Abstract
Lifestyle modifications focused on diet, physical activity, and behavior have a modest impact on weight reduction in children, adolescents, and young adults (YA) with overweight and obesity. Several anti-obesity medications (AOMs) have been approved by the Food and Drug Administration (FDA) for use among adult patients with a body mass index (BMI) ≥27 kg/m2 and at least one obesity-related illness. However, only two FDA-approved AOMs are available for use in children and adolescents, which leads to the frequent off-label use of adult AOMs among this population. We sought to investigate current prescribing patterns of AOMs from school age through to young adulthood in a large unified health system. Using a centralized clinical data registry containing the health data of ~6.5 million patients, individuals aged 5–25 years old with overweight and obesity who were taking one of eight commonly prescribed AOMs from 2009 to 2018 were extracted. A total of 1,720 patients were identified, representing 2,210 medication prescribing instances. The cohort was further stratified as children (5–12 years old), adolescents (13–18 years old), and YA (19–25 years old). The mean BMI at the time of medication initiation was 34.0, 39.1, and 39.6 kg/m2, respectively, which corresponded to a BMI z-score (BMIz) of 2.4 and 2.3 for children and adolescents, respectively. Metformin was the most commonly prescribed medication across all ages, including off-label use for weight-loss among children and adolescents. The most commonly off-label prescribed AOM among YA was topiramate. Multivariable analyses demonstrated phentermine was the most effective AOM, with a 1.54% total body weight among YA (p = 0.05) and a 0.12 decrease in BMIz among adolescents (p = 0.003) greater final weight loss when compared to the respective overall frequency-weighted means. Our study demonstrates a statistically significant weight loss among adolescents and young adults on select pharmacotherapy. The small magnitude of this effect should be interpreted carefully, as it is likely an underestimate in the absence of a true control group. Pharmacotherapy should therefore be considered in conjunction with other multimodal therapies such as lifestyle modification and metabolic and bariatric surgery when treating overweight and obesity.
Highlights
The most recent analysis of obesity prevalence using the National Health and Nutrition Examination Survey (NHANES) database shows that 1 in 5 children in the United States have obesity [1]
Current treatment modalities for childhood obesity are multidisciplinary in nature with a significant preference toward lifestyle modifications that target dietary and behavioral change as the foundation for treatment in most children, adolescents and young adults who present for care
While strides have been made toward encouraging the utilization of metabolic and bariatric surgery (MBS) for pediatric patients with severe obesity, with definitive guidance from organizations such as the American Academy of Pediatrics (AAP) and the American Society of Metabolic and Bariatric Surgery (ASMBS) [14,15,16,17], there remains a gap in care for patients who have been refractory to lifestyle modifications but do not meet criteria for MBS
Summary
The most recent analysis of obesity prevalence using the National Health and Nutrition Examination Survey (NHANES) database shows that 1 in 5 children in the United States have obesity [1]. Current treatment modalities for childhood obesity are multidisciplinary in nature with a significant preference toward lifestyle modifications that target dietary and behavioral change as the foundation for treatment in most children, adolescents and young adults who present for care. According to the most recently available data from the NHANES, the prevalence of severe obesity from 2015 to 2016 was 1.9% among children and adolescents 2 to 19 years old, with 4.5% of adolescents age 16–19 years old affected by severe obesity [1]. While strides have been made toward encouraging the utilization of metabolic and bariatric surgery (MBS) for pediatric patients with severe obesity, with definitive guidance from organizations such as the American Academy of Pediatrics (AAP) and the American Society of Metabolic and Bariatric Surgery (ASMBS) [14,15,16,17], there remains a gap in care for patients who have been refractory to lifestyle modifications but do not meet criteria for MBS
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