New drugs can cure obesity in teenagers, but young people don’t get them

Dr. Edward Lewis, a pediatrician in Rochester, NY, has seen hundreds of obese children in his medical practice over the years. He may finally get treatment for their medical condition: the powerful weight-loss drug Wegovy.

But that doesn’t mean Dr. Lewis prescribes it. And neither do most other pediatricians.

“I’m hesitant to prescribe medications that we don’t use every day,” said Dr. Lewis. And, he added, he is not inclined to use “a drug that is a relative newcomer to the pediatric field.”

Regulators and medical groups have all said these drugs are suitable for children aged 12 and over. But just like Dr. Lewis, many pediatricians are hesitant to prescribe Wegovy to young people because they fear that too little is known about the long-term effects, and are aware of the past. cases where problems arose years after a drug was approved.

Twenty-two percent of adolescents between 12 and 19 years old are overweight. Research shows that It is unlikely that most will ever overcome the condition – advice about diet and exercise has usually not helped. The reason, obesity researchers say, is that obesity is not caused by a lack of willpower. Instead, it is a chronic disease characterized by an overwhelming desire to eat.

Of particular interest to physicians are the 6 percent of children and adolescents with severe obesity, which is defined as a body mass index of 120 percent or more of the 95th percentile for height and weight.

“We’re not talking about mildly overweight children,” said Susan Yanovski, co-director of the Office of Obesity Research at the National Institute of Diabetes and Digestive and Kidney Diseases. Such extreme obesity in adolescents, she said, often has “a very serious course.” These teens are much more likely to develop diabetes, heart disease, high blood pressure, kidney failure and eye damage than obese adults.

“It’s terrifying,” added Dr. Yanovsky added.

The severity of health outcomes for obese teens motivated the American Academy of Pediatrics to do so recommend weight-loss drugs like Wegovy for adolescents in January, after the Food and Drug Administration approved it for people 12 and older.

When that happened, obesity medicine experts were elated, knowing full well the magnitude of the problem.

“We said, Wow, we finally have something we can offer,” said Dr. Yanovksi.

Yet drugs like Wegovy are new, and barriers to their use are increasing. Doctors are also concerned about the lack of data on long-term safety. And those who want to prescribe Wegovy say they are beset by roadblocks from health insurers, along with severe and persistent drug shortages.

The shortages could be at least partially alleviated if a similar drug, tirzepatide, made by Eli Lilly and sold as Zepbound, is approved for young people. It is being tested in obese adolescents, but a necessary large clinical trial will not be completed until 2026. Eli Lilly is also testing the drug in children aged 6 to 11 years. That study is in its earliest phase.

For now, pediatricians in private practice and at academic medical centers say few if any of their patients are using Wegovy. Depending on how safe the drug turns out to be, that hesitation to prescribe it could be a good thing, or a missed opportunity.

Doctors are all too aware that the history of medicine is full of treatments, including for weight loss, that seemed great until, with more experience, they weren’t.

Countering these concerns are the known long-term risks of obesity.

“This is the trade-off with adolescents,” says Dr. Jeffrey Flier, an endocrinologist and obesity and diabetes researcher at Harvard Medical School. “Children’s obesity is a major and increasing problem. What do you do about it?”

Medical specialists say pediatricians tend to be more cautious than other doctors when prescribing new medications and are less likely to prescribe drugs outside their usual arsenal. All of this limits their suggestions for anti-obesity medications to teenagers.

Adolescents report that their attempts to control obesity can seem like a losing battle, compounded by frustration with set advice on diet and exercise and assurances that they will outgrow the condition.

That was the experience of Ann A., an 18-year-old high school student in New York City, who asked to use only her middle name because of the stigma attached to anyone with obesity. For years, she was in despair as her weight crept up, her blood sugar rose to pre-diabetes levels and her lipid levels rose abnormally high. Her strenuous attempts at dieting and exercise, and even her summer at a weight-loss camp, were to no avail. Each time, she regained everything she lost and more.

Her mother took her from doctor to doctor, but, Ann said, the advice was the same: “It was always that I wasn’t eating right.”

Wegovy, made by Novo Nordisk, reduces appetite and food cravings. In a clinical trial132 adolescents who took the drug fared much better than their adult counterparts. The incidence of side effects – especially nausea and vomiting – was similar to the incidence in adults taking the drug.

But as Dr. Yanovski noted, much is unknown about how the drugs work, and the long-term effects may be different if treatment begins in adolescence.

That’s a concern for Dr. Winter Berry, a pediatrician in private practice in Syracuse, NY, who is concerned about “the lack of data” on long-term use. She said she and other pediatricians were not philosophically opposed to prescribing Wegovy. But, she says, “we want to do it right.”

“My colleagues and I feel like we are not there yet,” she says.

For Dr. Ilene Fennoy, professor of pediatrics at Columbia University Irving Medical Center, health insurance is a major obstacle.

For people with private insurance, doctors are often required to submit prior approval forms — an obstacle that also hinders doctors who treat adults.

“Someone has to sit down and put the data together,” said Dr. Fennoy, adding that “it’s not quick and easy.” This barrier, combined with uncertainty about the drug’s safety, has prompted some doctors to withdraw.

For most of Dr.’s patients. Fennoy, however, Wegovy is excluded because they rely on Medicaid. In New York, as in most other states, Medicaid does not pay for Wegovy, no matter how severe the obesity. The only exception is for adolescents who also have diabetes. In that case, they can be given another Novo Nordisk drug, Ozempic.

“If you don’t have diabetes but have severe high blood pressure, you’re out of luck in New York,” said Dr. Fennoy.

That’s a hurdle that most adults with obesity don’t face, because far fewer adults are insured through Medicaid than children.

Then there are the ongoing drug shortages. Parents report calling dozens of pharmacies only to be told Wegovy is on back order.

One of Dr.’s teenage patients Fennoy weighs 450 pounds – so heavy that he had to undergo hip surgery. “I approved his Wegovy, but his parents can’t find a pharmacy that has it,” said Dr. Fennoy.

“This is the landscape we are dealing with,” she said.

Some who have treated adolescents with Wegovy say it is not easy to bring up the idea of ​​using the drug.

Dr. Ihuoma Eneli, chief of the nutrition section at Children’s Hospital Colorado and professor of pediatrics at the University of Colorado School of Medicine, explained the problem she and other pediatricians were grappling with: “How can we reconcile the message when we tell a child that weight does not define him, that it is just a number, and then, in the next breath, suggest that the child takes a weight-loss drug?

Dr. Eneli, author of the American Academy of Pediatrics guidelines, says she tries to focus the conversation on the adolescent’s health — “not just physical health, but psychosocial health as a reason to consider the medication .”

Sometimes pediatricians decide that avoiding such problems is the best solution by sending an adolescent to a pediatric endocrinologist or other specialist.

That, says Dr. Stephanie Sisley, a pediatric endocrinologist and obesity medicine specialist at Baylor College of Medicine and Texas Children’s Hospital, doesn’t solve the problem.

“It’s easy to say that endocrine should do that, or that GI should do that, or that we should have a very special clinic,” she said.

But, she said, it is not clear where the patients should be sent.

“Unlike most diseases, there is no dedicated institute for obesity and therefore no one owns it,” said Dr. Sisley. “There’s no place where you can say, ‘Okay, solve the problem.’ It’s easy to say, “I don’t.”

And, she added, there are so many adolescents with obesity that there simply aren’t enough specialists available to help them.

For Ann, the teenager in New York, the outcome is a happy one. She is now being treated by Dr. Dina Peralta-Reich, an obesity medicine specialist in New York, who told her that her obesity was not her fault and suggested Wegovy.

Now, Ann said, her life has changed. She has lost 50 pounds and the shame associated with her weight is gone, as are the medical problems.

“I feel better not only physically but also mentally,” she said.