Adolescents with obesity may need a combination of medications to achieve health goals
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Pharmacotherapy can be an important intervention for adolescents with obesity, according to a speaker at the Obesity Medicine Association fall conference.
“Obesity is a disease at any age,” Ania Jastreboff, MD, PhD, an associate professor of medicine and pediatrics (endocrinology) at Yale University School of Medicine, director of weight management and obesity prevention at the Yale Stress Center, co-director of the Yale Center for Weight Management, and vice-chair of the Clinical Care Committee for The Obesity Society, said during the presentation. “There’s currently no cure for obesity, so prevention and compassionate, lifelong treatment is paramount for all children, adolescents and adults with the disease of obesity.”
Obesity epidemic
One in five adolescents in the U.S. have obesity, according to Jastreboff, who also serves on the Board of Directors for the American Board of Obesity Medicine. Adolescents who already have obesity have a significantly greater chance of having obesity as adults, she said.
While obesity in adults is usually defined as a BMI of greater than or equal to 30 kg/m², in children and adolescents, BMI is age- and sex-specific, Jastreboff said. Obesity in youth is considered severe at or above the 99th BMI percentile.
Treatment includes targeted lifestyle interventions, anti-obesity pharmacotherapy and bariatric/metabolic surgery. A 2019 American Academy of Pediatrics Position Statement recommends considering bariatric surgery for youth with a BMI greater than or equal to 35 kg/m² with concurrent severe comorbid disease, or a BMI greater than or equal to 40 kg/m². Anti-obesity pharmacotherapy can be used for adolescents with severe obesity (>99th BMI percentile) with a BMI greater than or equal to 30 kg/m2 with weight-related disease or BMI of greater than or equal to 35 kg/m2, according to Jastreboff.
Prescribing medications
Anti-obesity medications that have been approved by the FDA for adolescents include orlistat, liraglutide 3 mg (Novo Nordisk) and phentermine. Setmelanotide (Rhythm Pharmaceuticals) can be used to treat patients aged 6 years or older with several forms of monogenic obesity (POMC, PCSK1 and LepR deficiency). Although not currently approved for adolescents, Jastreboff said that randomized controlled trials are underway for phentermine/topiramate and semaglutide 2.4 mg weekly.
When prescribing orlistat, she said she usually tests patients’ vitamin D levels since this medication can cause malabsorption of fat-soluble vitamins.
Phentermine is FDA approved for short-term use and is contraindicated in patients with heart disease and uncontrolled hypertension, according to Jastreboff.
As providers treat youth with obesity, they are also helping to prevent or treat weight-related disease, such as type 2 diabetes, hypertension and hyperlipidemia.
She summarized three key considerations when treating patients with obesity. The first is that obesity is heterogenous, thus there is variability in response to the available medications in different patients, underscoring the need for research to elucidate precision medicine approaches. Second is that “obesity is complex, so oftentimes combination therapy is needed, just as it would be needed for any other complex disease,” Jastreboff said. And lastly, obesity is a chronic disease, thus patients require treatment over the course of their lifetime.