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Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US.

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.

Authors+Show Affiliations

Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.Department of General Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States. Liver Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States.Department of Bioethics, Harvard Medical School, Boston, MA, United States.Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States. Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States. MGH Weight Center, Massachusetts General Hospital, Boston, MA, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32477270

Citation

Czepiel, Kathryn S., et al. "Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US." Frontiers in Endocrinology, vol. 11, 2020, p. 290.
Czepiel KS, Perez NP, Campoverde Reyes KJ, et al. Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US. Front Endocrinol (Lausanne). 2020;11:290.
Czepiel, K. S., Perez, N. P., Campoverde Reyes, K. J., Sabharwal, S., & Stanford, F. C. (2020). Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US. Frontiers in Endocrinology, 11, 290. https://doi.org/10.3389/fendo.2020.00290
Czepiel KS, et al. Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US. Front Endocrinol (Lausanne). 2020;11:290. PubMed PMID: 32477270.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US. AU - Czepiel,Kathryn S, AU - Perez,Numa P, AU - Campoverde Reyes,Karen J, AU - Sabharwal,Shreya, AU - Stanford,Fatima Cody, Y1 - 2020/05/13/ PY - 2020/01/09/received PY - 2020/04/17/accepted PY - 2020/6/2/entrez PY - 2020/6/2/pubmed PY - 2020/6/2/medline KW - adolescents KW - anti-obesity medications KW - children KW - obesity KW - overweight KW - pharmacotherapy KW - weight loss medications KW - young adults SP - 290 EP - 290 JF - Frontiers in endocrinology JO - Front Endocrinol (Lausanne) VL - 11 N2 - 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. SN - 1664-2392 UR - https://www.unboundmedicine.com/medline/citation/32477270/Pharmacotherapy_for_the_Treatment_of_Overweight_and_Obesity_in_Children,_Adolescents,_and_Young_Adults_in_a_Large_Health_System_in_the_US L2 - https://doi.org/10.3389/fendo.2020.00290 DB - PRIME DP - Unbound Medicine ER -
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