Table 1.
Weight-loss medications commonly prescribed to children, adolescent, and young adults with obesity (31, 32).
| Generic name | Trade name(s) | Mechanism(s) of action in obesity treatment | FDA approved for weight loss in pediatrics (age) | Pediatric recommendation and strength of evidence |
|---|---|---|---|---|
| Bupropion | Wellbutrin | Increases extracellular dopamine in the nucleus accumbens, an important part of the neural circuitry of reward | No | |
| Liraglutide | Victoza, Saxenda | Increases insulin release through activation of the GLP-1 receptor, which causes increased cAMP | No, approved for use to treat T2DM in children >10 yo | |
| Metformin | Glucophage | Improves insulin sensitivity through increased peripheral glucose uptake and utilization | No, approved for use to treat T2DM in children >10 yo | |
| Naltrexone | Revia | Not completely understood, but may modulate the opioid receptor to decrease food cravings | No, off label use for alcohol and/or opioid dependence | |
| Orlistat | Xenical, Alli | Block fat absorption through inhibitory binding of pancreatic and gastric lipase in the gastrointestinal tract | Yes (≥12 yo) | IIa‡, Category B¥ for long-term use |
| Phentermine | Adipex and others | Appetite suppression through hypothalamic release of catecholamines | Yes (>16 yo) | IIb§, Category B¥ for short-term use |
| Topiramate | Topamax | Appetite suppression through potential augmentation of GABA | No | |
| Zonisamide | Zonegran | Not completely understood, but facilitates dopaminergic and serotonergic neurotransmission | No |
T2DM, Type II Diabetes Mellitus.
‡
Strength of recommendation IIa indicates that the treatment is generally considered to be useful and is indicated in most cases (33).
¥
Strength of evidence Category B is based on data derived from meta-analyses of randomized controlled trials (RCT) with conflicting conclusions with regard to the directions and degrees of results between individual studies. RCTs involved small numbers of patients or had significant methodological flaws (33, 34).
§
Strength of recommendation IIb indicates that the treatment may be useful, and is indicated in some, but not most cases (34).