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April 2013

Clinical Trials for Adolescent Obesity: Cooking Up an Alphabet Stew of What to Do

Author Affiliations

Author Affiliations: Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, and Liver Imaging Group, Department of Radiology, University of California, San Diego School of Medicine and Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego.

JAMA Pediatr. 2013;167(4):391-393. doi:10.1001/jamapediatrics.2013.1661

Exenatide is a glucagon-like peptide-1 (GLP-1) agonist. The GLP-1 is principally produced in the enteroendocrine cells of the ileum in response to local contact with postprandial nutrients in the intestinal lumen.1 It stimulates insulin secretion and inhibits glucagon release. Long-acting GLP-1 receptor agonists were developed as glucose-lowering drugs for the treatment of type 2 diabetes mellitus. In the large phase 3 trials conducted for diabetes, it was observed that these drugs also produced weight loss. The effect of GLP-1 agonists on body weight is believed to be a central effect leading to reduced food intake.2 Collectively, the studies in obese adults with or without diabetes demonstrate that long-acting GLP-1 agonists promote weight loss on the order of 2% to 4%.3 In this issue of the journal, Kelly et al4 report the results of a randomized, double-blind, placebo-controlled clinical trial of exenatide vs placebo injected twice daily for 3 months in severely obese adolescents.

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