The decision to use weight loss pharmacotherapy for teenagers who have obesity should involve a personalized approach, specific to each patient.
“Adolescent obesity is a critical public health issue that affects 26% of adolescents,” Neil Skolnik, MD, wrote in a viewpoint published in JAMA Pediatrics. “Guidelines recently published by the American Academy of Pediatrics (AAP) provide a much-needed update focusing on important advances in our understanding of the evaluation and management of obesity in children and adolescents.”
One recommendation in the guideline, which was published in Pediatrics, states that pediatricians and pediatric healthcare providers “should” offer weight loss pharmacotherapy to adolescents aged 12 and older with obesity (BMI, ≥95th percentile), based on medication indications and the risk-benefit profile, as an add-on to health behavior and lifestyle interventions.
In his viewpoint, Dr. Skolnik noted that the guideline employs the phrase “should offer” rather than “may offer” with regard to pharmacotherapy.
“This prescriptive statement means the recommendation applies broadly to all adolescents with obesity,” he wrote. “The guideline specifies that medication should be offered as an adjunct to lifestyle intervention. It does not recommend offering medication only after an adequate trial of lifestyle intervention.”
Physician’s Weekly spoke with Dr. Skolnik to learn more about his thoughts on the AAP statement and the management of pediatric obesity.
PW: Why did you focus on the statement about pharmacotherapy?
Dr. Skolnik: Correct use of modern pharmacotherapy is critically important in the treatment of obesity. The glucagon-like peptide-1 (GLP-1) receptor agonists in particular have advanced our ability to treat obesity in a safe, healthy, and effective manner for both adults and adolescents. I focused on this statement because it recommends a one-size-fits-all approach by saying providers should offer this group weight loss pharmacotherapy.
Every teenager is different, with different backgrounds, motivators, values, and preferences. When it comes to recommending a medication that has a reasonable chance of being needed long term, which may be 70 years or more for a teenager, we have a responsibility to carefully engage the teenager and their family in a detailed discussion and make the decision an individual one.
What were your specific concerns?
First is the use of the word “should.” In my opinion, weight loss pharmacotherapy is underused for adolescents, and the guidelines should have made clear to clinicians that weight loss medications are on the map for use in the treatment of obesity in teenagers. They could have accomplished that by using the less prescriptive word “may.” By using the word “should,” they risk the possibility that the guideline is misinterpreted as trying to establish a standard of care where every teenager who is obese should be treated with weight loss medications.
There are many reasons this is not a good idea. People differ in their degree of obesity, their motivation to change their eating and exercise habits, their family history, and levels of support, as well as the metabolic consequences they experience due to obesity.
What are the take-home messages of your viewpoint?
The take-home message is that this is an important class of medications that can offer enormous benefit to teenagers who are obese when the medications are used correctly. To use the medications correctly, we need to treat individuals as individuals and understand the context in which the individual’s obesity has occurred, as well as their motivations and values, before making a recommendation about the use of weight loss pharmacotherapy.
How can pediatricians apply these insights in their practices?
Pediatricians, family doctors, and other clinicians who take care of teenagers are already good at talking with patients about sensitive subjects. This is another one that we should regularly address and help determine which patients would best benefit from weight-loss pharmacotherapy.
