Pharmacotherapeutic options for overweight adolescents

Prevention and Control of Childhood Obesity: The Backbone in Prevention of Non Communicable Disease

Childhood obesity is one of the major public health problems. Childhood obesity mostly remains in adulthood and lead to non communicable diseases like diabetes and cardiovascular diseases at a younger age. Therefore, childhood obesity prevention needs high priority. Several risk factors including genetic factor, unhealthy dietary habits, physical inactivity related to childhood obesity.Providing suitable strategies and novel interventions should be considered by the entire health care system for prevention and management of obesity.

Childhood Obesity: Causes, Consequences, and Management

One-third of North American children are overweight or obese. Pathologic obesity accounts for only a small percentage of these cases. The vast majority are the result of a complex interaction of genetic and hormonal, nutritional, physical activity, and physical and social environmental factors. Obesity increases the risk for various cardiometabolic, pulmonary, and psychosocial complications for children, which often continues into adulthood. Multidisciplinary care, focusing on family-centered behavior change, is an evidence-based, essential part of the treatment, along with pharmacologic and surgical options for more complex cases. Prevention and early intervention strategies are key to reversing the obesity epidemic.

Interventions of weight reduction and prevention in children and adolescents: update

There is currently a plethora of information regarding the assessment and treatment of obesity in adults, adolescents, and children available to individuals working in health care-related fields. However, summarizing this information, especially for the pediatric population, is a daunting task. The purpose of this study is to simplify, summarize, and alert pharmacists, pharmacy technicians, and health care providers/workers to the main nonpharmacologic and pharmacologic treatment options concerning pediatric obesity and weight loss.

An evolving scientific basis for the prevention and treatment of pediatric obesity

The 2013 Pennington Biomedical Research Center's Scientific Symposium focused on the treatment and management of pediatric obesity and was designed to (i) review recent scientific advances in the prevention, clinical treatment and management of pediatric obesity, (ii) integrate the latest published and unpublished findings and (iii) explore how these advances can be integrated into clinical and public health approaches. The symposium provided an overview of important new advances in the field, which led to several recommendations for incorporating the scientific evidence into practice. The science presented covered a range of topics related to pediatric obesity, including the role of genetic differences, epigenetic events influenced by in utero development, pre-pregnancy maternal obesity status, maternal nutrition and maternal weight gain on developmental programming of adiposity in offspring. Finally, the relative merits of a range of various behavioral approaches targeted at pediatric obesity were covered, together with the specific roles of pharmacotherapy and bariatric surgery in pediatric populations. In summary, pediatric obesity is a very challenging problem that is unprecedented in evolutionary terms; one which has the capacity to negate many of the health benefits that have contributed to the increased longevity observed in the developed world.

Pharmacotherapy for childhood obesity: present and future prospects

Pediatric obesity is a serious medical condition associated with significant comorbidities during childhood and adulthood. Lifestyle modifications are essential for treating children with obesity, yet many have insufficient response to improve health with behavioral approaches alone. This review summarizes the relatively sparse data on pharmacotherapy for pediatric obesity and presents information on obesity medications in development. Most previously studied medications demonstrated, at best, modest effects on body weight and obesity-related conditions. It is to be hoped that the future will bring new drugs targeting specific obesity phenotypes that will allow clinicians to use etiology-specific, and therefore more effective, anti-obesity therapies.

Early intervention of eating- and weight-related problems

Obesity and other eating-related problems are widespread and are associated with harmful physical, psychological, and social problems. The dramatic increases in rates of pediatric obesity has created a mounting need for psychologists and other mental health care providers to play a significant role in the assessment and treatment of youth with eating- and weight-related problems. Therefore, it is imperative for providers to be aware of the causes and consequences of eating- and weight-related problems and to be familiar with evidence-based assessment and intervention approaches. Currently, the most well-established intervention approaches are family-based behavioral treatments, and weight loss maintenance treatments with a socio-ecological focus are promising. This paper provides a comprehensive review of these topics and highlights the important roles that mental health care providers can have. Medical settings are often the patient's first point of contact within the healthcare system, making mental health care providers in such settings uniquely suited to assess for a broad range of eating- and weight-related problems and associated comorbidities, to deliver relevant evidence-based interventions, and to make appropriate referrals. Moving forward, providers and researchers must work together to address key questions related to the nature of eating- and weight-related problems in youth and to achieve breakthroughs in the prevention and treatment of such problems in this vulnerable population.

Pharmacotherapy for obese adolescents

The pharmaceutical search to induce weight loss was precipitated by the United States Food and Drug Administration's (FDA) 1959 formal approval of phentermine for short-term weight loss despite limited research supporting its assertions of weight loss. In addition to sympathomimetic amine products like phentermine, other medications considered in this article include herbal products, sibutramine, orlistat, metformin, and rimonabant. The use of pharmacotherapy for morbidly obese adolescents should be part of a comprehensive weight-loss program that recommends diet, exercise, and behavioral modification. Side effects and the possibility of major adverse effects should be remembered when considering use of these products.

Drug-induced nutrient deficiencies

Good clinical care extends beyond mere diagnosis and treatment of disease to appreciation that nutrient deficiencies can be the price of effective drug therapy. The major risk factors for developing drug-induced nutrient deficiencies are lack of awareness by the prescribing physician and long duration of drug therapy. The field of pharmacogenomics has potential to improve clinical care by detecting patients at risk for complications from drug therapy. Further improvements in patient safety rely on physicians voluntarily reporting serious suspected adverse drug reactions.

Pharmacotherapy for eating disorders and obesity

Anorexia nervosa and bulimia nervosa are significant mental health problems in the adolescent population; however, there are no medications approved by the FDA for the treatment of adolescents with either of these disorders. Many medications are used off label for both the symptoms of eating disorders and their co-morbid conditions, particularly SSRIs and atypical anti-psychotics. The dosing, side effect profile, and long term effects of these medications in children and adolescents is unclear. Binge eating disorder, night eating syndrome, and sleep-related eating disorder often are associated with over-weight in adolescents. There are various pharmacological approaches to the treatment of obesity in the adolescent population some of which have FDA approval. In the article the authors discuss pharmacological approaches to guide the treatment of eating disorders and obesity in the pediatric population, including risks of treatment, monitoring of potential side effects, and recent outcomes in the literature.

Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion

OBJECTIVE

Our objective was to formulate practice guidelines for the treatment and prevention of pediatric obesity.

CONCLUSIONS

We recommend defining overweight as body mass index (BMI) in at least the 85th percentile but < the 95th percentile and obesity as BMI in at least the 95th percentile against routine endocrine studies unless the height velocity is attenuated or inappropriate for the family background or stage of puberty; referring patients to a geneticist if there is evidence of a genetic syndrome; evaluating for obesity-associated comorbidities in children with BMI in at least the 85th percentile; and prescribing and supporting intensive lifestyle (dietary, physical activity, and behavioral) modification as the prerequisite for any treatment. We suggest that pharmacotherapy (in combination with lifestyle modification) be considered in: 1) obese children only after failure of a formal program of intensive lifestyle modification; and 2) overweight children only if severe comorbidities persist despite intensive lifestyle modification, particularly in children with a strong family history of type 2 diabetes or premature cardiovascular disease. Pharmacotherapy should be provided only by clinicians who are experienced in the use of antiobesity agents and aware of the potential for adverse reactions. We suggest bariatric surgery for adolescents with BMI above 50 kg/m(2), or BMI above 40 kg/m(2) with severe comorbidities in whom lifestyle modifications and/or pharmacotherapy have failed. Candidates for surgery and their families must be psychologically stable and capable of adhering to lifestyle modifications. Access to experienced surgeons and sophisticated multidisciplinary teams who assess the benefits and risks of surgery is obligatory. We emphasize the prevention of obesity by recommending breast-feeding of infants for at least 6 months and advocating that schools provide for 60 min of moderate to vigorous daily exercise in all grades. We suggest that clinicians educate children and parents through anticipatory guidance about healthy dietary and activity habits, and we advocate for restricting the availability of unhealthy food choices in schools, policies to ban advertising unhealthy food choices to children, and community redesign to maximize opportunities for safe walking and bike riding to school, athletic activities, and neighborhood shopping.

Treatment of childhood obesity

PURPOSE OF REVIEW

To provide an overview of treatments for childhood obesity, highlighting recent advances and recommendations.

RECENT FINDINGS

The three main treatment modalities are lifestyle interventions, medications, and bariatric surgery. Recent data support the short-term effectiveness of lifestyle interventions, and show that continued behavioral intervention increases the likelihood of a sustained effect for up to 2 years. New studies and regulatory decisions on medications for obesity (including orlistat, sibutramine, and metformin) are discussed. Emerging data suggest substantial weight loss after bariatric surgery in morbidly obese adolescents but also indicate adverse effects. An expert panel recently provided guidelines that alter definitions of obesity and offer a framework for obesity management. These guidelines are compared with others, and integrated recommendations presented.

SUMMARY

While primary prevention of childhood obesity is important, broadly effective methods to do so are not yet available. Given the large population of obese children and the risks they face, an emphasis on treatment is also critical. We suggest a staged approach, emphasizing early intervention and lifestyle changes. We also suggest limiting bariatric surgery to selected adolescents in Institutional Review Board-approved research studies. Health-policy interventions can facilitate both prevention and treatment of childhood obesity.