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Pediatrics

Current and future state of pharmacological management of pediatric obesity

International Journal of Obesity (2024)Cite this article

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Abstract

Pediatric obesity is a highly prevalent chronic disease, which has traditionally been treated with lifestyle therapy alone. Yet for many youth, lifestyle intervention as a monotherapy is often insufficient for achieving clinically significant and durable BMI reduction. While metabolic/bariatric surgery achieves robust and long-lasting outcomes, it is neither widely accessible nor wanted by most pediatric patients and families. In the past 3 years, this treatment gap between lifestyle therapy and metabolic/bariatric surgery has been filled with a number of landmark clinical trials examining the safety and efficacy of anti-obesity medication (AOM) for use in children and adolescents. These trials include studies of liraglutide, phentermine/topiramate ER, semaglutide, and setmelanotide, all of which have led to FDA and/or EMA approval. Concurrent with this developing evidence base, in 2023, the American Academy of Pediatrics published their first Clinical Practice Guideline on the assessment and management of childhood obesity. The Guideline includes the recommendation that pediatric health care providers should offer AOM to youth ages ≥12 years with obesity. Recognizing that AOM use in the pediatric population will likely become the standard of care and to provide perspective on the recently generated data regarding new AOM, this narrative review summarizes the published randomized controlled trials (RCTs) from the past 10 years that examine AOM for the pediatric population. This report additionally includes RCTs examining AOM for special populations of pediatric obesity including monogenic obesity, Bardet Biedl syndrome, Prader Willi syndrome, and hypothalamic obesity. Finally, the clinical application of AOM for children and adolescents, as well as future directions and challenges are discussed.

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Authors and Affiliations

  1. University of Minnesota, Department of Pediatrics, Center for Pediatric Obesity Medicine, Minneapolis, MN, USA

    Claudia K. Fox, Aaron S. Kelly & Sarah J. Raatz

  2. Emory University School of Medicine, Department of Pediatrics, Atlanta, USA

    Jessica L. Reilly

  3. University of Minnesota, Health Sciences Library, Minneapolis, MN, USA

    Nicole Theis-Mahon

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Contributions

CKF was responsible for designing the review protocol, screening potentially eligible studies, assimilating results, and writing the manuscript. SJR, JLR, and ASK were responsible for assimilating results, making tables, and writing the manuscript. NTM was responsible for conducting the literature search and writing the manuscript.

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Correspondence to Claudia K. Fox.

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Competing interests

CKF receives research support for serving as a site principal investigator from Novo Nordisk and Eli Lilly. Compensation is paid directly to her institution. ASK engages in unpaid consulting and educational activities for Boehringer Ingelheim, Eli Lilly, Novo Nordisk, and Vivus; receives donated drug/placebo from Novo Nordisk and Vivus for National Institute of Diabetes and Digestive and Kidney Diseases-funded clinical trials. SJR receives research support for serving as a site co-investigator from Novo Nordisk and Eli Lilly. Compensations is paid directly to her institution. The other authors have no competing interests.

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Fox, C.K., Kelly, A.S., Reilly, J.L. et al. Current and future state of pharmacological management of pediatric obesity. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01465-y

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