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Pharmacotherapy underutilized in treatment of pediatric obesity
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NASHVILLE, Tenn. — Pharmacotherapy is still not a universally accepted treatment strategy for pediatric obesity, according to survey data presented at the ObesityWeek annual meeting.
“Even though lifestyle modification therapy is usually insufficient for treating severe pediatric obesity, only half of the surveyed pediatric weight management clinics are using medications to help support BMI reduction,” Claudia Fox, MD, MPH, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota, told Endocrine Today. “This is disturbing because the kids seen in these clinics almost universally have severe obesity and will not get better with lifestyle changes alone.”
Fox and colleagues sent surveys to 33 pediatric weight management programs identified in the Pediatric Obesity Weight Evaluation Registry. In the survey, the researchers attempted to identify how many programs offered pharmacotherapy, which medications were prescribed most often and the reasoning for not providing pharmacotherapy.
Among the 30 programs that responded, there were 7,880 patients, 38.3% with class 3 obesity. Class 2 obesity was present in 35.3% of the patient population and class 1 obesity was present in 26.4%. Most patients were aged 6 to 11 years (48.3%) or 12 to 18 years (46.7%).
The researchers found that 16 of the 30 responding programs provided obesity pharmacotherapy. The most frequently prescribed medications were topiramate, phentermine, metformin and orlistat (Alli, GlaxoSmithKline; Xenical, Roche).
“Many programs that care for children and adolescents with severe obesity are not using medications to manage this disease, and further, the medications that are used are mostly used in an off-label manner,” Fox said. “We need more studies that examine the safety and efficacy of medications for the use of pediatric obesity.”
Of the programs that did not offer obesity pharmacotherapy, the most common reasons were either not being in favor of the treatment (n = 7) and a lack of knowledge about the subject (n = 6). Lack of insurance coverage (n = 5) was another commonly cited roadblock.
“Severe pediatric obesity is difficult to manage,” Fox said. “Clinicians must recognize the biological underpinnings of this disease and accept that treatments that address this biology, such as medications and/or metabolic and bariatric surgery, may be necessary to achieve clinically significant and durable outcomes.” – by Phil Neuffer
Reference:
Fox C, et al. T-P-3423. Presented at: ObesityWeek; Nov. 11-15, 2018; Nashville, Tenn.
Disclosure: Fox reports she receives research support from Novo Nordisk.