Kelly Aaron S
Departments of Pediatrics and Medicine, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, Minn., USA.
Endocr Dev. 2016;30:23-8. doi: 10.1159/000439323. Epub 2015 Dec 10.
Obesity is a complex and retractable disease for which effective and durable treatments are elusive. Successful treatment of severe obesity with lifestyle modification therapy alone is highly unlikely, particularly for adolescents. Pharmacotherapy, if appropriately prescribed, can be an effective tool to use in conjunction with lifestyle modification therapy to achieve better weight loss outcomes. Only a few obesity medications have been evaluated in children and adolescents with results suggesting modest efficacy. However, a new pipeline of obesity drugs has been recently approved for use among adults. Among these, glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment appears to have reasonable weight loss efficacy along with other beneficial pleiotropic effects. Although larger trials will be required to confirm the results, two small pediatric clinical trials have suggested that GLP-1RA treatment may be useful in adolescents with severe obesity. Once sufficient evidence is generated supporting the safety and efficacy of GLP-1RAs and other obesity medications in youth, the pediatric medical community needs to become less resistant to the use of pharmacotherapy. Otherwise, poor outcomes will continue to be the norm.
肥胖是一种复杂且可逆转的疾病，目前尚无有效且持久的治疗方法。仅通过生活方式改变疗法成功治疗重度肥胖极不可能，尤其是对于青少年而言。如果合理开药，药物治疗可以作为一种有效的工具，与生活方式改变疗法结合使用，以取得更好的减肥效果。只有少数肥胖药物在儿童和青少年中进行了评估，结果显示疗效一般。然而，最近有一批新的肥胖药物已被批准用于成年人。其中，胰高血糖素样肽-1受体激动剂（GLP-1RA）治疗似乎具有合理的减肥效果以及其他有益的多效性作用。尽管需要更大规模的试验来证实结果，但两项小型儿科临床试验表明，GLP-1RA治疗可能对重度肥胖青少年有用。一旦有足够的证据支持GLP-1RA和其他肥胖药物在青少年中的安全性和有效性，儿科医学界就需要减少对药物治疗的抵触。否则，不良后果将继续成为常态。
