Which obesity medication is approved for pediatric obesity in patients over 12 years but often poorly tolerated?

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

Answer: (D)

Orlistat is the medication that fits this scenario because it is established as an option for teens 12 years and older, making it suitable for pediatric obesity in that age group. It works by blocking pancreatic lipase, which reduces the digestion and absorption of dietary fat. That mechanism leads to modest weight loss when combined with diet and physical activity, but it comes with a trade-off: a high likelihood of gastrointestinal side effects such as oily or fatty stools, flatulence with discharge, and sometimes fecal urgency. These issues, along with the need for fat-soluble vitamin supplementation, make it poorly tolerated for many patients and a common barrier to adherence.

Metformin is not approved specifically for obesity in children, though it’s sometimes used off-label for weight issues linked to insulin resistance. GLP-1 receptor agonists like liraglutide or semaglutide have been explored in pediatrics and may have regional approvals, but their pediatric use varies by age and area, and tolerability concerns exist with any injectable therapy. The question’s emphasis on a medication approved for 12+ with notable tolerability challenges points to orlistat as the best fit.