This week’s Medscape report by journalist Alicia Ault discusses the latest challenges faced by pediatric obesity specialists in accessing glucagon-like peptide 1 (GLP-1) agonists, medications approved by the U.S. Food and Drug Administration (FDA) for weight loss in adolescents aged 12 years or older. She opens with:
While adults, many of whom don’t meet the clinical definition of obesity, scramble to procure glucagon-like peptide 1 (GLP-1) agonists for weight loss, pediatric obesity specialists said their young patients who could benefit more over the long term often are unable to access the potentially life-altering medications.
The FDA approved two GLP-1 agonists so far — both marketed by Novo Nordisk — for use in adolescents aged 12 years or older: Saxenda and Wegovy. Several pediatricians told Medscape that despite the potential benefits of these medications for young patients with obesity, the increasing demand for GLP-1 agonists has led to supply shortages, making it difficult for pediatricians to initiate new treatments or maintain existing ones.
Ault writes:
The crushing demand for semaglutide in the past year, driving a thriving market in compounded versions and online prescriptions, has made it increasingly difficult to find pharmacies that can fill prescriptions.
Two pediatric specialists, Brooke Sweeney, M.D., medical director of weight management services at Children’s Mercy in Kansas City, Missouri, and Sarah Raatz, M.D., a pediatrician at the University of Minnesota’s Center for Pediatric Obesity Medicine, both said because of the supply issues they can’t prescribe the medication for new patients because then the patients already taking it might not have enough, which may lead to weight loss reversal and other negative outcomes.
Potential benefits appeal to some pediatricians
Ault quotes Susma Shanti Vaidya, MPH, M.D., associate medical director of the IDEAL pediatric obesity clinic at Children’s National Hospital in Washington, D.C., who said that “patients taking GLP-1 agonists in her practice have reduced their body mass index and have seen resolution of prediabetes, diabetes, and fatty liver disease.”
Insurance denials are piling up
Insurance coverage for these medications, even for FDA-approved indications, is also becoming more difficult, with insurers setting weight trajectory thresholds that, if not met, could result in coverage withdrawal. Ault explains:
In January 2023, the American Academy of Pediatrics urged aggressive treatment of childhood obesity, including using FDA-approved medications such as GLP-1 agonists combined with lifestyle and dietary modifications.
The U.S Preventive Services Task Force, however, has issued a draft proposal that recommends a variety of lifestyle and behavior modification interventions for children and adolescents but says the evidence does not yet support recommending bariatric surgery or medications.
Concerns about more restrictions this year
Pediatricians express concerns about potential restrictions in 2024, creating uncertainties for patients who have benefited from these medications. Some of the patients, for example, were told that prior authorization would be required for new prescriptions for a GLP-1 agonist.
Some parents want GLP-1 agonists for their kids, too
Some parents, when they feel they have exhausted all other options for their children, are requesting GLP-1 agonists for their children, emphasizing the life-changing effects reported in some cases. The pediatric obesity specialists quoted in the article cited one such effect as stopping the “food noise” and thus curbing cravings.
In a recent poll by Morning Consult, 65% of parents of children with weight-related issues said they would be interested in GLP-1 agonists for their kids. And a third of parents said “they would be interested in having their children use the drugs if they were available.”
However, there is a need for more data on the long-term effectiveness and safety of these medications in pediatric patients, and clinicians are counseling families that obesity is a chronic disease, requiring lifelong treatment with GLP-1 agonists in some cases.
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Source: “Pediatric Obesity Specialists Struggle to Get GLP-1 Agonists,” Medscape, 1/8/24
Source: “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity,” American Academy of Pediatrics, 1/9/23
Source: “High Body Mass Index in Children and Adolescents: Interventions,” U.S. Preventive Services Task Force, 12/12/23
Source: “A Third of Parents Are Interested in Weight Loss Drugs Like Ozempic for Their Children,” Pro.MorningConsult.com, 12/4/23
Image by Elena Leya on Unsplash
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