Anti-obesity medications in children and adolescents: blood pressure and chronic kidney disease implications

Pediatric obesity is a growing public health crisis with profound cardiometabolic and kidney consequences extending into adulthood. Emerging frameworks now distinguish preclinical obesity from clinical obesity, emphasizing excess adiposity-related organ dysfunction or functional limitations in activities of daily living. Obesity is a central driver of cardiovascular-kidney-metabolic syndrome, underscoring the need for integrated treatment approaches. This narrative review summarizes current evidence for lifestyle interventions and pharmacologic therapies for pediatric obesity, with a focus on implications for hypertension and chronic kidney disease. Intensive health behavior and lifestyle treatment remains first-line therapy, but access and sustainability barriers limit effectiveness. Pharmacotherapy is increasingly used as adjunctive treatment, with five medications currently approved for non-syndromic obesity in children. Among available agents, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and combination phentermine/topiramate demonstrate the greatest efficacy in adolescents, while older agents and off-label therapies offer modest benefit with greater limitations. Emerging data suggest GLP-1 RAs may improve blood pressure and kidney outcomes, although pediatric evidence remains limited. Lack of long-term safety data, durability of weight loss, cost, and access remain substantial barriers in the use of obesity pharmacotherapy for children. Sustained, coordinated care across the lifespan is essential to effectively manage pediatric obesity and its cardiometabolic and kidney sequelae.