Decision Focus: Weight-Loss Drugs for Children
Learn when a weight-loss drug might be prescribed for an overweight child and how it works.
If life were like a textbook, overweight teens could drop extra pounds by simply increasing their activities and eating healthier. But for many kids, life doesn’t always follow in neat chapters. When older children or teens with severe weight problems cannot lose weight through lifestyle changes alone, a weight-loss medicine may be an option.
The only weight-loss medicine approved for use in children is called orlistat. It can be prescribed for use in children 12 or older. Its weight loss effects are modest, at best. But, the few pounds that are lost while on a weight-loss drug may help spur needed behavior changes that can lead to more significant weight loss.
Note: Sibutramine (Meridia), the other weight-loss drug that was prescribed for children and adults, was withdrawn from the market because of cardiovascular side effects.
How does orlistat work?
Orlistat (Xenical) is the only FDA-approved weight-loss drug for use in children 12 or older. There are no weight-loss drugs approved for children under age 12. Orlistat works by blocking the body’s ability to absorb fat. This unabsorbed fat is removed from the body in stool. Many calories are contained in fat, so the resulting loss in calories helps weight loss.
When might my child’s doctor consider using a weight-loss medication?
Doctors will recommend that your child try intensive lifestyle changes before medication is considered. Over the course of weeks and months, these efforts focus on behavior change. For instance, kids learn to choose healthy snacks and practice portion control. And they are encouraged to get more physical activity. Your child may also see a nutritionist and a counselor.
If these strategies don’t begin to make a dent in your child’s weight, your doctor may consider a trial of medication. Often doctors will only consider medication if the following two criteria are met:
- A child weighs more than what 95 percent of other children weigh
- A child has high blood pressure, diabetes, or another significant weight-related health problem
What does the evidence show?
Studies have shown that teens using orlistat may have a small to moderate short-term decrease in weight.
What are the pros and cons of using this medicine for weight loss?
Orlistat may have some benefit in the weight-loss program of some children and teens. However, there are also several drawbacks in terms of side effects and the need for continued monitoring.
Orlistat pros and cons
- May help a weight-loss program when used along with diet and exercise.
- Orlistat may cause stomach and intestinal side effects, such as excess gas and oily stools. This can lead to oily spotting on underwear, rectal discomfort, and an urgent need to have a bowel movement.
- Gallbladder problems and, rarely, severe liver damage have been reported with the use of orlistat. Contact your doctor right away if you notice any of these symptoms of liver problems in your child:
- Abdominal pain
- Jaundice (yellowing of the skin and the whites of the eyes)
- Dark urine and light-colored stools
- Weakness or fatigue
- Loss of appetite
- Orlistat has to be taken with every meal, which means your child will need to take it during school hours.
- Because orlistat blocks the absorption of fat, it also blocks the absorption of fat-soluble vitamins. This may lead to vitamin deficiency (fat-soluble vitamins A, D, and E). Anyone taking orlistat needs to take a daily multivitamin.
What else do I need to think about when considering weight loss medication for my child?
- Orlistat causes bothersome and sometimes embarrassing side effects like gas and soiling. You and your child’s doctor will need to monitor your child for signs of liver damage and gallbladder, stomach, and intestinal problems. Some children have to stop taking the medication because of the side effects.
- You need to continue to serve as a role model and play an active part of your child’s weight-loss program. Help your child understand that medication is just one tool to be used along with more important lifestyle changes.
- Medicine usually only helps a child lose a few pounds. When the medicine is stopped, this weight may be regained.
- While on medication, your child will need to continue eating right and exercising regularly to reach and maintain a healthy weight.