult obesity management: lorcaserin, phentermine/topiramate, and naltrexone SR/bupropion SR. Adverse effects relating to phentermine and naltrexone SR/bupropion SR may preclude their use in adolescent patients. While study results for lorcaserin use in adolescents is still pending, the authors suggest this therapy may be a tolerable option for adolescent patients. Other drugs evaluated in this study included the diabetes drugs metformin and exenatide, both of which demonstrated BMI reductions and mild GI side effects in clinical trials. Patients being treated with topiramate and zonisamide for epilepsy also reported weight loss in clinical trials. The authors conclude that while diabetes and antiepileptic drugs may help with weight loss, the safety of these therapies needs to be further evaluated. For now, lifestyle intervention continues to be the main treatment for obese pediatric patients; orlistat may be considered a second-line therapy when pharmacological intervention is necessary.
To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research.