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The Weight Debate: Considering the Use of Anti-obesity Medications in Pediatric Populations

October 11, 2024
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Editor’s Note: Abby Temple (she/her/hers) is a resident physician in the Boston Combined Residency Program. She is interested in the integration of advocacy and health equity research into undergraduate medical education. Abby is interested in pursuing a fellowship specializing in gastroenterology or critical care. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

Obesity affects nearly 20% of children and adolescents in the US, becoming one of the most prevalent diseases affecting the pediatric population. Due to its increasing prevalence, obesity management has been a large topic of conversation amongst pediatricians.

In 2023, the American Academy of Pediatrics (AAP) released clinical practice guidelines for the management of pediatric obesity. In addition to recommending the initiation of lifestyle changes, the AAP also recommended the use of anti-obesity medications (AOMs) when medically indicated.

While these medications appear to have great potential for reducing body weight, there is minimal evidence to help guide when and how to use AOMs and their potential effects on growth and development in the pediatric population.

Therefore, in November 2023, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Heart, Lung, and Blood Institute, and National Institutes of Health (NIH) Office of Behavioral and Social Sciences Research sponsored a workshop entitled, “Pharmacotherapy for Obesity in Children and Adolescents: State of the Science, Research Gaps, and Opportunities.”

In an article and accompanying video abstract being early released by Pediatrics this week, Dr. Sarah Armstrong and colleagues summarize the conclusions from this workshop (10.1542/peds.2024-067858).

The group of experts first defines obesity as a complex, chronic disease impacted by each person’s genetics, metabolism, and environment. They also note that AOMs have been shown in many high-quality clinical trials to help impact one’s metabolism and interaction with the environment to successfully reduce BMI.

However, this workshop identified many areas for further research on AOM use in the pediatric population, including:

  • a more in-depth understanding of the optimal rate of weight loss
  • when and how to discontinue the medication
  • the effect of medications on muscle mass, bone health, growth, mental health, and pubertal development
  • the safety and efficacy of AOMs in patients with existing mental health conditions

As there is still much unknown about the effects of AOM use in the pediatric population, many primary care providers feel uncomfortable prescribing this medication, and this limits equitable access to these medications. Lack of health insurance coverage also significantly limits the ability to equitably prescribe AOMs. Therefore, the workshop proposed more widespread training of physicians in prescribing as well as advocating for insurance coverage of AOMs.

While AOMs have a large potential to help treat pediatric obesity, there are still many looming questions that require investigation and many barriers to accessing these medications for interested patients. Therefore, there is much progress to be made before AOMs are likely to be widely used in pediatric populations.

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