ork actively to maintain behaviors that promote weight loss. Regular contact with the clinician is essential to reinforce treatment goals and skills. Pharmacotherapy Pharmacotherapy for children or adolescents with obesity is used only if intensive lifestyle modification has failed to stop weight gain or to ameliorate comorbidities. Use of medication should not be the only mode of treatment in obese children. Only one drug is approved for use in children for weight loss. TABLE 11 Drug Mechanism of action Side effects Other uses Orlistat FDA approved for ≥12years of age Inhibits gastric & pancreatic lipases, resulting in reduced absorption of fats Fatty/oily stool, abdominal cramps, fecal incontinence, reduced absorption of fat soluble vitamins Metformin not FDA approved for treatment of obesity Reduces hepatic glucose production, decreases intestinal absorption of glucose & increases peripheral insulin sensitivity GI complaints, nausea/vomiting, vitamin B12 deficiency, lactic acidosis (rare) Approved for ≥10 years of age for treatment of T2DM, metformin could also be used to regulate menses in obese girls with PCOS Other drugs used only in certain special situations are: • Growth hormone: Prader Willi syndrome • Octreotide: Hypothalamic obesity • Leptin: Leptin deficiency The FDA approved a number of weight-loss medications for adults and these medications are appropriate for those ≥16 years of age with BMI ≥30kg/m2 or who have BMI ≥27 kg/m2 and at least one weight related comorbidity (e.g., hypertension or T2DM). Medication should be discontinued and the child should be re-evaluate>