Children and adolescents: approved drugs and their current use in clinical practice

Abstract

Pediatric obesity is a chronic, complex, and multifactorial disease that affects physical and psychosocial health and increases the risk of morbidity and mortality throughout life. The rise in obesity incidence has been accompanied by a greater incidence of metabolic, cardiovascular, hepatic, respiratory, orthopedic, and psychological complications from an early age, as well as a high probability of persistent obesity into adulthood, with the consequent increased risk of type 2 diabetes mellitus (T2DM), cardiovascular disease, and premature mortality. Lifestyle interventions remain the cornerstone of treatment and should be implemented in all patients. However, they may be insufficient, especially in adolescents with severe obesity or multiple comorbidities. In this context, pharmacotherapy should not be understood as an isolated weight-loss strategy, but rather as a tool to modify the course of the disease, improve its complications, and promote adherence to sustained behavioral changes.

The pharmacological treatment of pediatric obesity has transformed significantly in recent years: it has gone from having limited options with modest efficacy to incorporating therapies targeting specific physiological pathways, particularly those related to the incretin system and the melanocortin pathway, with results significantly superior to those previously obtained with other drugs.

Therefore, pharmacotherapy can be an effective therapeutic tool in carefully selected patients, always combined with intensive behavioral and lifestyle interventions. However, evidence is insufficient regarding its safety and long-term effects, its benefits beyond BMI reduction, and its application in certain patient groups, such as children under 12 years of age and minority populations.

This presentation will aim to analyze the available evidence on the pharmacological treatment of pediatric obesity, considering the efficacy, safety, clinical indications, limitations, and quality of evidence for each available drug.