Which medication is commonly used off-label for obesity in children?

• A. Metformin
• B. Orlistat
• C. Liraglutide
• D. Semaglutide

Answer: (A)

Metformin is commonly used off-label for obesity in children because it can help address the insulin resistance that often accompanies excess weight. It isn’t approved specifically to treat obesity in kids, but it’s prescribed to improve how the body handles glucose and to decrease hepatic glucose production. This can support weight management when obesity is associated with insulin resistance or conditions like polycystic ovary syndrome in adolescents.

In practice, metformin is usually considered after lifestyle changes have been tried, particularly for children who have insulin resistance, prediabetes, or PCOS features. It tends to produce modest weight loss or weight stabilization rather than a dramatic drop, and it’s generally well-tolerated aside from possible stomach upset or loose stools. People also monitor for long-term effects, such as vitamin B12 levels, during extended use.

Orlistat, while used for some pediatric patients, is typically approved for adolescents and operates by reducing fat absorption, so its use isn’t classified as off-label in many settings. Liraglutide and semaglutide are newer agents with regulatory approvals for certain pediatric age groups in some regions, which makes their off-label use less common. The broad, practical reason metformin stands out for this question is its widespread off-label use in pediatric obesity tied to insulin resistance, despite not being approved specifically to treat obesity in children.