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Pharmacological interventions for the management of children and adolescents living with obesity- taking a more person-centred approach.
Louisa Ells is Professor of Obesity and Co-Director of the Obesity Institute and Tamara Brown is Reader of Obesity in the Obesity Institute at Leeds Beckett University. Through their international collaborations on various obesity research projects, they established a team of clinical and methodological experts from Austria, Germany, the United States, as well as local colleagues Alex Griffiths and Jamie Matu in the School of Health and Andy Jones at Liverpool John Moores University.
Tamara used her expertise in review methodology to lead a systematic review including meta‐analyses of all medications used to treat children and adolescents living with obesity, regardless of licence. We updated a Cochrane systematic review co-authored by Louisa Ells in 2017 and expanded the outcomes to capture outcomes prioritised by young people, including psychosocial outcomes. We focused on studies with at least six months follow-up because obesity is a chronic and relapsing disease.
We included 35 trials which included an anti-obesity medication usually with diet, exercise and behaviour change components, with over 4000 people with an average age between 9 and 16 years, and a body mass index (BMI) of between 26 and 42 kg/m2. Key findings are that reduction in BMI varied significantly according to individual drug (BMI reduced by 0.8 to 5.9 units) and the largest reduction in BMI was -5.88 kg/m2 in 201 adolescents using semaglutide (GLP-1 receptor agonists). Furthermore, we identified 10 ongoing trials to add to the future evidence base and highlighted gaps relating to very limited evidence for children aged less than 12 years. We concluded that anti-obesity medications in addition to behaviour change improve BMI but may require dose adjustment, with 1 in 100 adolescents experiencing a serious adverse event.
As Tamara states: “Publishing these findings will help clinicians to choose a specific drug, policymakers to understand the changing ‘era’ of anti‐obesity medications, researchers to plug evidence gaps and inform evidence‐based guidelines and most importantly benefit young people living with obesity.”
This was a challenging and high-profile unfunded research project working with an international team of experts and is only one example of the numerous and varied research projects carried out by the Obesity Institute. Aligning with the tenets of the Obesity Institute, Tamara worked hard to make sure the approach adopted was person-centred and a context which placed anti-obesity medication within a suite of options, and only as an adjunct to a healthy lifestyle. As Theme Lead for ‘Tackling Disparities’ with the Obesity Institute, Tamara highlighted the limited evidence for minoritised groups and populations from low- and middle-income countries, as well as the challenges for equity around prescribing and access to anti-obesity medications.
Evidence from this update can inform future guidelines for managing obesity in children and adolescents. It is anticipated that our findings will have huge impact as they include a new class of drugs, GLP-1 receptor agonists, already hailed as ‘game changers’ for adults living with obesity. We have already shared our findings at international conferences and with NICE who are starting a surveillance review of medicines for overweight and obesity in children & young people. The relevant NICE guideline is Obesity: identification, assessment, and management (CG189). The aim of surveillance is to check that guidelines are up to date. This is done by exploring if there is any new evidence to contradict, reinforce or clarify guideline recommendations. We believe that our review findings will have a significant impact on the NICE decision regarding an update of the guidelines.
1. Late-Breaking Abstracts for ECO2023. Obes Facts 16 May 2023; 16 (Suppl. 1): 352–416.
2. The 32nd Annual Conference of ECOG, Albena, Bulgaria, September 7-9 2023, Abstracts: Congress Abstracts 2023. Ann Nutr Metab 26 October 2023; 79 (4): 381–399. https://doi.org/10.1159/000533360
3. Abstracts des Gemeinsamen Kongresses der Deutschen Adipositas-Gesellschaft (DAG) und Deutsche Gesellschaft für Essstörungen (DGESS), Gera, 27.–29.10.2023. Adipositas – Ursachen, Folgeerkrankungen, Therapie, 2023: 17 (3), S18-01, pp 150. https://www.thieme-connect.de/products/ejournals/issue/10.1055/s-013-58199/grouping/127456/10.1055/s-00034923
To find out more about their work please read their paper: “Pharmacological interventions for the management of children and adolescents living with obesity – an update of a Cochrane systematic review with meta‐analyses.” Gabriel Torbahn, Andrew Jones, Alex Griffiths, Jamie Matu, Maria-Inti Metzendorf, Louisa J Ells, Gerald Gartlehner, Aaron S Kelly, Daniel Weghuber, Tamara Brown.
Image credit: © 2023. Provided by Impact on Urban Health licensed via a CC BY-NC-ND 4.0 license.
Professor Louisa Ells
Louisa is a registered public health nutritionist with a specialist interest in multi-disciplinary, cross-sector applied obesity research. Her research focuses on obesity related public health, service evaluation, inequalities and e-health, delivered using systematic reviewing, mixed method, coproduction and person-centred approaches.
Dr Tamara Brown
Tamara is passionate about translating evidence-based research into practice and enjoys helping practitioners to deliver the best care. She is particularly interested in interventions for behavioural risk factors for non-communicable disease, such as lifestyle interventions for obesity prevention.
