The pharmaceutical search to induce weight loss was precipitated by the United States Food and Drug Administration’s (FDA) 1959 formal approval of phentermine for short-term weight loss despite limited research supporting its assertions of weight loss. In addition to sympathomimetic amine products like phentermine, other medications considered in this article include herbal products, sibutramine, orlistat, metformin, and rimonabant. The use of pharmacotherapy for morbidly obese adolescents should be part of a comprehensive weight-loss program that recommends diet, exercise, and behavioral modification. Side effects and the possibility of major adverse effects should be remembered when considering use of these products.
Obesity is a well-known global phenomenon among children, adolescents, and adults. Although pharmacotherapy can be effective in the management of obesity in some adults, its application to most adolescents is often limited to research protocols. The precise safety, effectiveness, and long-term consequences of these medications for obese youth are presently unclear. Use of such medications should only be part of a comprehensive program that emphasizes appropriate diet, exercise, and behavioral modification.
Pharmacologic management is often used in obese youth who have not responded to changes in lifestyle or when medical complications develop (eg, obstructive sleep apnea or hypertension). Use of medication is considered before bariatric surgery. Only modest weight loss is obtained with use of medication, such as 2 to 10 kg, and typically only during the first 6 months of use. At present, only a few agents have been approved by the FDA for use by those less than 18 years of age, including sibutramine and orlistat. Sibutramine was FDA approved for obese individuals 16 years of age and older, and orlistat still is for those 12 years and older. Voluntary withdrawal of sibutramine was announced in October, 2010. This article discusses a variety of medications used for the treatment of obesity in adolescents.
Over-the-counter herbal agents
Various formulations of phenylpropanolamine (PPA), caffeine, and ephedrine are available that are adrenergic medications and recommended as products that will induce weight loss. However, they have limited, if any, effectiveness and should be avoided because they also have significant adverse cardiovascular effects. PPA is a member of the phenethylamine family of drugs previously used as an appetite suppressant or decongestant. The FDA issued a public health advisory against PPA on November 6, 2000, because of reports of increased risk of hemorrhagic cerebrovascular accidents in 18- to 49-year-old female users; the FDA requested that pharmaceutical companies cease manufacturing and promoting any PPA-containing products. The reasoning was that, although the risk for such adverse events was low, the event itself was serious.
Some Korean researchers have advocated the short-term safety and effectiveness of a traditional Korean herbal formula that is based on Taeumjowi-tang for children with an average age of 11 years. This formulation is a popular herbal product in Korea that is recommended as a weight-loss product for children, adolescents, and adults. It consists of a mixture of various roots, berries, nuts, seeds, and stalks, as noted in Box 1 . One of its ingredients is Ephedra sinica (a species of ephedra or ma huang), and this contains alkaloids of pseudoephedrine and ephedrine.
