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The Effects of Anti-obesity Pharmacotherapy Interventions on Psychosocial Factors Among Adolescents with Obesity: a Scoping Review

  • Maternal and Childhood Nutrition (AC Wood, Section Editor)
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Abstract

Purpose of Review

The purpose of this review was to investigate and synthesize psychosocial outcomes from pharmacotherapy experimental trials for weight loss among adolescents with obesity.

Recent Findings

There is a paucity of research regarding pharmacological interventions for adolescents with obesity. These studies have typically reported reductions in weight, and side effects have been inconsistently described. Overall, medication seems to be a safe and effective obesity treatment modality for adolescents with obesity.

Summary

Six articles were included in this review. Studies varied in medication type, medication dosing, lifestyle components, psychosocial measures, measurement intervals, and psychosocial outcomes. All studies found a reduction in weight and/or BMI. Studies were often underpowered to detect differences in psychosocial variables, which were always considered secondary or exploratory outcomes. Future research should include psychosocial outcomes as a primary endpoint of pharmacological interventions for adolescent obesity. Ultimately, the treatment of the complex disease of obesity deserves to be assessed through multiple health domains extending beyond weight reduction.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016 key findings data from the National Health and Nutrition Examination Survey [Internet]. 2015. Available from: https://www.cdc.gov/nchs/data/databriefs/db288_table.pdf#1. 23 Oct 2020.

  2. Ernst ND, Obarzanek E. Child health and nutrition: obesity and high blood cholesterol. Prev Med. 1994;23:427–36.

    Article  CAS  Google Scholar 

  3. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents [Internet]. Available from: www.aappublications.org/news. 23 Oct 2020.

  4. Zeller MH, Reiter-Purtill J, Jenkins TM, Ratcliff MB. Adolescent suicidal behavior across the excess weight status spectrum. Obesity. 2013;21:1039–45.

    Article  Google Scholar 

  5. Bucchianeri MM, Eisenberg ME, Neumark-Sztainer D. Weightism, racism, classism, and sexism: Shared forms of harassment in adolescents. J Adolesc Health. 2013;53:47–53.

    Article  Google Scholar 

  6. Fox CK, Gross AC, Rudser KD, Foy AMH, Kelly AS. Depression, anxiety, and severity of obesity in adolescents: is emotional eating the link? Clin Pediatr. SAGE Publications Inc. 2016;55:1120–5.

    Article  Google Scholar 

  7. Pont SJ, Puhl R, Cook SR, Slusser W. Stigma experienced by children and adolescents with obesity. Pediatrics. 2017;140:e20173034.

    Article  Google Scholar 

  8. Cardel MI, Jastreboff AM, Kelly AS. Treatment of adolescent obesity in 2020. JAMA. 2019;322(17):1707–8. https://doi.org/10.1001/jama.2019.14725.

  9. Rubio M, Gargallo M, Isabel Millán A, Moreno B. Drugs in the treatment of obesity: Sibutramine, orlistat and rimonabant. Public Health Nutrition. 2007;10(10A):1200–5. https://doi.org/10.1017/S1368980007000717.

  10. Chanoine J, Hampl S, Jensen C, Boldrin M, Hauptman J. Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA. 2005;293(23):2873–83. https://doi.org/10.1001/jama.293.23.2873.

  11. Ryder JR, Kaizer A, Rudser KD, Gross A, Kelly AS, Fox CK. Effect of phentermine on weight reduction in a pediatric weight management clinic. Int J Obes. 2017;41:90–3.

    Article  CAS  Google Scholar 

  12. Park MH, Kinra S, Ward KJ, White B, Viner RM. Metformin for obesity in children and adolescents: a systematic review. Diabetes Care. 2009;32(9):1743–5. https://doi.org/10.2337/dc09-0258.

  13. Bouza C, López-Cuadrado T, Gutierrez-Torres LF, Amate J. Efficacy and safety of metformin for treatment of overweight and obesity in adolescents: an updated systematic review and meta-analysis. Obes Facts. 2012;5:753–65.

    Article  CAS  Google Scholar 

  14. Czepiel KS, Perez NP, Campoverde Reyes KJ, Sabharwal S, Stanford FC. Pharmacotherapy for the treatment of overweight and obesity in children, adolescents, and young adults in a large health system in the US. Front Endocrinol (Lausanne). 2020;11:290. Published 2020 May 13. https://doi.org/10.3389/fendo.2020.00290

  15. •• Kelly AS, Auerbach P, Barrientos-Perez M, Gies I, Hale PM, Marcus C, et al. NN8022-4180 Trial Investigators. A randomized, controlled trial of liraglutide for adolescents with obesity. N Engl J Med. 2020 May 28;382(22):2117–28. https://doi.org/10.1056/NEJMoa1916038. This article is the most recent of randomized controlled trials included in the review. This trial also assessed psychosocial outcomes in a relatively comprehensive manner, similar to suggestions made in this review.

  16. van der Aa MP, Elst MA, van de Garde EM, van Mil EG, Knibbe CA, van der Vorst MM. Long-term treatment with metformin in obese, insulin-resistant adolescents: results of a randomized double-blinded placebo-controlled trial. Nutr Diabetes. 2016 Aug 29;6(8):e228. https://doi.org/10.1038/nutd.2016.37

  17. Stang M, Wysowski DK, Butler-Jones D. Incidence of lactic acidosis in metformin users. Diabetes Care. 1999;22:925–7.

    Article  CAS  Google Scholar 

  18. Cheung BMY. Drug treatment for obesity in the post-sibutramine era.

  19. Melnyk BM, Small L, Morrison-Beedy D, Strasser A, Spath L, Kreipe R, et al. Mental health correlates of healthy lifestyle attitudes, beliefs, choices, and behaviors in overweight adolescents. J Pediatr Health Care. 2006;20:401–6.

    Article  Google Scholar 

  20. Dimatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment meta-analysis of the effects of anxiety and depression on patient adherence [Internet]. Available from: https://jamanetwork.com/. 23 Oct 2020.

  21. Kretchy IA, Owusu-Daaku FT, Danquah SA. Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence. Int J Ment Health Syst. 2014 Jun 21;8:25. https://doi.org/10.1186/1752-4458-8-25.

  22. Academy for Eating Disorders (AED). Research risk/benefit ethics position statement. 2019.

  23. Cardel MI, Taveras EM. Let's not just dismiss the weight watchers kurbo app. Child Obes. 2020 Dec;16(8):547–8. https://doi.org/10.1089/chi.2019.29000.car.

  24. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI manual for evidence synthesis: JBI; 2020. Available from https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-12.

  25. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169:467–73.

    Article  Google Scholar 

  26. Cochrane. PICO Ontology. https://linkeddata.cochrane.org/pico-ontology. 23 Oct 2020.

  27. Whitlock EP. Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. PEDIATRICS. 2005;116:e125–44.

    Article  Google Scholar 

  28. Cote AT, Harris KC, Panagiotopoulos C, Sandor GGS, Devlin AM. Childhood obesity and cardiovascular dysfunction. J Am Coll Cardiol. 2013;62:1309–19.

    Article  Google Scholar 

  29. Barlow SE. Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120:S164–92.

    Article  Google Scholar 

  30. World Health Organization. Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. 23 Oct 2020.

  31. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS Peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40–6.

    Article  Google Scholar 

  32. Norgren S, Danielsson P, Jurold R, Lötborn M, Marcus C. Orlistat treatment in obese prepubertal children: a pilot study. Acta Paediatr Int J Paediatr. 2003;92:666–70.

    Article  CAS  Google Scholar 

  33. Hsia DS, Gosselin NH, Williams J, Farhat N, Marier JF, Shih W, et al. A randomized, double-blind, placebo-controlled, pharmacokinetic and pharmacodynamic study of a fixed-dose combination of phentermine/topiramate in adolescents with obesity. Diabetes Obes Metab. 2020;22:480–91.

    Article  CAS  Google Scholar 

  34. García-Morales LM, Berber A, Macias-Lara CC, Lucio-Ortiz C, Del-Rio-Navarro BE, Dorantes-Alvárez LM. Use of sibutramine in obese mexican adolescents: a 6-month, randomized, double-blind, placebo-controlled, parallel-group trial. Clin Ther. 2006;28:770–82.

    Article  Google Scholar 

  35. Maahs D, de Serna DG, Kolotkin RL, Ralston S, Sandate J, Qualls C, et al. Randomized, double-blind, placebo-controlled trial of orlistat for weight loss in adolescents. Endocr Pract. 2006;12:18–28.

    Article  Google Scholar 

  36. Ware JE Jr, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473–83.

    Article  Google Scholar 

  37. Derogatis L. Brief symptom inventory (BSI).

  38. Allgaier A-K, Frühe B, Pietsch K, Saravo B, Baethmann M, Schulte-Körne G. Is the Children’s Depression Inventory Short version a valid screening tool in pediatric care? A comparison to its full-length version. J Psychosom Res. 2012;73:369–74.

    Article  Google Scholar 

  39. Kovacs M. Children’s depression inventory 2 (CDI 2). 2nd ed. North Tonawanda, NY: Multi-Health Systems Inc; 2011.

  40. Garner DM, Garfinkel PE. The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med. 1979 May;9(2):273–9. https://doi.org/10.1017/s0033291700030762.

  41. Maloney MJ, McGuire J, Daniels SR, Specker B. Dieting behavior and eating attitudes in children. Pediatrics. 1989 Sep;84(3):482–9 Erratum in: Pediatrics 1990 May;85(5):714.

  42. Smolak L, Levine M. Psychometric properties of the children’s eating attitude test. Int J Eat Disord. 1994;16:275–82.

    Article  CAS  Google Scholar 

  43. Halberstam MA, Mann B. Risk factors for suicidal behavior: utility and limitations of research instruments. 2003.

  44. Kimber B, Sandell R, Bremberg S. Social and emotional training in Swedish classrooms for the promotion of mental health: results from an effectiveness study in Sweden. Health Promot Int. 2008;23:134–43.

    Article  Google Scholar 

  45. Forinder U, Löf C, Winiarski J. Quality of life and health in children following allogeneic SCT. Bone Marrow Transplant. 2005;36:171–6.

    Article  CAS  Google Scholar 

  46. Ehrenfors R, Borell L, Hemmingsson H. Assessments used in school-aged children with acquired brain injury – linking to the international classification of functioning, disability and health. Disabil Rehabil. 2009;31:1392–401.

    Article  Google Scholar 

  47. Kolotkin RL, Zeller M, Modi AC, Samsa GP, Polanichka Quinlan N, Yanovski JA, et al. Assessing weight-related quality of life in adolescents*. Obesity. 2006;14:448–57.

    Article  Google Scholar 

  48. Ambak R, Mohamad Nor NS, Puteh N, et al. The effect of weight loss intervention programme on health-related quality of life among low income overweight and obese housewives in the MyBFF@home study. BMC Womens Health. 2018;18(Suppl 1):111. Published 2018 Jul 19. https://doi.org/10.1186/s12905-018-0591-3.

  49. O'Neil PM, Aroda VR, Astrup A, Kushner R, Lau DCW, Wadden TA, et al. Wilding JPH; satiety and clinical adiposity - liraglutide evidence in individuals with and without diabetes (SCALE) study groups. Neuropsychiatric safety with liraglutide 3.0 mg for weight management: Results from randomized controlled phase 2 and 3a trials. Diabetes Obes Metab. 2017 Nov;19(11):1529–36. https://doi.org/10.1111/dom.12963.

  50. • Kolotkin RL, Gadde KM, Peterson CA, Crosby RD. Health-related quality of life in two randomized controlled trials of phentermine/topiramate for obesity: What mediates improvement? Qual Life Res. 2016 May;25(5):1237–44. https://doi.org/10.1007/s11136-015-1153-x. This is an important paper that investigates the effects on psychosocial outcomes in relation to pharmacological interventions, showing the importance of assessing these variables.

  51. Kaukua JK, Pekkarinen TA, Rissanen AM. Health-related quality of life in a randomised placebo-controlled trial of sibutramine in obese patients with type II diabetes. Int J Obes. 2004;28:600–5.

    Article  CAS  Google Scholar 

  52. Chao AM, Wadden TA, Walsh OA, et al. Changes in health-related quality of life with intensive behavioural therapy combined with liraglutide 3.0 mg per day. Clinical Obesity. 2019 Dec;9(6):e12340. https://doi.org/10.1111/cob.12340.

  53. MacLean PS, Rothman AJ, Nicastro HL, Czajkowski SM, Agurs-Collins T, Rice EL, et al. The Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures Project: rationale and approach. Obesity. Blackwell Publishing Inc. 2018;26:S6–15.

    Article  Google Scholar 

  54. Roeser K, Eichholz R, Schwerdtle B, Schlarb AA, Kübler A. Relationship of sleep quality and health-related quality of life in adolescents according to self- and proxy ratings: a questionnaire survey. Front Psychiatry. 2012 Sep 3;3:76. https://doi.org/10.3389/fpsyt.2012.00076.

  55. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med. 2001;16:606–13.

    Article  CAS  Google Scholar 

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Funding

Dr. Cardel is supported by the National Institute of Health National Heart, Lung, and Blood Institute (K01HL141535 and R25HL126146) and the National Center for Advancing Translational Sciences (UL1TR001427).

Author information

Authors and Affiliations

Authors

Contributions

Conceptualization: JRD and MIC

Methodology: JRD, JMD, and LEA

Resources: MIC

Data curation: JMD and LEA

Visualization: JMD and LEA

Supervision: MIC

Project administration: JRD and FAN

Data interpretation: all authors

First draft of manuscript: JRD, FAN, JMD, and LEA

Major revisions and final review of manuscript: all authors

Corresponding authors

Correspondence to Julia R. Dillard or Michelle I. Cardel.

Ethics declarations

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Conflict of interest statements

Julia R. Dillard declares that she has no conflict of interest.

Faith A. Newsome is a DEEP member for Novo Nordisk. Novo Nordisk occasionally sends her projects to offer feedback on as a patient. She is sometimes paid for these activities.

Aaron S. Kelly has served as an unpaid consultant for Novo Nordisk, Vivus, and Weight Watchers, and has been provided drugs/placebo from AstraZeneca to conduct a clinical trial funded by the National Institutes of Health (NIH).

Amy C. Gross has received research support from Rhythm Pharmaceuticals, and has served as an unpaid consultant for Vivus.

Jane Morgan-Daniel declares that she has no conflict of interest.

Lauren E. Adkins declares that she has no conflict of interest.

Sweta S. Madem declares that she has no conflict of interest.

Michelle I. Cardel is supported by grants from the NIH National Heart, Lung, and Blood Institute and the National Center for Advancing Translational Sciences and WellCare Health Plans, Inc.; has received compensation from Weight Watchers for service as a consultant; and has received non-financial support from Novo Nordisk.

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This article is part of the Topical Collection on Maternal and Childhood Nutrition

Julia R. Dillard and Faith A. Newsome are co-first authors.

Appendix 1

Appendix 1

Table 3 Search Strategy for CINAHL

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Dillard, J.R., Newsome, F.A., Kelly, A.S. et al. The Effects of Anti-obesity Pharmacotherapy Interventions on Psychosocial Factors Among Adolescents with Obesity: a Scoping Review. Curr Nutr Rep 10, 58–70 (2021). https://doi.org/10.1007/s13668-021-00351-7

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