Pharmacologic Weight Management in the Era of Adolescent Obesity

Context: Pediatric obesity is a serious health problem in the United States. While lifestyle modification therapy with dietary changes and increased physical activity are integral for the prevention and treatment of mild to moderate obesity in youth, only a modest effect on sustained weight reduction is observed in children and young adults with severe obesity. This underscores the need for additional evidence-based interventions for children and adolescents with severe obesity, including pharmacotherapy, before considering invasive procedures such as bariatric surgery. Evidence Acquisition: This publication focuses on recent advances in pharmacotherapy of obesity with an emphasis on medications approved for common and rarer monogenic forms of pediatric obesity. Evidence Synthesis: We review medications currently available in the United States, both those approved for weight reduction in children and "off-label" medications that have a broad safety margin. Conclusion: It is intended that this review will provide guidance for practicing clinicians and will encourage future exploration for successful pharmacotherapy and other interventions for obesity in youth. Key Words: obesity, pharmacotherapy, pediatrics Abbreviations: [alpha]-MSH, [alpha]-melanocyte--stimulating hormone; BBS, Bardet-Biedl syndrome; BMI, body mass index; BMIz, body mass index z score; FDA, US Food and Drug Administration; GABA, [gamma]-aminobutyric acid; GI, gastrointestinal; GLP-1RA, glucagon-like peptide 1 receptor agonist; HO, hypothalamic obesity; LEP, leptin; LEPR, leptin receptor; MC4R, melanocortin-4 receptor; MD, mean difference; PCSK1, proprotein convertase subtilisin/kexin type 1; PHEN/TPM, phentermine and topiramate extended-reselase; POMC, proopiomelanocortin; STEP, Semaglutide Treatment Effect in People With Obesity.