Pharmacotherapy for the Treatment of Obesity in Children and Adolescents

I'm Dr. Tryggvi Helgason, a pediatrician and childhood obesity expert working in Iceland. In this 5-Minute CPD, I will review some practical and clinical aspects of pharmacotherapy for the treatment of obesity in children and adolescents.

In the last few years, there have been substantial changes in the perception of obesity and how we treat it. We have seen the blame shift away from the individual with obesity to society. A deepening understanding of the underlying biology has enforced that change. We now have new medications affecting our satiety and hunger system, a system we didn't even realize existed 10 to 20 years ago.

But how are these medications best used in the treatment of children and adolescents? That's today's topic. Most of the data we have on the new GLP-1 analogs for obesity are from studies involving adults. And while we don't have a large body of evidence or longstanding experience with medications to target the body's satiety system, they certainly provide a new hope for some people living with obesity.

At this moment, the European Medicines Agency approves two medications for obesity treatment in adolescents. Both of them are in the GLP-1 analog category: liraglutide and semaglutide. These medicines are closely related and work in the same way in most aspects. Both are indicated for adolescents with confirmed obesity.

Their main difference is that liraglutide, or Saxenda, is injected daily, whereas semaglutide or Ozempic/Wegovy is injected one time per week. The most common side effects are from the gut and include digestion, nausea, vomiting, stomach pain, constipation or diarrhea. There are some concerns about long-term adverse effects, but none have been shown to be relevant in adolescents yet.

Both medications have been shown in industry supported randomized clinical trials to result in a clinically meaningful reduction in weight when combined with health behavioral change support and treatment. With liraglutide, 43% of adolescents lost more than 5% of their body weight, while with semaglutide, 73% of participants, or three out of four adolescents, experienced more than 5% weight loss.

No studies have been published on the effect of these medications without health behavioral change treatment, and similarly, no studies have been published on these medications and their effect in children. with neurodevelopmental disorders alongside their obesity.
Several other medications impact appetite.

Metformin is maybe the one most widely used and best known in adolescents with obesity, particularly for managing glucose metabolism. Orlistat is still used in some parts of Europe where the GLP-1 analogues are not available yet. And we have, of course, a lot of other medications like the ADHD medications, the antiepileptic drugs, the antidepressants, the antipsychotic drugs, and steroids that we know that do affect appetite and weight. So sometimes we have to review which drugs or medications our patients are using, and we have to take that into account if we don't reach our obesity management goals.

Children's body composition naturally changes as they grow. Growth charts help track these changes, and rapid weight gain may indicate underlying biological, medical or psychosocial factors. That's why it's not surprising that leading pediatric obesity centers use a multidisciplinary approach, involving healthcare professionals from various fields to support families. This holistic care is critical for identifying root causes and helping families overcome barriers to treatment. And long-term follow up and management is the key to success.

Pharmacotherapy alone, without such an interdisciplinary healthcare team, has not been shown to be effective or even extensively studied. But where a healthcare professional has a longstanding therapeutic relationship with the family and little means or funding of other specialities, treating obesity is still important.

Childhood obesity is preferably going to be solved by prevention, but we must also support children and adolescents who are already living with obesity.

Well-researched medications do play a role in this treatment, and more options will likely become available soon. However, medication must always be part of a comprehensive long term management plan, focused on improving health and wellbeing.

I'm Dr.  Tryggvi Helgason for 5-Minute CPD. Thanks for watching. Be sure to check out additional resources on this page and more learning at easo.org.