There is a gap in treatment modalities for pediatric patients with
obesity for whom lifestyle modification
therapy, on the one hand, may be insufficient to meaningfully reduce BMI, and
bariatric surgery, which on the other hand, may not be indicated, available or desired. Although
pharmacotherapy may help fill this treatment void, there is a paucity of FDA-approved medications indicated for
pediatric obesity and further, most are single agents with only modest mean treatment effects. In contrast, combination
pharmacotherapy, such as
phentermine/
topiramate, appears to offer greater
weight loss efficacy in adults and may prove to be superior to monotherapy for pediatric patients as well. This case report describes the clinical management of
severe obesity in
a 10 year old girl with lifestyle modification
therapy and subsequent addition of first
topiramate and later
phentermine. Using the case as a platform, the current state of
pharmacotherapy for
pediatric obesity will be described thereby highlighting the limited efficacy of single agents. Additionally, the
biological rationale for combination
pharmacotherapy, including potential mechanisms which may account for the poor response to single agents, will be discussed.