US experts suggest weight loss drugs for obese children

• The American Academy of Pediatrics endorsed the use of weight-loss medications in children.
• A BMI that is 20% above the limit for the 95th percentile is considered severe obesity.
• Qsymia, Phentermine, and topiramate extended-release capsules were also approved.

The American Academy of Pediatrics (AAP) endorsed the use of weight-loss medications in children and adolescents aged 12 and older on Monday to address obesity, which affects 14.4 million children and adolescents in the US and can have major health repercussions.

The new recommendations—the first in more than a decade—concentrate on treating obesity rather than preventing it.

Dr. Marc Michalsky of Nationwide Children’s Hospital in Columbus, Ohio, a co-author of the guidelines, said: “I think they are important because there are a number of misunderstandings about exactly what causes obesity and there are some unintended biases, even by medical providers with regard to childhood obesity.”

The expert group suggested that treatments like the weight-loss drug orlistat, the injectable diabetes drug semaglutide made by Novo Nordisk (NOVOb.CO), which is marketed as Wegovy, and the older, generic form of the drug metformin, could be used in addition to alterations in health-related behavior and way of life.

Children’s weight loss has been achieved using metformin off-label. 74% of the 27 randomized trials of metformin for pediatric weight loss that the recommendations panel examined revealed some benefit from the drug.

“In particular, children with more immediate and life-threatening comorbidities, those who are older, and those affected by more severe obesity may require additional therapeutic options,” the group said.

A body mass index (BMI), which measures the relationship between weight and height, above the 95th percentile for children of the same age and gender is the threshold for pediatric obesity. A BMI that is 20% above the limit for the 95th percentile is considered severe obesity.

The US Food and Drug Administration has authorized orlistat from GlaxoSmithKline (GSK.L) for the long-term treatment of obesity in children 12 years of age and older. Phentermine, an appetite suppressant, is authorized for use by those 16 and older.

Wegovy received US approval last month for the treatment of persistent obesity in kids 12 and older. The Novo Nordisk diabetes medication Saxenda (liraglutide) has also received FDA approval for use in treating obesity in adolescents 12 years of age and older.

Additionally, the FDA approved Qsymia (phentermine and topiramate extended-release capsules) from Vivus for the treatment of persistent obesity in patients 12 years of age and older.

The recommendations panel observed that many of the studies it examined omitted kids with mental health issues, restrictions on their physical activity, or usage of specific medications.

“In clinical practice, these children often have the greatest need for support in addressing obesity,” the authors said.

According to the AAP, there is not yet enough data to endorse the use of these drugs in children between the ages of 2 and 12.

They also offer suggestions for conducting BMI examinations and using techniques like motivational interviewing to diagnose obesity in children aged 6 and older on a yearly basis.

The committee also suggests metabolic and bariatric surgery as a course of treatment for severely obese teenagers.

Although intensive health behavior and lifestyle counseling for children and parents over a three to twelve-month period is an effective treatment for childhood obesity, the AAP noted that it is “difficult to implement and not widely available.”

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