Each month, the OMA Pediatric Committee reviews a pediatric-focused obesity research update to help keep you up to date about the latest findings. This month’s update addresses pediatric obesity and anti-obesity medication.
Dextroamphetamine Treatment in Children With Hypothalamic Obesity
Patients with acquired or genetic hypothalamic obesity generally experience greater difficulty decreasing or maintaining their weight, often due to hyperphagia and decreased energy expenditure. In this retrospective study, 82% of children with hypothalamic obesity who were treated with dextroamphetamine experienced an improvement in body mass index, and 76% reported improvement in hyperphagia, behavior, and/or energy. Read the full article.
Disruption of hypothalamic pathways regulating hunger and energy expenditure, either acquired (due most commonly to treatment for suprasellar tumor, trauma, or infection), or genetic, often leads to treatment-refractory obesity. Patients with hypothalamic obesity (HO) have greater degrees of hyperphagia and decreased energy expenditure. Prior studies including a small number of children with hypothalamic obesity have shown that treatment with dextroamphetamine led to stabilization or reduction in weight/ body mass index (BMI). This retrospective study analyzed 19 patients with HO, both congenital and acquired, assessing changes in BMI, resting energy expenditure, body composition, behavior, and hyperphagia.
Initial dextroamphetamine dose was 5 mg/day. The dose was increased weekly by 5mg/day to a maximum of 0.5 mg/kg/day or 40mg/day, depending on treatment response and side effects. They were instructed to continue lifestyle modifications that had been previously recommended. Of note, 2 of the 19 patients were also enrolled in a parallel study and received additional extensive dietary counseling.
In this study, 82% of children with hypothalamic obesity treated with dextroamphetamine experienced improvement (64.7%) or stabilization (35.3%) in body mass index. The greatest effect was noted during the first 6 months of treatment. Resting energy expenditure increased in 76%,with two patients experiencing an increase in body mass index. There was no significant difference in percent fat mass. The majority of patients reported improvement in hyperphagia. Forty-seven percent reported improvement in behaviors (including food seeking, concentration, and rage attacks), while 29% reported increase in activity level. Less than 10% reported adverse effects like elevated blood pressure (10%) and undesired behavior changes (i.e. flat affect, hypo- or hyperactivity, and anger).
Stimulant medications are FDA-approved for use in pediatrics to treat attention deficit hyperactivity disorder, binge eating disorder (Lisdexamfetamine). The sympathomimetic, phentermine, is approved to treat obesity in adolescents age 16 and older. In closing, children and adolescents with hypothalamic obesity may benefit from a trial of stimulant medication, after appropriate counseling regarding off-label use, potential side effects, tolerance and addictive properties.
Find more resources, curated by OMA’s Pediatric Committee, on our Pediatric Resources page. There you’ll find additional article reviews on various topics related to obesity as well as public resources for clinicians and families.