Host: Childhood obesity is a growing problem and puts children at risk
for poor health in the future.
The CDC estimates that between 2017 and 2020, 14.
7 million children were considered obese in the United States.
This is Pediatric Insights, Advances in Innovation with Children's
Health, where we explore the latest in pediatric care and research.
I'm your host, Dr.
Kori Cross.
Today we have with us Dr.
Soumya Krishnan, Pediatric Endocrinologist at Children's Health and Professor
at UT Southwestern, and she's here to discuss weight loss medications
and treatments for children.
Welcome, Dr.
Krishnan.
Thank you so much for being here with us today.
Guest: Thank you for having me.
Host: Let's jump right in.
So I'm sure everyone has heard of the weight loss drug, EGG.
Ozempic.
It's all over the television.
So weight loss drugs like Ozempic have been trending and it's a topic
that in the news for all adults, but children also struggle with obesity
and childhood obesity isn't always caused by overeating or poor diet.
We know that sometimes there are social determinants of health, genetics,
certain medications, or even preexisting health conditions that play a role.
Can you share how prevalent is childhood obesity and what are
some common misconceptions?
Guest: According to recent data, approximately 14.
4 million children and adolescents have obesity.
And thus, this is the most common chronic disease affecting
children in this country.
One of the most common misconception of childhood obesity is to think of
it as solely the result of unhealthy personal choices without understanding
the complex interplay of behavioral, environmental, genetic, and metabolic
factors that could contribute to this.
So increasingly we are understanding the role of all of these factors
that lead to childhood obesity.
I would say this is one of the most common misconceptions.
Host: Yeah, no, I would agree with you.
So let's dive into specific weight loss treatments and drugs for children.
There are several FDA approved drugs being used as treatments for obesity
in adolescents, age 12 and older.
Could you tell us what they are?
Guest: At this time, FDA has approved four drugs for treatment of childhood
obesity for children age 12 or older.
These are 1.
Orlistat.
Orlistat acts by blocking dietary fat absorption.
This was first approved by FDA in 2020, 2003 for children age 12 years
and older, making it the first drug to be approved for use in children.
At a dose of 120 milligram, Three times a day, taken before or up to one hour
before each meal, Orlistat can block up to 30 percent of fat absorption.
But it has significant side effects, including steatorrhea, flatulence,
stool urgency, and thus is poorly tolerated, especially in children and
adolescents, as you can understand.
Malabsorption of nutrients, including fat soluble vitamins, and its effect
on growing children is another concern.
The other two drugs approved for children or that come under the class
of GLP one receptor agonist or the glucagon-like peptide receptor agonist.
They are one as liraglutide or sex.
This was approved in 2020 for treatment of children age 12 years or older with A BMI
for agent six and the 95th percent tie.
or greater for age.
GLP 1 is one of the several peptide hormones encoded by the proglocagon gene
and its primary mechanism of action is through stimulation of insulin release
from the beta cells in the pancreas.
It also delays gastric emptying and also decreases appetite due to its effect
on the hypothalamus and hindbrain.
Leraglotide is given as a daily subcutaneous injection.
A dose is started at usually at a lower dose and slowly titrated up
to a target dose of 3 mg daily.
The second drug that is used in this same class of drugs as semaglutide.
And that is given as once a week injection semaglutide or WigoV.
And this was approved recently this year for treatment of
children aged 12 years or older.
the approval was based on a clinical trial that showed 73 percent of Children
in the semaglutide group had a weight loss of 5 percent or more compared
to 18 percent of the placebo group.
Side effects of these medications are mainly gastrointestinal side
effects including nausea, vomiting, and these are contraindicated in
children who have a family history of multiple endocrine neoplasia.
The last group of drug that has been approved by FDA is a drug called
Qcemia, which is a combination of Phenteramine and Topiramate.
And this was approved in June 2022 by the FDA for use in children 12 years or
older who fall under the obese category.
Phenteramine is a sympathomimetic amine and acts in the hypothalamus and
decreases appetite, and topiramate is also supposed to do the same thing.
And in combination, both of them actually are given in lower doses
and can lead to weight loss.
Host: how does children's health determine which of their patients actually should
be getting one of these medications or what treatment they should give for
a patient who comes in who is obese?
Guest: That's a very good question, Dr.
Krause.
So, Children's Health offers all these drugs for Children who qualify and
the choice of these drugs is really based on patient and family preferences
and goals and we use a team based approach including incorporating
lifestyle changes to manage weight loss.
Tailored approach for the treatment of obesity and its related comorbid
morbidities is the most successful to achieve what we want to do.
So, any child above the age of 12 years who have been unsuccessful with
modifying their weight with just lifestyle modification can be offered this drug.
Host: And I'm assuming as a pediatrician myself, that some of the things that
weigh into what is the best choice for each particular patient isn't just
their weight or their BMI, but rather their blood pressure, their blood
sugar, their cholesterol, any sort of metabolic things that are going
on, their family history, correct?
Guest: Absolutely.
Yes.
One of that is preference is some two medications, a GLP 1 receptagonist
are given as injections, which, some children may not want.
The QC Mya can cause Increased heart rate can be associated with suicidal
thoughts and ideation, which may be a contraindication for some, patients.
So it's all very individual based approach on what would be the
best choice for that patient.
Host: and continuing on that sort of train of thought, are there other, I
know you mentioned malabsorption suicide, suicidality, are there other common
risks of these drugs that need to be taken into account when you're choosing
what to use in a particular patient?
Guest: Absolutely.
QCMIA, for example contraindicated in pregnancy.
And so a pregnancy test is recommended before we start QCMIA.
And ideally, females of childbearing age should use contraception
while they are on this drug.
GLP 1 agonist have a very good is particularly preferred for
treatment with type 2 diabetes as it's approved for treatment for both
type 2 diabetes and weight loss.
Host: Mm hmm.
Guest: So, those will be the few things that, that come to my mind when
I think of certain things to think about when we choose these drugs.
And the GLP 1 receptor agonist drugs are contraindicated if there's a family
history of multiple endocrine myoplasia.
So, when there is a history such, we don't use those medications.
Host: Now, the GLP 1 receptor agonists, those are the ones that we
hear in the news and that are just getting so much attention right now.
How much do we have to think about that they seem to work wonderfully
while you're on the medication and when you're an older individual and adult?
Maybe you're not thinking about how long you might have to take this medication.
How are we doing with adolescents when they come off this medication?
Is it something they can come off or is this something that
they are going to be on for life?
Guest: you know, these medications have been very recently
approved for use in children.
So I think there is a lot we are going to still learn as we prescribe
these medications, but it's, that's why it's so important to emphasize
that these medications are not just the end all and cure all.
These medications have to be used with lifestyle modification.
Meaning change in diet and increase in physical activity.
And our hope is that with weight loss with this medicine, then it can be sustained
with just lifestyle modification.
Host: I'm so glad to hear you say that because I agree.
I think that it's a way to sort of Stop the obesity trend from going up while
we institute lifestyle modifications, diet modifications, and get other things
under control with the hope that we can not have a child on medication for life.
Are there other preventative measures aside from well child visits that you
recommend providers share with parents?
Guest: I think certain things that providers recommend which are based
on American Academy of Pediatrics guidelines is to Decrease the screen
time for children, decreased sugary beverage intake, have a good sleep
routine and always incorporate changes as a family instead of just prescribing
a particular diet or activity to a child and having a family make these
lifestyle modifications together would be the few things that I would recommend.
Host: I would agree.
Is there one thing that you would want other endocrinologists to
know about childhood obesity since this is your specialty and weight
loss treatments for children?
Is there something that you wish your colleagues knew?
Guest: thing that we're recently seeing is with the approval of these medications,
there has been an increase in demand for these drugs and the companies
unable to keep up with this demand.
So some families and patients are turning to use using compounding
pharmacies for getting these medications.
As providers, it's very important to know that families are doing that and
that compounded medications have actually not been approved by FDA and may have
side effects that we are not aware of.
So it's important for us to educate the patients of these dangers and
to want them to not go that route.
Host: That's a very good point.
Guest: thank you, yeah, and also avoid over the counter, unapproved
medications for weight loss.
It would be one thing that I would recommend providers educate families on.
Host: Right, lots of people don't realize that if it's coming in as a
vitamin or nutritional supplement, it's not necessarily FDA approved.
Guest: Uh Huh.
Exactly.
Host: Well, as we wrap up, is there anything you'd like to share or give us
a 30 second sort of take home message?
Guest: I think it's important to recognize obesity has been
stigmatized so far as it was thought to result from poor personal choices.
And we, as practitioners, we have to understand the complex genetic,
physiological and socioeconomic and environmental contributors to obesity.
Social determinants of health impact obesity and obesity related comorbidities,
and it's up to us to recognize that and help these at risk children to
prevent obesity related comorbidities.
Host: Thank you so much, Dr.
Krishnan, for taking the time to share your expertise with us today.
This has been such an educational discussion.
Thank you.
Guest: Thank you for having me.
Host: To learn more about Children's Health, nationally recognized pediatrics
endocrinology program, visit childrens.
com slash endocrinology.
Thank you so much for your time today with us and to our audience
for listening to Pediatric Insights Advances and Innovations with Children's
Health, where we explore the latest in pediatric care and research.
You can find more information at childrens.
com.
And if you found this podcast helpful, please rate and review or share the
episode and please follow Children's Health on your social channels.