Week in Review: Obesity Med for Teens, Keto vs. Mediterranean Diet, Thyroid-Dementia Link

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It’s the peak of summer and there’s plenty of exciting endocrinology news this week. First, the FDA expanded usage of the weight loss drug Qsymia (phentermine-topiramate), opening it up to adolescents 12 and older who cannot manage their weight with diet and exercise alone. A Taiwanese study found that older people with underactive thyroid may be at an increased risk of dementia. And in a showdown between two popular diets for people with diabetes—keto and Mediterranean—a new study determined a clear winner.

Weight loss drug Qsymia now available to those 12 and up

A new treatment has been green-lighted by the Food and Drug Administration ((FDA) for chronic weight management in children ages 12 and older.

The FDA approved the diet drug Qsymia (phentermine-topiramate) for a supplemental indication, meaning that the drug, which is already available to adults, can now be prescribed to overweight children as young as 12. It is meant to be used in combination with a low-calorie diet and increased physical activity for chronic weight management.

In order to be prescribed Qsymia, an adolescent must have a body mass index (BMI) in the 95 percentile or greater for their age group.

Qsymia first received FDA approval a decade ago to treat adults who have obesity or are overweight and have a weight-related comorbidity such as diabetes or hypertension.

Childhood obesity is the most common nutritional disorder for children in America and worldwide. The FDA noted that adolescent obesity has increased over the last 50 years with 21% of U.S. adolescents now considered obese. Obese children and adolescents are 5 times more likely to to be obese in adulthood than those who are not obese.

To fight childhood and adolescent obesity, the first line of treatment—as in adults—should be lifestyle modifications such as increasing physical activity and improving diet. When lifestyle changes are unsuccessful in meeting weight loss goals, medication may be considered, according to the FDA.

In a 56-week, double-blind, placebo-controlled study of obese adolescents 12 to 16, those taking a lower dose of Qsymia (7.5 mg/46 mg per day) lost 4.8% of their BMI on average, while those taking a higher dose (15 mg/92 mg) lost 7.1% of their BMI on average. Participants who received the placebo gained an average of 3.3% of their BMI.

Qsymia should not be taken by anyone who is pregnant as it may cause fetal harm, including an increased risk of cleft lip and cleft palate. Teens who can become pregnant (have started menstruating) and are sexually active should obtain a negative pregnancy test before starting Qsymia, perform monthly pregnancy testing, and use effective contraception.

Mediterranean diet prevails over keto for people with diabetes

Both the Mediterranean diet and the keto (ketogenic) diet are embraced by people looking to lose weight and live a healthier lifestyle, but which is better for people living with prediabetes or type 2 diabetes?

While both diets provide several health benefits, a new study published in the American Journal of Clinical Nutrition finds that the Mediterranean diet is the clear winner.

Both Mediterranean and keto diets emphasize non-starchy vegetables while limiting added sugars and refined grains. But the Mediterranean diet includes legumes (such as beans, peas, and lentils), fruits, and whole grains. The keto diet, which is a very low-carb plan, avoids all three of these.

The randomized, crossover, clinical trial compared the two diets in 33 participants with prediabetes or type 2 diabetes recruited from the San Francisco Bay area. Each participant followed both diets, one after the other, for 12 weeks apiece. The participants were provided with diet-appropriate meal kits for the first four weeks of each plan, followed by eight weeks of purchasing their own food.

Weight loss was not discouraged, but the endeavor was also not intended to be a weight-loss study.

During the study, researchers monitored participants’ blood sugar levels, cardiovascular risk levels, and how well participants adhered to each diet.

Both diets helped people to lose weight—about 7% to 8% of their starting body weight—and improve blood glucose levels, without statistically significant differences between the two. But the keto diet had a major drawback: It significantly increased low-density lipoprotein (LDL), or bad cholesterol, while the Mediterranean diet decreased it (a 10% increase in LDL on keto compared to a 5% decrease on the Mediterranean diet).

Participants were also more likely to adhere to a Mediterranean eating plan after the study, the authors found, whereas most participants dropped the keto diet after the 12-week period ended. This led the authors to conclude that the Mediterranean diet is more sustainable.

Hypothyroidism may increase dementia risk

Older people with hypothyroidism may be at a severely increased risk of developing dementia, particularly if they are taking medication to treat the condition, according to new research from Taiwan.

The study was published in Neurology, the medical journal of the American Academy of Neurology.

People 65 and older with hypothyroidism were 80% more likely to develop dementia than people the same age who did not have thyroid problems. For people younger than 65, having a history of hypothyroidism was not associated with an increased risk of dementia.

The risk increased when researchers looked only at people who took medication for hypothyroidism. They found those people were three times more likely to develop dementia than those who did not take medication for hypothyroidism.

For the study, researchers looked at the health records of 7,843 people (average age 75) newly diagnosed with dementia in Taiwan and compared them to the same number of people who did not have dementia.

Researchers identified 102 people with hypothyroidism (underactive thyroid) and 133 with hyperthyroidism (overactive thyroid). Among those with hypothyroidism, 68 also had dementia and 34 did not. The researchers found no link between hyperthyroidism and dementia.

Hypothyroidism occurs when the body doesn’t create enough thyroid hormone. While estimates vary, about 10 million Americans are likely to have this common medical condition, which is more prevalent in women.

Millions of people in the U.S. are currently hypothyroid and don’t know it.

“In some cases, thyroid disorders have been associated with dementia symptoms that can be reversible with treatment. While more studies are needed to confirm these findings, people should be aware of thyroid problems as a possible risk factor for dementia and therapies that could prevent or slow irreversible cognitive decline,” study author Chien-Hsiang Weng, MD, of Brown University in Providence, Rhode Island, said in a press release.

The study does not prove that hypothyroidism causes dementia, because the data are observational and therefore can only show association, the study authors stressed.

  • Woodard K, Louque L, Hsia DS. Medications for the treatment of obesity in adolescents. Ther Adv Endocrinol Metab. 2020 May 27;11:2042018820918789. doi: 10.1177/2042018820918789. PMID: 32523671; PMCID: PMC7257846.
  • Xu S, Xue Y. Pediatric obesity: Causes, symptoms, prevention and treatment. Exp Ther Med. 2016 Jan;11(1):15-20. doi: 10.3892/etm.2015.2853. Epub 2015 Nov 11. PMID: 26834850; PMCID: PMC4726862.
  • Daniel R Wieland, Julia R Wieland, Han Wang, Yi-Huei Chen, Ching-Heng Lin, Jing-Jie Wang, Chien-Hsiang Weng. Thyroid Disorders and Dementia Risk: A Nationwide Population-Based Case-Control Study. Neurology Jul 2022, 10.1212/WNL.0000000000200740; DOI: 10.1212/WNL.0000000000200740
  • Christopher D Gardner, Matthew J Landry, Dalia Perelman, Christina Petlura, Lindsay R Durand, Lucia Aronica, Anthony Crimarco, Kristen M Cunanan, Annie Chang, Christopher C Dant, Jennifer L Robinson, Sun H Kim, Effect of a ketogenic diet versus Mediterranean diet on glycated hemoglobin in individuals with prediabetes and type 2 diabetes mellitus: The interventional Keto-Med randomized crossover trial, The American Journal of Clinical Nutrition, 2022;, nqac154, https://doi.org/10.1093/ajcn/nqac154

Freelance writer

Melissa Erickson has more than 30 years of experience as a journalist, including reporting for a group of weekly newspapers in the Chicago suburbs and contributing to the news service for GateHouse Media Inc. and Gannett Co.