Weight-Loss Drugs on the Horizon

There are medications that a child needs in order to preserve life, improve an aspect of health, or prevent a damaging condition from occurring. With some pharmaceutical products, like for instance GLP-1 weight-loss drugs, the case is not so clear-cut, and the use of such products on children can initiate a vigorous discussion among adults.

At any rate, no one wants to see minors sticking hypodermic needles into themselves. Even adults who need to treat their type 2 diabetes would prefer not to carry out the self-injection process day after day, but they don’t have a choice.

A healthcare marketing research and business consulting firm called DelveInsight is one of several similar companies that issue annual reports on the state of the pharmaceutical arts. The typical report covers the “present clinical development scenario and growth prospects” in the specialized market of weight loss and weight management. It describes “pipeline products from the pre-clinical developmental phase to the marketed phase.” According to DelveInsight,

In the report, a detailed description of the drug is proffered including mechanism of action of the drug, clinical studies, NDA approvals (if any), and product development activities comprising the technology, Weight Loss/Weight Management (Obesity) collaborations, licensing, mergers and acquisition, funding, designations, and other product-related details.

Such a report includes all the companies in the field, along with descriptions of their various products in early-, mid-, and late-stage development. It includes information on the drug’s target receptor within the human organism, along with the route of administration, mechanism of action, molecular type, and whether it is suitable for monotherapy or combination therapy. The list of “key questions” covered by the report comprises 14 areas of inquiry. This year’s report covers more than 80 companies and 100 pipeline drugs. So there is a lot going on.

Weird and unanticipated

The human body has a vested interest in keeping unknown and potentially dangerous chemicals out of itself. Where medicine is concerned, in many cases the body can adapt, even though that might take time and entail discomfort. Science persists in trying to find ways to make ingestion work because needles are expensive, a lot of trouble to use properly and dispose of, and just generally icky.

Now let’s segue to tomorrow, and a fascinating article by Anil Oza about an amazing innovation the future might bring to the realm of drugs that require needles because the destructive nature of stomach acid precludes oral delivery. Very recently, STATNews.com reported on a device that is under development after drawing its inspiration from sea creatures. Hopefully, this item will introduce into the body drugs that formerly had to be injected either quickly by syringe or slowly via intravenous drip.

Described as blueberry-sized, it is meant to be swallowed. Also,

It then uses jets, modeled after the organs cephalopods use to propel themselves through the water and to release ink, to eject drugs into the tissue lining the digestive tract. The researchers report […] a series of experiments that serve as a proof of concept, showing that the device was more efficient at delivering drugs than other methods of delivering drugs orally.

The innovation has been tested on a pig, with GLP-1 drugs, and the outlook is promising although of course a long and complicated program of testing and more testing lies ahead. But the implications are exciting, especially if the results will make useful drugs available to children without the necessity for needles.

Your responses and feedback are welcome!

Source: “Obesity Pipeline Insight, 2024,” DelveInsight.com, undated
Source: “A new device for delivering drugs without needles draws inspiration from the elegant squid,” STATNews.com, 11/20/24
Image by Dawn Pedersen/Attribution 2.0 Generic

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