Intended for healthcare professionals

Clinical Review State of the Art Review

Emerging treatments for severe obesity in children and adolescents

BMJ 2016; 354 doi: (Published 29 September 2016) Cite this as: BMJ 2016;354:i4116
  1. Nicole Coles, pediatric endocrine fellow1,
  2. Catherine Birken, staff physician and associate professor of pediatrics2,
  3. Jill Hamilton, staff physician and professor of pediatrics1
  1. 1Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada, M5G 1X8
  2. 2Division of Pediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada
  1. Correspondence to: J Hamilton Jill.hamilton{at}


Severe obesity in childhood is increasing in prevalence and is associated with considerable morbidity. Studies into pediatric obesity have focused largely on interventions that do not necessarily target the unique biologic or psychological underpinnings for the weight gain in the individual child or adolescent. Outcomes show modest improvement and are of questionable benefit for patients with severe obesity. Although weight is a commonly used outcome, other psychological and metabolic parameters including normalization of physical activity and eating behaviors should be primary outcome goals. The durability of weight loss is often limited by physiologic systems that are evolutionarily designed to promote weight gain. Drug therapies for children are limited, as is their effect on weight and metabolism. Existing drugs that are incidentally found to cause weight loss through off-target effects are being actively investigated for obesity indications. Bariatric surgery results in the most significant weight reduction, but it is associated with potential morbidity and long term data are not available for adolescents undergoing this procedure. As understanding of the biologic and psychosocial contributors to eating behaviors and body weight regulation increases, multifaceted and targeted behavioral, pharmacological, and surgical treatment algorithms should be developed and applied to target the underlying pathways involved for the individual child or adolescent with severe obesity.


  • We acknowledge the work of Matan Berson in helping to conceptualize and design the figures for this manuscript.

  • Contributors: All three authors were involved in drafting and revising the manuscript. All approved the final version.

  • Competing interests: We have read and understood the BMJ policy on declarations of interest and declare the following interests: JH is supported by the Mead Johnson chair in nutritional science.

  • Provenance and peer review: Commissioned; externally peer reviewed.

  • Patient consent: Consent was obtained to include the patient perspective.

View Full Text

Log in

Log in through your institution


* For online subscription