Childhood obesity is on the rise globally, reaching alarming levels. The COVID-19 pandemic exacerbated this trend due to lifestyle changes and increased sedentary behaviors during lockdowns. While the first-line treatments typically focus on lifestyle interventions such as diet and exercise, these often prove ineffective, leading to weight regain. As a result, alternative treatments are needed for more resistant cases.
The rise in childhood obesity is outpacing that of adult obesity, and studies show that children with obesity are at higher risk of remaining obese into adulthood. This is due to the unhealthy eating habits and sedentary lifestyle adopted early on in childhood that become ingrained and harder to change in adulthood. This prolonged obesity increases the likelihood of developing chronic conditions such as type 2 diabetes, hypertension, dyslipidemia, polycystic ovary syndrome (PCOS), sleep disorders, and fatty liver disease.1
In addition to physical health risks, pediatric obesity is linked to psychological and social issues. Children with obesity are more likely to experience low self-esteem, depression, and eating disorders compared to their peers.
A recent study on Liraglutide, presented the drug as weight loss drug for children, published in the New England Journal of Medicine, showed promising results favoring use of the drug in children less than 12 years of age.
The study was conducted on eighty-two children (53.7% male) between the ages of 6 and under 12 years. The mean age was 10 years, with a body mass index of 31.0 kg/m2 and a weight of 70.2 kg (11st 1lb). Over half of children experienced at least one obesity-related issue, such as insulin resistance or premature puberty.
Out of the 82 children, 56 received liraglutide injections for an average of about 13 months (range, 12 to14), and the other group (n=26) was given a placebo. Research findings are giving hope to some, as the study showed that children who used the drug decreased their BMI by 5.8% versus a 1.6% increase in BMI for those on placebo.
The children on liraglutide also significantly showed a 3% reduction in their BMI levels after one year, and the effect was constant up to two years. There were minor gastrointestinal adverse events such as nausea and vomiting in some of the children.2
The initial approach to treating childhood obesity is lifestyle modification, including balanced diets, increased physical activity, and behavioral therapy. However, because childhood obesity is a multifactorial condition, a multidisciplinary approach involving pediatricians, dietitians, personal trainers, and psychologists is essential.
For cases where lifestyle interventions alone are ineffective, pharmacological treatments are needed. In such instances, second-line therapies combine lifestyle changes with medications.
The FDA has approved three medications for chronic weight management in children aged 12 years and older: Orlistat, liraglutide, and semaglutide. While in Europe, the EMA has approved only liraglutide and semaglutide for use in children 12 years and older.3
Orlistat works by inhibiting pancreatic and gastric lipases, reducing fat absorption. It can reduce BMI, waist circumference, and cholesterol levels when combined with diet and exercise.
Liraglutide and semaglutide act on the central nervous system to reduce hunger and slow gastric emptying, promoting weight loss.
Phentermine and topiramate have also been approved for short-term use (three months) in adolescents aged 16 and older. These medications reduce appetite through catecholamine stimulation and neurotransmitter modulation.
Liraglutide, a GLP-1 receptor agonist originally used to treat diabetes, has shown promising results in treating adult obesity. This success has led to its investigation in pediatric populations.
Liraglutide is particularly known for mimicking the incretin hormone GLP-1. This hormone is crucial for glucose tolerance and weight loss by reducing appetite and energy intake. GLP-1 is secreted in response to food intake and promotes insulin secretion while inhibiting glucagon release, thereby lowering blood glucose levels.
The presence of GLP-1 receptors in the central nervous system further explains the appetite-suppressing effects of these drugs. Lower levels of GLP-1 are often observed in individuals with obesity and are inversely correlated with insulin resistance.4
Liraglutide is emerging as a potential therapeutic option for pediatric obesity. The drug is well tolerable in adult patients while it may show some adverse reactions in children like
gastrointestinal discomfort,
nausea,
vomiting and
diarrhea.
Rarely hypoglycemia has been seen during the early treatment period, though these were not serious.
The drug therefore, demonstrated a good tolerability and safety profile in the pediatric population.5 However the current was conducted on a small number of subjects and further studies including larger population and for longer duration are required to draw better conclusions.
Childhood obesity is a significant health concern worldwide, with the number of affected pediatric population doubling over the last two decades. The research highlights that, under medical supervision, Liraglutide can help children achieve significant weight loss while minimizing potential risks. This finding could provide a new avenue for treating childhood obesity, complementing lifestyle changes and other interventions.
References
1. Cornejo-Estrada, Alejandra, Carlos Nieto-Rodriguez, Darwin A. Leon-Figueroa, Emilly Moreno-Ramos, Cielo Cabanillas-Ramirez, and Joshuan J. Barboza. "Efficacy of liraglutide in obesity in children and adolescents: systematic review and meta-analysis of randomized controlled trials." Children 10, no. 2 (2023): 208.
2. Barrett, Timothy, and Julian Hamilton-Shield. "Childhood Obesity and GLP-1 Receptor Agonists—A Coming of Age?." New England Journal of Medicine (2024).
3. Agosta, Marcello, Maria Sofia, Salvatore Pezzino, Sara D’Amato, Giorgia Litrico, Chiara Mazzone, Gaetano La Greca, and Saverio Latteri. "EFFICACY OF LIRAGLUTIDE IN PEDIATRIC OBESITY: A REVIEW OF CLINICAL TRIAL DATA." Obesity Medicine (2024): 100545.
4. Kelly, Aaron S. "Current and future pharmacotherapies for obesity in children and adolescents." Nature Reviews Endocrinology 19, no. 9 (2023): 534-541.
5. Jensterle, Mojca, and Andrej Janež. "Glucagon-like peptide-1 receptor agonists in the treatment of obesity." Hormone Research in Pædiatrics 96, no. 6 (2023): 599-608.