Prescribing GLP-1 Drugs 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
