Editor’s note: The 2024 AAP National Conference & Exhibition will take place from Sept. 27-Oct. 1 in Orlando, Fla. For more coverage, visit https://bit.ly/AAPNationalConference2024 and follow @AAPNews on Facebook and X.
With increased interest in newly approved weight loss drugs, more pediatric clinicians, patients and families are weighing whether the medications may be the right treatment.
Childhood obesity rates have increased significantly, now affecting an estimated one in five U.S. children and adolescents, according to the Centers for Disease Control and Prevention.
The AAP’s 2023 Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity outlines screening techniques and treatments for children with obesity, including lifestyle therapy, bariatric surgery and pharmacotherapy.
Several weight loss medications have been approved for adolescents. However, many factors must be considered when deciding which treatment is best.
Claudia Fox, M.D., M.P.H., FAAP, will discuss these options during a session at the 2024 AAP National Conference & Exhibition titled “When and How to Prescribe Anti-Obesity Medications” (S3407). The session will be from 3:30-4:30 p.m. EDT Sept. 29 in the Orange County Convention Center in Orlando.
“We do use these newer agents quite regularly,” said Dr. Fox, a member of the AAP Section on Obesity Executive Committee and co-director and fellowship program director at the Center for Pediatric Obesity Medicine at the University of Minnesota Medical School. “Some of the medications have been transformative to patients. With semaglutide, we are seeing quite substantial body mass index (BMI) reduction like we’ve never seen before. Some people come in asking for them, but most often those who are asking are parents who have been taking them for themselves.”
During the session, Dr. Fox will present cases, discuss how and when to use weight loss medications, and offer tips on answering questions about weight loss options.
Use of medications surging
Evidence supports the safety and efficacy of obesity medications, and there is no evidence for a watchful waiting approach, according to the AAP guideline. Therefore, pediatric health care professionals should offer treatment options early and at the highest available intensity.
Weight loss drugs approved by the Food and Drug Administration for adolescents as young as 12 years old include semaglutide (Wegovy), liraglutide (Saxenda), orlistat (Alli, Xenical) and phentermine/topiramate (Qsymia). Interest has surged in these medications, particularly Wegovy and Saxenda, which belong to a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists.
Between 2020-’23, the number of adolescents and young adults prescribed a GLP-1 medication increased nearly 600%, from 8,722 patients to 60,567 (Lee JM, et al. JAMA. 2024;331:2041-2043). That number includes those taking the medications for diabetes and weight management.
Jeannie S. Huang, M.D., M.P.H., FAAP, a member of the AAP Section on Gastroenterology, Hepatology and Nutrition Executive Committee, said medications should be used in conjunction with a weight management plan to give patients a greater chance at long-term success. Additional options may include health behavior and lifestyle treatment; partnerships with registered dietitians, behavioral health and exercise professionals; and community programs. Dr. Huang said weight loss surgery should rarely be the primary option.
“Ideally, we always recommend that medications should be taken after a true trial of a behavioral weight management program,” said Dr. Huang, medical director of the Inflammatory Bowel Disease Center at Rady Children’s Hospital-San Diego.
Identifying a treatment option
In June, the U.S. Preventive Services Task Force (USPSTF) recommended clinicians provide or refer children and adolescents ages 6 years and older with a BMI at or above the 95th percentile for age and sex to comprehensive, intensive behavioral interventions.
BMI is a commonly used screening tool and is recommended in the AAP’s clinical practice guideline.
Sarah C. Armstrong, M.D., FAAP, a co-author of the AAP guideline and member of the Section on Obesity, said recent media coverage of the USPSTF decision may have led families to believe inaccurately that the task force recommendations differ from the AAP’s.
“The USPSTF did not recommend against the medications. The task force just declined to make a review on it. They said there wasn’t enough evidence for them to comment on it one way or another at this point, and I think that’s an important distinction,” said Dr. Armstrong, a professor of pediatrics and chief of the Division of General Pediatrics and Adolescent Health at Duke University School of Medicine in Durham, N.C. “There really haven’t been any trials with these newer medicines longer than a year. So we don’t know what it’s going to do … more than a year out, in terms of obesity and chronic disease prevention. The AAP recommendations are focused on obesity treatment now, and these drugs clearly work for that.”
Dr. Armstrong said patients should undergo a comprehensive evaluation before a treatment option is selected. Evaluations should include a review of medical history, behavioral history, family history of obesity and conditions such as food insecurity, social drivers of health, and screenings for eating disorders, diabetes, high blood pressure and liver disease.
“Once the clinician has all of these various pieces of information, then you can decide on the urgency and intensity of the treatment that’s most appropriate and that the family is looking for and willing to do,” Dr. Armstrong said.
Access, equity issues
Dr. Armstrong said less than half of states are covering weight loss medications for patients with Medicaid, which impacts many children of color. In addition, some health plans reversed initial coverage of the medications because of high costs. Clinicians and patients also may face prior authorization hurdles, adding to access barriers.
“The reality of the situation is that decision is often based on insurance coverage of medications and on supply shortage issues,” Dr. Armstrong said.
While some families may be hesitant to discuss obesity treatments with a pediatrician, it often can lead to changes needed for a healthy lifestyle.
“There’s a lot of weight bias and stigma still in society, and I expect there will be for some time,” Dr. Armstrong said. “Some people feel just even asking about the medicine is an indication that they have somehow failed to ‘fix the problem’ on their own. They should really know obesity is a disease and there’s a lot of drivers to it and if they think they might benefit from treatment, they should ask their doctor, get good information and have that open conversation.”
