Use of weight-loss drugs increases among adolescents

Key takeaways:

• AAP began recommending weight-loss medications for adolescents with obesity in 2023.
• Providers prescribed medications more often after the guidelines came out, but lifestyle medicine remains far more common.

Although prescriptions for weight-loss medication have increased for adolescents with obesity in the years since the AAP started recommending them, lifestyle treatment remains much more common, a study found.

The AAP issued a policy statement at the beginning of 2023 recommending that physicians offer weight-loss medication to adolescents aged 12 years or older and evaluate teens for bariatric and metabolic surgery. The authors noted that the increase in prescriptions could be tied to the explosion in interest in GLP-1 medications for weight loss, as well as greater acceptance for using anti-obesity drugs.

“The AAP guidelines led to criticism and broad public unease about indiscriminate use of these medications, particularly in young children,” Davene R. Wright, PhD, associate professor of population management at Harvard Medical School, told Healio. “The data show this is not the case.”

Wright and colleagues compared how often physicians prescribed different weight-loss treatments to their pediatric patients before and after the AAP published its guidance. They analyzed electronic health records from a subset of 30 U.S health systems, for 310,503 children and adolescents (45.9% girls; mean age, 13.2 years) aged 8 to 17 years who were eligible for obesity treatment and visited a physician between Jan. 1, 2021, and Dec. 31, 2024. Roughly half of the visits occurred before the AAP published its guidance in January 2023, and just over half occurred after.

The patients’ mean BMI percentile was 97.4 (standard deviation, 1.6), and one-third had class 2 or class 3 obesity (23.2% and 12.5%, respectively). Most (96.2%) visits where the clinician was known were with primary care providers, the researchers noted.

Out of 281,807 patients who did not have evidence of nutrition counseling before their documented visit, 9.7% had evidence of lifestyle treatment during the study period. Lifestyle treatment rates increased over the 4-year study period, but Wright and colleagues did not find a significant difference in how often providers referred patients for nutrition counseling before or after the guidelines were published.

In contrast, prescriptions for medications increased significantly after the guidelines were published, according to the authors. An estimated 0.4% of patients received new prescriptions for weight loss medications during the study period, and clinicians were 65% more likely to prescribe them after Jan. 1, 2023 (OR = 1.65; 95% CI, 1.23-2.21). Prescription rates increased 5% per month after the AAP published its guidelines.

Metformin was the most commonly prescribed medication before and after the new guidance, but the proportion of patients receiving metformin decreased afterward (80.2% before vs. 63% after), according to the researchers. Compared with before the guidelines were published, the proportion of patients receiving semaglutide increased 10-fold (2.5% vs. 26.8%; P <0.01).

Wright said kids who received medications tended to be older and have more severe obesity.

“Lifestyle intervention remains far more common than medications for weight management,” she said. However, only 1 in 10 eligible children were referred to nutritional counseling, Wright said, showing there is room for improvement.

“Continued research is needed to better understand long-term safety, effectiveness and access to care — especially as clinical practice and public discourse evolve related to the use of anti-obesity medications in adolescent populations,” Tricia Rodriguez, PhD, MPH, director of applied research at Truveta, told Healio.

References:

For more information:

Davene R. Wright, PhD, and Tricia Rodriguez, PhD, MPH, can be reached at ellief@truveta.com.