Recombinant human growth hormone (rhGH) is usually dosed according to total body weight, but there is limited evidence as to whether this is appropriate for obese children.
In a study in PLoS One (17 July 2017), researchers analysed data on 354 paediatric patients who received rhGH dosed according to total bodyweight at their hospital
They found that in the first year of treatment, height gain increased with body-mass index, except for in obese patients. However, levels of insulin-like growth factor 1, a hormone that is released in response to rhGH, were significantly elevated in obese patients.
The researchers say that, given that higher than normal IGF-1 levels may be associated with adverse effects such as increased cancer risk, alternative dosing strategies in obese patients could improve safety and reduce costs while maintaining sufficient height gains.
 Hawcutt D, Bellis J, Price V et al. Growth hormone prescribing and initial BMI SDS: Increased biochemical adverse effects and costs in obese children without additional gain in height. PloS One 2017. doi: 10.1371/journal.pone.0181567