Weighing the effectiveness of drugs in managing obesity.

First, What is Type 2 Diabetes Mellitus, (in this case in kids)?

Patients with type 2 diabetes are a distinct group, having certain clinical features.  (Cross reference the Treatment Options for Type 2 Diabetes in Adolescents and Youth [TODAY] cohort of adolescents with type 2 diabetes.)"First, type 2 diabetes occurs almost exclusively in obese children and adolescents; the average BMI of patients with type 2 diabetes ranges from 35 to 39 kg/m2, one-third have a BMI greater than 40 kg/m2  Furthermore, at the time of diagnosis, pediatric patients are in the midst of puberty. The mean age at presentation is 14 years, at Tanner stage 4 or 5. More than half of patients have an affected parent, and close to 90% have at least 1 first- or second-degree relative with type 2 diabetes.  Finally, adolescents with type 2 diabetes come predominately from single-parent families of low income and educational attainmment."

Zeitler P. "Type 2 diabetes mellitusChallenges in diagnosis and treatment."

Contemporay Pediatrics  Publish date: Jul 1, 2012

See: Obesity Drug Failure Leaves Fewer Options for Diabetics; A commentary on obesity pills—and the information gap in helping diabetics avoid health risks.  See also,

"Drugs to treat obesity can be divided into three groups: those that reduce food intake; those that alter metabolism; and those that increase thermogenesis. Monoamines acting on noradrenergic receptors, serotonin receptors, dopamine receptors, and histamine receptors can reduce food intake. A number of peptides also affect food intake. The noradrenergic drugs phentermine, diethylpropion, mazindol, benzphetamine, and phendimetrazine are approved only for short-term use. Sibutramine, a norepinephrine-serotonin reuptake inhibitor, is approved for long-term use. Orlistat inhibits pancreatic lipase and can block 30% of the triacylglycerol hydrolysis in subjects eating a 30% fat diet. The only thermogenic drug combination that has been tested is ephedrine and caffeine, but this treatment has not been approved by regulatory agencies. In clinical trials other drugs that may modulate peptide-feeding systems are being developed."

George A Bray, MD "A concise review on the therapeutics of obesity." Nutrition Oct. 2000;16(10):953-960

Weighing effectiveness versus risk in obesity drugs  Tuesday, December 14th, 2010

"In their quest to find drugs to curb obesity, scientists have had about as much success as long-term dieters who want to stay thin — which is to say, very little. In fact, the last year has been so bleak on the research front that some experts are questioning whether a long-desired safe and effective diet pill can be found.

Advisory panels for the Food and Drug Administration recommended against approval of two experimental weight-loss drugs this year — Lorqess in September and Qnexa in July — citing unacceptable risks for unimpressive benefits. Another drug, Meridia, was withdrawn from the market in October after it was linked to higher risks of heart attacks and strokes."  More