On a weekly basis, I am being asked by a patient or patient—or a trainee—whether a glucagon-like peptide-1 (GLP-1) receptor agonist might be an appropriate treatment. There is a lot to know about these new medications.
Fortunately, this week, Pediatrics is early releasing a State-of-the-Art article by Margaret Stefater-Richards, MD, PhD, Grace Jhe, PhD, and Yanjia Zhang, MD, PhD, from Boston Children’s Hospital, entitled “GLP-1 Receptor Agonists in Pediatric and Adolescent Obesity” (10.1542/peds.2024-068119).
Obesity is a huge problem. The authors point out that 20% of US children and adolescents have obesity, and these children are more likely to develop serious chronic diseases, such as diabetes, hypertension, and hyperlipidemia. They are also more likely to have mental health issues. While the American Academy of Pediatrics recommends intensive health and lifestyle treatment as optimal treatment for obesity, its impact is modest, and medications are also recommended for those who are 12 years and older.
This is where GLP-1 receptor agonists, like liraglutide (Saxenda, Victoza) and semaglutide (Wegovy) come in. Both are given subcutaneously; semaglutide has the advantage of weekly dosing, compared to daily dosing for liraglutide. Victoza is approved for children with type 2 diabetes who are as young as 10 years; Saxenda and Wegovy are approved to treat obesity in children 12 years and older.
If you want or need to learn more about this class of medications, this State-of-the-Art article is a great place to start. The authors discuss when these medications are appropriate, their efficacy, and their side effect profile. Importantly, they also talk about nutritional and mental health considerations—including disordered eating and eating disorders—for these patients. Finally, they discuss access to these medications.
If you are considering prescribing GLP-1 receptor agonists for your adolescent patients, this is a must read. There are many caveats and considerations—from the side effect profile to mental health implications—that must be carefully thought through if you prescribe these medications, and this article will help you begin to think about these.
