Expert: Risks, Benefits Must be Considered When Using Potent Anti-Obesity Drugs in Youth

Following the release of guidelines for evaluating and treating children and adolescents with obesity from the American Academy of Pediatrics, some experts raised concerns about the use of potent new anti-obesity drugs in children. The guidelines advise adjunct pharmacotherapy in addition to positive lifestyle changes for children aged 12 years and older, as well as metabolic or bariatric surgery for severely obese children aged 13 years and older.

In an interview with Pharmacy Times, Sheldon Litwin, MD, said careful consideration of the risks and benefits in these populations is crucial.

Pharmacy Times: The American Academy of Pediatrics recently released new guidelines for childhood obesity, which have gotten a lot of attention. In particular, many critics have raised concerns about the use of anti-obesity medications in children as young as 12. Can you respond to this?

Litwin: So, the data in children and adolescents is relatively new. We know the drugs work in young people. We know that obesity today starts younger and younger. Sort of the fastest growing segment of the population with increasing obesity is children. And people's weight at age 18, or 20, or whatever you look at, is highly predictive of what's going to happen subsequently. And we also know that heart disease starts to develop in young people. So, data going back to the Korean War showed that young men or soldiers who died in combat who had autopsies had evidence of atherosclerotic streaks in their aorta, you know, around the time that they're going to the army, which was like age 18 back then. And today, there's abundant evidence that now those changes are starting much, much earlier. And so, atherosclerosis is a disease that typically develops over 20, 30, 40 years. And, if it's starting in 10-year-olds, instead of 20-year-olds or 30-year-olds, then it's going to manifest itself sooner. Today, there are children with diabetes, there are children with non-alcoholic fatty liver disease, there are children with hypertension, with all these things that we never had in kids before. And it's almost entirely driven by obesity and physical inactivity.

So, you know, is it right to use these kind of high potency drugs in kids? And the answer is probably—at least in selected people. And of course, we have to think long and hard about risks and benefits in young people. And yet, the risks seem really to be very low. I mean, we haven't had these drugs—we’ve only been using them really for 5 to 10 years, and the high potency ones probably about 5 years or so. So, we don't know what happens if 20 years, 30 years of usage, and whether there's some risk associated with that, but they seem to be quite safe in general. And again, the incretin drugs are for analogues of naturally occurring hormones. It's not really something exogenous, it's just giving you a pharmacologic type of effect as opposed to a physiologic dose. So, much higher levels than what we would get on our own. But I mean, it makes sense that treating something earlier, rather than waiting until people have diabetes or starting to have the ravages of diabetes, which mostly aren’t reversible, that it would be better to tackle these things early on.