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.
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.
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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.
Ernst ND, Obarzanek E. Child health and nutrition: obesity and high blood cholesterol. Prev Med. 1994;23:427–36.
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.
Zeller MH, Reiter-Purtill J, Jenkins TM, Ratcliff MB. Adolescent suicidal behavior across the excess weight status spectrum. Obesity. 2013;21:1039–45.
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.
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.
Pont SJ, Puhl R, Cook SR, Slusser W. Stigma experienced by children and adolescents with obesity. Pediatrics. 2017;140:e20173034.
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.
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.
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.
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.
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.
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.
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
•• 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.
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
Stang M, Wysowski DK, Butler-Jones D. Incidence of lactic acidosis in metformin users. Diabetes Care. 1999;22:925–7.
Cheung BMY. Drug treatment for obesity in the post-sibutramine era.
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.
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.
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.
Academy for Eating Disorders (AED). Research risk/benefit ethics position statement. 2019.
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.
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.
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.
Cochrane. PICO Ontology. https://linkeddata.cochrane.org/pico-ontology. 23 Oct 2020.
Whitlock EP. Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. PEDIATRICS. 2005;116:e125–44.
Cote AT, Harris KC, Panagiotopoulos C, Sandor GGS, Devlin AM. Childhood obesity and cardiovascular dysfunction. J Am Coll Cardiol. 2013;62:1309–19.
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.
World Health Organization. Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. 23 Oct 2020.
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.
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.
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.
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.
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.
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.
Derogatis L. Brief symptom inventory (BSI).
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.
Kovacs M. Children’s depression inventory 2 (CDI 2). 2nd ed. North Tonawanda, NY: Multi-Health Systems Inc; 2011.
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.
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.
Smolak L, Levine M. Psychometric properties of the children’s eating attitude test. Int J Eat Disord. 1994;16:275–82.
Halberstam MA, Mann B. Risk factors for suicidal behavior: utility and limitations of research instruments. 2003.
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.
Forinder U, Löf C, Winiarski J. Quality of life and health in children following allogeneic SCT. Bone Marrow Transplant. 2005;36:171–6.
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.
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.
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.
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.
• 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.
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.
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.
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.
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.
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med. 2001;16:606–13.
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).
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
Jackson R. Dillard declares that he 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.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Maternal and Childhood Nutrition
Jackson R. Dillard and Faith A. Newsome are co-first authors.
About this article
Cite this article
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 (2021). https://doi.org/10.1007/s13668-021-00351-7
- Adolescent obesity
- Pharmacological interventions
- Psychosocial outcomes