title: Pharmacological management of obesity in pediatric patients.
abstract: OBJECTIVE
  To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research.
  
  
  METHODS
  A MEDLINE search (1966 to October 2014) was conducted using the following keywords: exenatide, liraglutide, lorcaserin, metformin, obesity, orlistat, pediatric, phentermine, pramlintide, topiramate, weight loss, and zonisamide.
  
  
  METHODS
  Identified articles were evaluated for inclusion, with priority given to randomized controlled trials with orlistat, metformin, glucagon-like peptide-1 agonists, topiramate, and zonisamide in human subjects and articles written in English. References were also reviewed for additional trials.
  
  
  RESULTS
  Whereas lifestyle modification is considered first-line therapy for obese pediatric patients, severe obesity may benefit from pharmacotherapy. Orlistat is the only Food and Drug Administration (FDA)-approved medication for pediatric obesity and reduced body mass index (BMI) by 0.5 to 4 kg/m(2), but gastrointestinal (GI) adverse effects may limit use. Metformin has demonstrated BMI reductions of 0.17 to 1.8 kg/m(2), with mild GI adverse effects usually managed with dose titration. Exenatide reduced BMI by 1.1 to 1.7 kg/m(2) and was well-tolerated with mostly transient or mild GI adverse effects. Topiramate and zonisamide reduced weight when used in the treatment of epilepsy. Future studies should examine efficacy and safety of pharmacological agents in addition to lifestyle modifications for pediatric obesity.
  
  
  CONCLUSIONS
  Lifestyle interventions remain the treatment of choice in pediatric obesity, but concomitant pharmacotherapy may be beneficial in some patients. Orlistat should be considered as second-line therapy for pediatric obesity. Evidence suggests that other diabetes and antiepileptic medications may also provide weight-loss benefits, but safety should be further evaluated.
authors.affiliation: Wingate University School of Pharmacy, Wingate, NC, USA c.boland@wingate.edu.
authors.forename: Cassie L
authors.initials: CL
authors.lastname: Boland
authors.affiliation: Wingate University School of Pharmacy, Wingate, NC, USA.
authors.forename: John Brock
authors.initials: JB
authors.lastname: Harris
authors.affiliation: Wingate University School of Pharmacy, Wingate, NC, USA.
authors.forename: Kira B
authors.initials: KB
authors.lastname: Harris
mesh_terms: D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D003920:Diabetes Mellitus / Q000188:drug therapy; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008019:Life Style; D009765:Obesity / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D015431:Weight Loss / Q000187:drug effects
chemical_list: D019440:Anti-Obesity Agents; D000927:Anticonvulsants
keywords: exenatide; liraglutide; lorcaserin; metformin; obesity; orlistat; pediatric; phentermine; pramlintide; topiramate; weight loss; zonisamide