A growing number of youth suffer from obesity and in particular severe obesity for which intensive lifestyle intervention does not adequately reduce excess adiposity. A treatment gap exists wherein effective treatment options for an adolescent with severe obesity include intensive lifestyle modification or metabolic and bariatric surgery while the application of obesity pharmacotherapy remains largely underutilized. These youth often present with numerous obesity-related comorbid diseases, including hypertension, dyslipidemia, prediabetes/type 2 diabetes, obstructive sleep apnea, nonalcoholic fatty liver disease, musculoskeletal problems, and psychosocial issues such as depression, anxiety, and social stigmatization. Current pediatric obesity treatment algorithms for pediatric primary care providers focus primarily on intensive lifestyle intervention with escalation of treatment intensity through four stages of intervention. Although a recent surge in the number of Food and Drug Administration-approved medications for obesity treatment has emerged in adults, pharmacotherapy options for youth remain limited. Recognizing treatment and knowledge gaps related to pharmacological agents and the urgent need for more effective treatment strategies in this population, discussed here are the efficacy, safety, and clinical application of obesity pharmacotherapy in youth with obesity based on current literature. Legal ramifications, informed consent regulations, and appropriate off-label use of these medications in pediatrics are included, focusing on prescribing practices and prescriber limits.
Bibliographical noteFunding Information:
Funding agencies: This work was funded with NIH core support from P30DK046200 and P30DK040561. Disclosure: GS has served as a consultant for Johnson and Johnson. CKF receives research support from Novo Nordisk. ASK receives research support (drug/placebo) from Astra Zeneca Pharmaceuticals and serves as a consultant for Novo Nordisk, Orexigen, and Vivus Pharmaceuticals but does not accept personal or professional income for these activities. AMJ has served as a consultant for Novo Nordisk and Medtronic. SC serves as a consultant for Novo Nordisk and Rhythm Pharmaceuticals and has received grant funding from PCORI. CML receives support from New Balance Foundation. CMA reports grants from Aspire Bariatrics, Myos, the Vela Foundation, the Dr. Robert C. and Veronica Atkins Foundation, Coherence Lab, Energesis, and PCORI; grants and personal fees from Orexigen, GI Dynamics, and Takeda; personal fees from Nutrisystem, Zafgen, Sanofi-Aventis, Novo Nordisk, Scientific Intake, Xeno Biosciences, Rhythm Pharmaceuticals, Eisai, EnteroMedics, and Bariatrix Nutrition; and other support from Science-Smart LLC, outside the submitted work. AFB, NTB, JSAP, CB, and MPM, declared no conflict of interest. Author contributions: All authors contributed to the manuscript content. GS conceptualized, wrote the first draft of, and edited the manuscript. All authors reviewed and edited the manuscript for critical content and manuscript preparation. Additional Supporting Information may be found in the online version of this article. Received: 12 April 2018; Accepted: 7 November 2018; Published online 24 January 2019. doi:10.1002/oby.22385