Current and forthcoming pharmacotherapies for adolescent obesity: Evidence-based review

Abstract

The prevalence of adolescent obesity has increased substantially in recent decades. This disease affects more than 20% of young people. Obesity is associated with metabolic disorders and heart disease. Conservative treatments are not effective in severe obesity. Therefore, this minireview aims to compare and clarify the effectiveness of treatments. It also seeks to identify areas requiring attention to guide clinical practice and future research. A literature search was conducted in databases including PubMed and Scopus. The study focused on randomised trials and meta-analyses in patients aged 12 to 18 years and lasting more than 12 weeks. The results show an improvement induced by glucagon-like peptide 1 receptor agonists, such as semaglutide. Semaglutide reduces body mass index by 16.1%. It is more effective than liraglutide in improving insulin sensitivity. The use of these drugs faces challenges, such as cost. There are also social inequalities that affect health equity. Although no short-term safety issues have been reported, there is still little information available on Tirzepatide and CagriSema in adolescents, compared to their known effect on adults. Therefore, we conclude that semaglutide is the current gold standard, but that there is an urgent need for longer-term studies, comparative evaluations, and safety trials that include paediatric cohorts in order to ensure safe access to pharmacological innovations.

Keywords: Adolescent obesity; Pediatric obesity; Anti-obesity medications; Weight reduction; Adherence; Quality of life

Core Tip: This minireview demonstrates that current evidence confirms that lifestyle interventions are insufficient for severe cases, proposing pharmacotherapy as a clinical necessity, where glucagon-like peptide 1 receptor agonists, especially semaglutide, are positioned as the current standard of care; while critically evaluating the horizon of dual agonists and other combinations. The article identifies new structural barriers such as high costs, global shortages, and strict insurance requirements. It highlights the urgency of conducting new direct comparisons emphasizing the need to integrate data from ongoing Food and Drug Administration-mandated post-marketing surveillance and prospective registries to monitor outcomes in pubertal maturation, bone health, and neurobiological impact.