Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
Nat Rev Endocrinol. 2023 Sep;19(9):534-541. doi: 10.1038/s41574-023-00858-9. Epub 2023 Jun 19.
Obesity is a common chronic disease in children and adolescents and its prevalence is increasing worldwide. The causes are multifactorial but involve biological predisposition towards a specific body-weight set point and defended adipose tissue mass converging with an obesogenic environment. Comprehensive treatment of paediatric obesity includes lifestyle modification therapy, anti-obesity medications (AOMs) and/or metabolic surgery. Lifestyle modification therapy used alone produces fairly modest weight loss for most youth with obesity. The emergence of new AOMs has changed the landscape of paediatric weight management, improving the outlook for youth with obesity. This Review briefly highlights obesity development pathways in youth and the role that pharmacotherapy can play in counteracting these pathophysiological forces. Here, results from adolescent AOM clinical trials published since 2020 are reviewed, including the safety, efficacy and tolerability of the newest treatments (glucagon-like peptide 1 receptor agonists and phentermine-topiramate). The importance of a comprehensive and chronic care model, including both lifestyle modification and ongoing pharmacotherapy, will be discussed in the context of maximizing long-term health outcomes. Finally, insight will be provided into the emerging pipeline of AOMs (for example, incretin receptor co-agonists and tri-agonists) and how future therapies might fundamentally change the prognosis for youth with obesity.
肥胖是儿童和青少年的一种常见慢性疾病，其发病率在全球范围内呈上升趋势。病因是多因素的，但涉及到对特定体重设定点的生物学倾向和与肥胖环境相吻合的防御性脂肪组织质量。儿童肥胖的综合治疗包括生活方式改变疗法、抗肥胖药物（AOM）和/或代谢手术。单独使用生活方式改变疗法，大多数肥胖青少年的体重减轻幅度相当有限。新型 AOM 的出现改变了儿童体重管理的格局，改善了肥胖青少年的前景。这篇综述简要强调了青少年肥胖的发展途径，以及药物治疗在对抗这些病理生理力量方面可以发挥的作用。本文回顾了自 2020 年以来发表的青少年 AOM 临床试验结果，包括最新治疗方法（胰高血糖素样肽 1 受体激动剂和苯丁胺/托吡酯）的安全性、疗效和耐受性。将讨论包括生活方式改变和持续药物治疗在内的全面和慢性护理模式的重要性，以最大限度地提高长期健康结果。最后，将深入了解 AOM 的新兴药物（例如，肠促胰岛素受体共激动剂和三激动剂）以及未来的治疗方法如何从根本上改变肥胖青少年的预后。
