Recent data reveal a troubling trend in adolescent obesity rates in the United States, with approximately one in five adolescents affected by this chronic disease.
Obesity not only influences physical health but also has profound implications for social and emotional well-being. It significantly heightens the risk of major health issues such as type 2 diabetes mellitus (T2DM) and heart disease, which can persist into adulthood.
In a noteworthy turn, the Food and Drug Administration (FDA) expanded its approval in 2022 for the use of obesity medications like phentermine and topiramate, as well as semaglutide, for adolescents aged 12 to 17 years seeking chronic weight management.
Following this change, the American Academy of Pediatrics (AAP) issued new guidelines in early 2023 recommending that obesity medications, specifically glucagon-like peptide-1 receptor agonists (GLP-1RAs), be offered alongside health behavior and lifestyle treatment for adolescents aged 12 years and older.
While previous studies have indicated a sharp increase in prescriptions for GLP-1RAs among adolescents, comprehensive data for obesity medications remain sparse.
A recent study projected staggering increases from 504% among boys to 588% among girls in prescriptions for GLP-1RAs from 2020 to 2023 without assessing individual body mass index (BMI) categories.
Similarly, another study highlighted a rise in prescriptions following the release of the AAP guidelines, even for off-label uses, without addressing the prescribing factors in detail. This report aims to address these gaps by assessing trends in prescription prevalence and characteristics of adolescents receiving FDA-approved obesity medications.
**Understanding the Study’s Methods**
The analysis utilized data from IQVIA Ambulatory Electronic Medical Records (EMR) spanning 2018 to 2023, focusing on adolescents aged 12 to 17 years with recorded obesity (defined as a BMI at or above the 95th percentile).
These records indicated whether individuals received prescriptions for FDA-approved obesity medications—specifically orlistat, phentermine, phentermine-topiramate, setmelanotide, liraglutide, and semaglutide—during the calendar year their obesity was documented.
Notably, the analysis intentionally excluded medications not specifically approved for obesity treatment in adolescents.
For the years 2018 to 2023, the primary outcome measured was the presence of a prescription for obesity medication at least once per patient annually. Variational trends were assessed, revealing that prescriptions overall were on the rise.
**Yearly Analysis of Obesity Medication Prescriptions**
The analysis revealed that out of 526,973 adolescents with obesity, only 0.1% obtained obesity medication prescriptions in 2020. This number rose gradually, reaching 0.5% in 2023, marking a significant increase relative to prior years.
By 2023, the proportion of adolescents prescribed obesity medications had surged by over 300% when compared to the numbers from 2020. Notably, semaglutide emerged as the most frequently prescribed medication, followed by combinations of phentermine and topiramate.
The prevalence of obesity medication prescriptions among adolescents reveals a complex picture, highlighting both strides in addressing adolescent obesity and the stark reality that less than 1% received such treatments in 2023.
**Analyzing Patient Characteristics**
A closer examination of the 2023 data showcased that a significant percentage of adolescents receiving prescriptions had severe obesity, with 82.9% of those prescribed obesity medications falling into this category.
When analyzed by demographics, it became clear that characteristics such as age, sex, and geographic location influenced prescription rates.
For instance, girls were found to be more likely than boys to be prescribed these medications. Additionally, older adolescents were more likely to receive prescriptions, with rates notably elevated in boys aged 15 to 17 compared to their younger counterparts.
Geographically, adolescents residing in the West and South were more frequently prescribed obesity medications than those in the Northeast.
However, disparities also emerged based on race. A significant proportion of Black adolescents had severe obesity compared to their White counterparts, yet they were notably less likely to be prescribed obesity medications. This discrepancy raises questions surrounding equity in healthcare access and treatment opportunities.
The study highlights a troubling trend in which despite higher prevalence rates of severe obesity among Black adolescents, their likelihood of receiving treatment was substantially lower than that of White adolescents.
**Implications of the Findings**
The study’s findings elucidate a critical concern for public health. While the uptick in the proportion of adolescents prescribed medications is promising, the overall rate remains alarmingly below what would be expected given the prevalence of obesity in this demographic.
Close to 83% of those receiving prescriptions had severe obesity—indicating that healthcare providers may be targeting their intervention efforts towards the most at-risk populations. However, the factors influencing prescribing rates warrant further investigation.
Potential barriers such as medication availability, high costs, and insurance coverage limitations could obstruct access to these necessary treatments.
Moreover, health care providers’ sentiments about medication safety and efficacy, and their experience or comfort level with prescribing these treatments, could also affect prescription trends.
**Need for Continued Monitoring and Public Health Strategies**
Given the increase in obesity medication prescriptions among adolescents, the necessity for ongoing monitoring of both efficacy and safety is more crucial than ever.
Concerns related to potential side effects, including the impact of recent GLP-1RA shortages and related counterfeit medications, also underline the importance of ensuring safety in prescribing practices.
All adolescents, especially those prescribed obesity medications, must receive comprehensive, evidence-based health behavior interventions aimed at achieving sustainable lifestyle changes. These strategies are essential for promoting greater health outcomes and improved quality of life.
Moving forward, public health and healthcare organizations must assess their capabilities to deliver evidence-based interventions effectively, ensuring that all adolescents in need of obesity treatment, including both medications and lifestyle modifications, can access these valuable resources.
In conclusion, while there has been a notable increase in prescribed obesity medications, the findings from this study signal the continued need for a holistic approach to treating adolescent obesity—one that promotes equitable access to both medical treatments and empowering lifestyle strategies.
image source from：https://www.cdc.gov/mmwr/volumes/74/wr/mm7420a1.htm
