In the battle against the obesity epidemic that has swept the nation, the expansion of waist lines and body mass indexes (BMI) are reflected on kids’ bathroom scales. Doctors and researchers have come to the realization that only a few children are able to achieve weight loss and keep it off with just a healthy diet and exercise alone. This has led to the pharmacotherapy of childhood obesity with doctors prescribing orlistat, sibutramine, metformin and rimonabant pharmacologic agents as a drug intervention approach. According to a recent study, metformin — a diabetes drug — only leads to short-term weight loss in obese children.
The Centers for Disease Control and Prevention (CDC) says nearly a third of adolescents are considered to be overweight or obese. These terms typically apply to children whose body weight is greater than what is considered healthy for their height. The disease can have detrimental health and social consequences that can continue into adulthood such as heart disease, diabetes, sleep apnea, and even certain cancers. While implementing healthy behaviors, such as diet and exercise, are essential in achieving weight loss in kids, doctors have turned to pharmacotherapy to treat obesity in children in extreme but rare cases where other factors or comorbidities are present.
Metformin, a diabetes drug, has been prescribed by doctors when intensive behavioral treatments, which are set to reduce body weight, have limited efficacy in severe pediatric obesity cases. The diabetes drug is approved by the Food and Drug Administration (FDA) for treatment of type 2 diabetes in children 10 years of age and older. In cases involving obese children, metformin is suggested to induce small BMI/weight reductions. However, children who take the diabetes drug while improving their diet and exercise habits, only seem to lose an insignificant amount of weight compared to the weight kids lose by only making lifestyle changes.
Published in the journal JAMA Pediatrics, a team of researchers assessed 14 clinical trials that compared lifestyle interventions of not a very intensive diet and exercise advice to lifestyle interventions plus metformin. Across these trials published from 1996 to 2012, a total of 1,000 participants between 8 and 14 years old, who had a BMI between 26 and 41, were mostly followed anywhere between six months and 12 months. Metformin doses in these studies ranged from the participants receiving 1000 to 2000 milligrams a day.
Researchers of this study used a change in BMI as their primary outcome measure followed by study quality, pool data, and subgroup and sensitivity analyses. On average, children who took metformin for six months achieved a 3.6 percent greater reduction in their BMI compared with those who just practiced lifestyle changes alone. While this percentage seems like a notable difference, weight-loss treatments are considered to lead to meaningful improvements in health if they reduce BMI by five to 10 percent, said Marian McDonagh, study researcher of Oregon Health and Science University, LiveScience reports.
"This is not going to be your go-to treatment for these obese children," McDonagh wrote in the report. "It will be the rare child that you'll say 'Okay, this person just might benefit from this little jumpstart for six months' — but really, these are not great results."
Overall, the drug provides a statistically significant, but a very modest reduction in BMI when combined with lifestyle intervention over the short term. The researchers do not shy away from the possibility that the drug could be beneficial for certain groups of children, for example, those with BMI greater than 35, those aged 12 years or younger, and those who have not failed previous lifestyle interventions. A large study is needed to identify these groups in order to accurately assess the effects of metformin in various clinical trials.
"In the context of other options for treating childhood obesity, metformin has not been shown to be clinically superior," concluded the researchers.
The researchers believe family-based interventions may help children lose more weight whether they are taking a drug or not than interventions that do not take the child’s family into account. A family-based approach could achieve better results as they take into account the family behaviors in the home that can influence children’s eating habits.
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Source: Foley C, McDonagh M, Ozpinar A, et al. Systematic Review of the Benefits and Risks of Metformin in Treating Obesity in Children Aged 18 Years and Younger. JAMA Pediatrics. 2013.