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Review
. 2023 Apr 27:6:100066.
doi: 10.1016/j.obpill.2023.100066. eCollection 2023 Jun.

Clinical review: Guide to pharmacological management in pediatric obesity medicine

Valerie O'Hara  1 , Suzanne Cuda  2 , Roohi Kharofa  3 , Marisa Censani  4 , Rushika Conroy  5 , Nancy T Browne  6
Affiliations
Review

Clinical review: Guide to pharmacological management in pediatric obesity medicine

Valerie O'Hara et al. Obes Pillars. .

Abstract

Introduction: Newer pharmacotherapy agents (anti-obesity medication [AOM]) are revolutionizing the management of children and adolescents with obesity. Previously, treatment based on intensive behavioral therapy involved many patient and family contact hours and yielded improvements in obesity status of 1-3 percent of the 95th percentile of the body mass index (BMI). Newer AOMs are yielding more clinically significant improvement of 5-18 percent. This review provides guidance for practitioners in the care of children and adolescents with obesity who frequently have complex medical and behavioral health care needs. Specifically, we discuss the use of newer AOMs in these complex patients.

Methods: This review details an approach to the care of the child and adolescent with obesity using AOMs. A shared decision-making process is presented in which the provider and the patient and family collaborate on care. Management of medical and behavioral components of the disease of obesity in the child are discussed.

Results: Early aggressive treatment is recommended, starting with an assessment of associated medical and behavioral complications, weight promoting medications, use of AOMs and ongoing care. Intensive behavioral therapy is foundational to treatment, but not a specific treatment. Patients and families deserve education on expected outcomes with each therapeutic option.

Conclusions: The use of new AOMs in children and adolescents has changed expected clinical outcomes in the field of pediatric obesity management. Clinically significant improvement in obesity status occurs when AOMs are used early and aggressively. Ongoing, chronic care is the model for optimizing outcomes using a shared decision-making between provider and patient/family. Depending on the experience and comfort level of the primary care practitioner, referral to an obesity medicine specialist may be appropriate, particularly when obesity related co-morbidities are present and pharmacotherapy and metabolic and bariatric surgery are considerations.

Keywords: Advanced therapies; Obesity; Pediatrics; Pharmacotherapy; Phenotype.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Valerie O'Hara reports a relationship with Novo Nordisk that includes: consulting or advisory and speaking and lecture fees. Suzanne Cuda reports a relationship with Rhythm Pharmaceuticals Inc that includes: consulting or advisory. Suzanne Cuda reports a relationship with Novo Nordisk Inc that includes: consulting or advisory. Roohi Kharofa reports a relationship with Rhythm Pharmaceuticals Inc that includes: funding grants and speaking and lecture fees.

Figures

Fig. 1
Fig. 1
Child-family-clinician partnership obesity care.
Fig. 2
Fig. 2
Decision Tree: Medication considerations for obesity-driven comorbidities [4]; Figure 14. Decision Tree: Medication considerations for obesity-driven comorbidities Copyright © 2022 Cuda et al. [4]. This is an open access article distributed under the terms of the Creative Commons Attribution License.
Fig. 3
Fig. 3
Decision Tree: Medication Considerations for Phenotypes [89] From: Figure 15. Decision Tree: Medication Considerations for Phenotypes Copyright © 2022 Cuda et al. [4]. This is an open access article distributed under the terms of the Creative Commons Attribution License.
Fig. 4
Fig. 4
Case study.
See this image and copyright information in PMC

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References

    1. Berthoud H.R., Münzberg H., Morrison C.D. Blaming the brain for obesity: integration of hedonic and homeostatic mechanisms. Gastroenterology. 2017 May;152(7):1728–1738. doi: 10.1053/j.gastro.2016.12.050. Epub 2017 Feb 10. PMID: 28192106; PMCID: PMC5406238. - DOI - PMC - PubMed
    1. Gadde K.M., Martin C.K., Berthoud H.R., Heymsfield S.B. Obesity: pathophysiology and management. J Am Coll Cardiol. 2018 Jan 2;71(1):69–84. doi: 10.1016/j.jacc.2017.11.011. PMID: 29301630; PMCID: PMC7958889. - DOI - PMC - PubMed
    1. Berthoud H.R., Albaugh V.L., Neuhuber W.L. Gut-brain communication and obesity: understanding functions of the vagus nerve. J Clin Invest. 2021 May 17;131(10) doi: 10.1172/JCI143770. PMID: 33998597; PMCID: PMC8121510. - DOI - PMC - PubMed
    1. Cuda S., Censani M., Kharofa R., et al. Medication-induced weight gain and advanced therapies for the child with overweight and obesity: An Obesity Medicine Association (OMA) Clin Pract Statement. 2022;4 - PMC - PubMed
    1. Hampl S.E., Hassink S.G., Skinner A.C., et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023;151(2) doi: 10.1542/peds.2022-060640. - DOI - PubMed

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