What Doctors Say About Prescribing GLP-1 Receptor Agonists to Kids

Yesterday, MedPage Today published another part of its series called “Ozempic: Weighing the Risks and Benefits.” In the piece, Enterprise & Investigative Writer Sophie Putka examines how often doctors prescribe new weight loss drugs to kids and interviews a few professionals about their thinking process, reservations, and concerns.

As enthusiasm for GLP-1 receptor agonists as a weight-loss solution has grown, their use in children has also increased. Currently, liraglutide and semaglutide are the only GLP-1 drugs approved by the FDA for treating obesity in children aged 12 and older.

Between October 2022 and September 2024, prescriptions for these two medications by pediatric and adolescent medicine specialists surged from 3,448 to 24,435 — a sevenfold increase in just two years, according to a MedPage Today analysis of Symphony Health data. During this time, total prescriptions for all GLP-1 drugs written by these specialists more than doubled, rising from 59,868 to 125,538. These figures include prescriptions for 11 GLP-1 brands, many of which are approved for type 2 diabetes, but exclude those written by primary care or family medicine physicians and compounding pharmacies.

Many specialists feel cautiously comfortable prescribing GLP-1 medications to children when other options have been exhausted, provided that families are engaged in lifestyle interventions. However, concerns remain about long-term effects, particularly on bone density, and some experts remain uneasy about the rapid adoption of these drugs in pediatric care.

The jury is still deliberating

According to a recent article in Scientific American, written by Lauren J. Young, an associate editor for health and medicine, experts express concerns about potential impacts on bone health, growth, puberty, and restrictive eating habits, emphasizing the need for long-term studies like this JAMA study. These medications, considered lifelong treatments, pose unique challenges for teenagers compared to adults. Here at Childhood Obesity News, we also covered all kinds of questions and concerns regarding the potential risks of pediatric, adolescent, and adult use of GLP-1 drugs.

Still,

Clinical trials in younger age groups have shown significant weight and BMI reductions compared to lifestyle changes like diet and exercise, leading to FDA approvals of liraglutide (Saxenda) in 2020 and semaglutide (Wegovy) in 2022 for children 12 and older. A recent study reported a nearly 600% increase in GLP-1 prescriptions for adolescents and young adults between 2020 and 2023, largely driven by Wegovy’s approval for weight management in late 2022.

Proceeding with care

Last year, the American Academy of Pediatrics (AAP) issued an updated Clinical Practice Guideline for recommending the use of pharmacotherapy for adolescents 12 and up, including GLP-1 agonists.

Sarah Hampl, M.D., of the University of Missouri-Kansas City School of Medicine and lead author of the AAP guidelines, emphasized the role of other interventions that accompany medication. She said:

It was recommended, not in isolation or not as a monotherapy, but as adjunct or addition to intensive health behavior and lifestyle treatment… [AAP] needed to comment on [pharmacotherapy], because it can be a very effective form of treatment — again, as an adjunct and these kids, especially with severe obesity, they have some really serious and real comorbidities right here and now, in their childhood.

On the other hand, Dr. Fatima Cody Stanford, a pediatric obesity specialist at the Massachusetts General Hospital in Boston, avoids prescribing GLP-1 drugs to children under 12.

She said:

I would still probably use my other drugs where we do have some data, like a topiramate or metformin, or if they have very severe obesity, I would wonder if they had something else,” such as proopiomelanocortin (POMC) deficiency or leptin receptor deficiency.

Dr. Stanford ensures her adolescent patients receive comprehensive care, including dietitian support and psychological counseling, while closely monitoring bone health given the lack of long-term data on GLP-1 use.

It looks like family medicine doctors tend to use weight-loss drugs as a last resort. Dr. Tochi Iroku-Malize, former board chair of the American Academy of Family Physicians, noted that while medications might be necessary for some children with severe obesity, their long-term effects on developing bodies remain unclear.

She said:

When we’re starting with children, they have a longer way to go than adults when it comes to using these medications… [W]e don’t yet know what the long-term effects of taking the weight-loss medications are, and whether the young patients would have to continue taking them indefinitely to maintain their weight.

Despite these challenges, experts agree on the importance of combining medication with healthy lifestyle habits, stressing that the long-term success of any treatment relies on addressing the broader environmental and behavioral factors contributing to childhood obesity.

Your responses and feedback are welcome!

Source: “How Often Do Doctors Use New Weight-Loss Drugs in Kids?,” MedPage Today, 11/18/24
Source: “Teenagers Are Taking New Weight-Loss Drugs, but the Science Is Far from Settled,” Scientific American, 10/25/24
Image by Ben Wicks on Unsplash

Digital Technology Can Help Reduce Obesity

We continue looking at the role of digital technology in improving pediatric care. Two recent studies, both published in JAMA, found that adding a digital component to health counseling — even something as simple as a text message — may help reduce childhood obesity.

One study, funded by the Patient-Centered Outcomes Research Institute, used REDCap data tools hosted by Vanderbilt University Medical Center, with support from the National Institutes of Health. It was co-led by Dr. Eliana Perrin, a Bloomberg Distinguished Professor of Primary Care at Johns Hopkins University.

Text messages as a tool against obesity in infants

Dr. Perrin and her team developed the Greenlight Program, an initiative designed to educate parents about promoting healthy growth in infants. With most parents owning smartphones, this digital program is easily accessible.

The researchers recruited nearly 900 parent-infant pairs from hospitals and pediatric clinics at six different medical institutions. All participating infants were 21 days old or younger, born after 34 weeks of pregnancy, at a healthy weight, and without chronic conditions affecting weight gain.

Participants were divided into two groups. Both groups received Greenlight Program materials, which included counseling on nutrition and healthy habits, as well as age-appropriate booklets with goal-setting advice. However, only half of the group received interactive, personalized text messages from an automated system. These texts offered immediate feedback, tips for addressing challenges, and words of encouragement as they made progress.

The impact of text messages

The study tracked the outcomes of the text messages on childhood obesity until the children reached two years old. Researchers measured various health metrics, including weight and growth, to evaluate the program’s success. Through regular followups and digital monitoring, they could capture a comprehensive view of each child’s development.

Results showed a marked improvement in maintaining healthy growth patterns in children whose parents received the personalized texts. Between the two groups, children of parents who received digital support had healthier growth trajectories over their first two years compared to those who received only counseling.

The digital program led to a 45% relative reduction in obesity. Researchers found that the benefits of the digital intervention began as early as four months and continued over the two-year period, marking this study as one of the first large-scale efforts to prevent early childhood obesity.

Dr. Perrin said:

If we can prevent obesity in these children at the highest risk, we can also work toward greater health equity.

Implications for broader applications

The success of this study suggests that similar text-based interventions could be adapted to address other age groups or health issues. Digital technology offers a scalable way to deliver health education tailored to individual needs and support in real-time. The duration and size of this groundbreaking study adds confidence that the outcomes are not a coincidence.

Another study focuses on diversity

A recent study published in JAMA focused on infants coming from diverse racial and ethnic backgrounds. Called Greenlight Plus, the trial randomized 449 parent-child pairs to the digital intervention group and 451 to the counseling-only group. The study included 45% Hispanic children, 20.6% non-Hispanic White, 15.9% non-Hispanic Black, and 18.3% identifying as other or mixed races. Among parents, 65.2% preferred English and 34.8% preferred Spanish; 15.6% reported food insecurity, and 55.6% had limited health literacy.

Results showed a lower mean weight-for-length in the digital intervention group compared to the counseling-only group. Although the proportion of children classified as overweight was similar between groups, the digital intervention group had a significantly lower obesity rate (7.4% vs. 12.7%).

The authors noted that some population groups were not well represented in the study and that only English and Spanish speakers were included. Nonetheless, they highlighted the potential for a meaningful population-level impact if the intervention is scaled up, suggesting further studies on broader implementation.

Finally, a quick reminder about Dr. Pretlow’s app and an upcoming study geared at teens. The ability to rechannel displacement into less harmless activities rather than succumbing to urges is behind the behavior modification app, BrainWeighve, currently ramping up for a trial through the University of California Los Angeles (UCLA). The trial focuses on weight loss for obese teens using a self-directed, physician-supervised program withdrawing from one problem food at a time.

Your responses and feedback are welcome!

Source: “Digital Intervention Reduces Early Childhood Obesity Risk in Diverse Populations,” American Journal of Managed Care, 11/4/24
Source: “Simple text messages could help tackle childhood obesity,” Earth.com, 11/4/24
Image by Eyestetix Studio on Unsplash

How Thinking on Obesity Has Shifted Over Time

Over the years, the way society thinks about obesity has undergone a profound transformation. What was once viewed as a simple issue of personal responsibility has now evolved into a more nuanced understanding of a complex, chronic condition influenced by various factors beyond individual control. This shift in thinking has far-reaching implications for public health, healthcare, and the well-being of individuals living with obesity.

From personal failure to a complex condition

For much of recent history, obesity was seen as the result of poor lifestyle choices — too much food and too little exercise. It was commonly viewed as a moral or personal failing, with public health campaigns often focusing on slogans like the “war on obesity” or the “obesity epidemic.”

These messages reinforced harmful stereotypes of larger-bodied people as lazy or lacking self-control. As a result, many people with obesity experience stigma, discrimination, and shame, not only from society but also within the healthcare system. (We’ve written plenty about fat shaming alone over the years.)

This narrow view of obesity failed to consider the broader range of factors that contribute to weight gain. In recent years, research has increasingly shown that obesity is influenced by a variety of complex factors, including genetics, socioeconomic status, psychological well-being, medications, and the environment. While diet and physical activity remain important, they are only part of the puzzle.

Is the word “obesity” offensive?

A recent article for The Conversation, “How we think about ‘obesity’ and body weight is changing. Here’s why,” Executive Editor Stephen Khan used the word “obesity” with an asterisk (“ob*sity”) throughout his article, explaining,

Historical reflections on the word “obesity” reveal its offensive origins, with advocates suggesting the term ob*sity should be used with an asterisk to acknowledge this. To show our respect, we will adopt this language here.

He also noted that in 2014, the American Medical Association classified obesity as a chronic disease, sparking debate about whether this label pathologizes natural body changes and fuels discrimination.

Why we should fight stigma

A lengthy article by the American Psychological Association by Zara Abrams cites plenty of research to back up the notion that stigma can lead to serious consequences in the person’s physical and mental well-being, quoting a few experts, including Sarah Novak, Ph.D., an associate professor of psychology at Hofstra University in Hempstead, New York, who says,

There’s a perception that weight stigma might feel bad but [that] it’s tough love and it’s going to motivate people… But research shows that this isn’t true.

Citing this and this research on the subject, Abrams writes,

Like other forms of bias and discrimination, weight stigma, also called sizeism, leads to suffering and psychological distress. Sizeism increases a person’s risk for mental health problems such as substance use and suicidality.

Perception of sizeism has been difficult to change

Sizeism is one of the most deeply entrenched stigmas in today’s society, partly because of “sociocultural ideals tying thinness to core American values such as hard work and individualism.” Abrams also notes that “weight-based bullying is more common than bullying based on race, sexual orientation, or disability status” among children, according to some research results published in the Journal of Adolescence. Sadly, family members are “high on the list of perpetrators.”

Psychologists have tested various interventions to reduce sizeism, including empathy-building and education about body weight. However, these approaches have had little effect on anti-fat biases. Unlike racism and sexism, weight discrimination remains legal in most places, with only a few states and cities banning it. This lack of legal protection allows weight-based discrimination in hiring, promotions, and wages to persist. Though public support exists for stronger protections, policy changes have been slow.

Shifting public health approaches

As our understanding of obesity has grown, so too has the way public health professionals approach the issue. The previous weight-centric model — where weight loss was the primary health goal — has come under scrutiny. Many experts now believe that focusing solely on weight loss can lead to negative outcomes, including weight cycling (repeatedly losing and regaining weight), increased stigma, and negative mental and physical health effects.

In response, a new weight-inclusive approach to health has gained momentum. This perspective promotes healthy behaviors — such as balanced eating, regular physical activity, and mental well-being — regardless of whether they lead to weight loss. This approach aims to reduce the harm caused by weight stigma and support people in improving their overall health, rather than fixating on a number on the scale.

The role of healthcare providers

Healthcare providers play a critical role in how obesity is addressed in medical settings. Historically, larger-bodied patients often experienced weight bias, even from their doctors. This stigma can lead to worse health outcomes, as patients may avoid seeking care or feel blamed for their condition rather than supported.

Today, there is a growing recognition of the need for more compassionate and inclusive care. Health professionals are encouraged to use person-first language (e.g., “person living with obesity”) to avoid reducing individuals to their weight. Additionally, clinicians are urged to shift their focus from weight to health behaviors, helping patients set goals around physical activity, nutrition, and mental well-being without making weight loss the central objective.

Your responses and feedback are welcome!

Source: “How we think about ‘obesity’ and body weight is changing. Here’s why,” The Conversation, 9/18/24
Source: “The burden of weight stigma,” American Psychological Association, 3/1/22
Image by RDNE Stock project

As Obesity Booms, Doctors Seek Additional Treatment Options

A recent article on Medscape highlights the work and the opinions of Dr. Gitanjali Srivastava, a professor of medicine, pediatrics, and surgery, and the medical director of Obesity Medicine at Vanderbilt University, who had been practicing pediatric medicine for nearly a decade before completing an obesity medicine fellowship at Massachusetts General Hospital in 2013. Reflecting on that time, she recalls that there were no established guidelines or curricula for the specialty.

At that point, obesity was already a widespread issue, but there was still significant stigma both in the medical field and among the general public. After completing her fellowship, Dr. Srivastava spent months traveling and meeting with hospital executives across the country, explaining the importance and value of obesity medicine, covering details about its budget, business model, space needs, and revenue potential.

Specialized obesity treatment gains traction

Today, the field of obesity medicine is growing rapidly. More patients are seeking obesity treatment, and healthcare systems are actively recruiting specialists and building metabolic health centers. Since 2020, the number of doctors certified by the American Board of Obesity Medicine (ABOM) has nearly doubled, and fellowships have more than doubled as well. This year, over 2,100 doctors from various specialties will take the board exam, marking obesity medicine’s increasing integration with other medical fields.

The growing demand for obesity treatment has coincided with the U.S. Food and Drug Administration’s approval of GLP-1 injections, which have shown remarkable weight loss effects. Dr. Marcio Griebeler, head of the obesity medicine fellowship at Cleveland Clinic, explains that the recognition of obesity as a chronic disease, rather than a lifestyle issue, has been long overdue. Obesity treatment has shifted away from advice about diet and exercise to a more scientific understanding of the disease.

Dr. Kimberly Gudzune, chief medical officer for the ABOM Foundation, and others highlight that the brain functions differently in people with obesity, making it more challenging for them to lose weight through willpower alone. New treatments like GLP-1 have shown that obesity can be managed with medication, much like conditions such as high blood pressure or diabetes, but the disease often returns if treatment stops.

More obesity management and treatment training is needed

As more patients seek obesity care, doctors from various specialties are being asked about obesity treatment options, yet many feel unprepared due to a lack of education in this area. Medical training has historically neglected obesity and metabolic health, according to Dr. Nina Paddu, an obesity medicine specialist, who notes that her own training barely addressed these topics.

Dr. Srivastava explains that while the medical community has long sought to establish guidelines for obesity treatment, only recently has enough evidence emerged to create standards. Over the past five years, understanding of obesity’s underlying causes has advanced, with research highlighting the brain’s role and its connections to other diseases. This progress is transforming the way multiple specialties, including endocrinology and surgery, approach obesity.

In response to the growing need, more doctors are pursuing additional training in obesity management. The ABOM offers two certification pathways: completing 60 hours of continuing medical education (CME) credits or undertaking a 12-month fellowship. Dr. Srivastava points out that while the fellowship is more intensive, many physicians are choosing to immerse themselves in it to further their careers. Some return to their previous specialties, but many take on roles specifically focused on obesity medicine.

Despite the field’s growth, there are still not enough obesity specialists to meet the rising demand. With only a small percentage of U.S. physicians certified by the ABOM, many patients may not have access to comprehensive care. Dr. Gudzune emphasizes that while the field is expanding, it remains small relative to the number of patients in need.

Liraglutide is safe for kids as young as six, study finds

Speaking of weight loss medications, a new study shows that liraglutide, a drug already approved for treating obesity in adults and teens, is safe and effective for children as young as six when combined with diet and exercise. The results of the study were published in The New England Journal of Medicine. The drug was found to reduce body mass and slow weight gain in kids aged 6 to 11. Based on these results, the manufacturer, Novo Nordisk, has asked U.S. regulators to expand its use for this younger age group. If approved, it would be the first drug authorized for treating the most common form of obesity affecting over 20% of U.S. children in this age range.

The study involved 82 children, with those receiving liraglutide showing a 5.8% reduction in body mass index (BMI) after over a year of treatment, compared to a BMI increase of 1.6% in the placebo group. Nearly half of the children taking the drug saw significant health improvements. However, side effects, particularly gastrointestinal issues like nausea and vomiting, were common. While experts welcome the potential benefits of the drug, they urge caution in its widespread use due to the risks and lack of long-term data.

The study highlights liraglutide’s potential to treat the underlying causes of obesity in young children, potentially preventing serious health issues like diabetes and heart disease later in life. The trial will continue, with further results expected in 2027.

Your responses and feedback are welcome!

Source: “Doctors Seek Additional Obesity Training in Wake of Obesity Patient Boom,” Medscape.com, 10/1/24
Source: “Weight-loss drug Saxenda effective for kids as young as 6, study shows,” MSN.com, 9/29/24
Source: “Liraglutide for Children 6 to <12 Years of Age with Obesity — A Randomized Trial,” NEJM.org, 9/10/24
Image by Accuray on Unsplash