What role do pharmacological treatments play in the management of obesity in children, and when should they be considered?

Pharmacological treatments for obesity in children are considered only after behavioural and lifestyle interventions have been optimised and if the child has severe obesity or weight-related comorbidities requiring specialist support. The UK guidelines emphasise that medicines should be part of a broader, tailored management plan that includes behavioural interventions and specialist services, rather than a first-line treatment. Pharmacological options are generally reserved for children with a BMI at or above the 98th centile who have not achieved sufficient benefit from non-pharmacological approaches and who have significant health risks or comorbidities related to obesity. Referral to specialist paediatric or obesity management services is recommended before initiating pharmacological treatment to ensure comprehensive assessment and monitoring NICE NG246.

Recent literature supports this cautious approach, highlighting that pharmacological treatments can be effective adjuncts in managing paediatric obesity but should be used judiciously due to limited long-term safety and efficacy data in children. Medications may help improve weight outcomes when combined with lifestyle changes, especially in cases of severe obesity or when comorbidities such as type 2 diabetes or obstructive sleep apnoea are present Jebeile et al. 2022Gasmi et al. 2023. However, the evidence base remains evolving, and pharmacotherapy is not a substitute for sustained behavioural change but rather a complementary tool within a multidisciplinary framework Jebeile et al. 2022Gasmi et al. 2023.

In summary, pharmacological treatments in children with obesity should be considered only after comprehensive behavioural interventions have been tried and when the child has severe obesity or significant comorbidities. These treatments require specialist oversight and should be integrated into a holistic management plan that addresses the child's individual needs and health risks NICE NG246 Jebeile et al. 2022Gasmi et al. 2023.