ABSTRACT
Childhood obesity is a highly prevalent, complex, heterogeneous disease that is difficult to treat. Many children and adolescents who do not respond to behavioral interventions alone and/or who have severe obesity will require tailored multi-modality treatment to achieve optimal risk reduction over their lifetime. Anti-obesity pharmacotherapy is an underutilized tool for primary (common) pediatric obesity which, when used as an adjunct to lifestyle-focused interventions, may result in superior weight loss and comorbidity improvement. Historically, medication use has been limited by a lack of clinical trial data in the pediatric population, concern for adverse effects given the chronic nature of therapy, obesity stigma, and practical barriers to access including lack of insurance coverage. In this chapter, we cover principles, indications, and monitoring of anti-obesity pharmacotherapy in youth, and key pediatric-specific safety and efficacy data for treatment of primary and secondary (monogenic and hypothalamic) obesity. We also highlight anti-obesity medications in the pipeline and outline future opportunities, which include maximizing the neuroplasticity of childhood and adolescence and developing precision-based treatment approaches.
