Written by Hannah Harp
Spoon Feed
GLP-1RAs can be an important component of obesity management in conjunction with nutritional and behavioral health support and consideration of the risks of nutritional deficiency and restrictive eating.
Stop, think, inject – considering the whole patient when using GLP-1RAs
Obesity is on the rise in all ages, and adolescent obesity really predisposes to adult obesity –obese adolescents have an 89% chance of going on to have adult obesity. This state-of-the-art review describes the history of weight loss medications, the timeline of approval of GLP-1RAs for pediatric populations, efficacy, side effects, and risks when used in the pediatric and adolescent population. Liraglutide, a once-daily injection, and semaglutide, a weekly injection, are FDA-approved for children 12 and older with obesity, and there are trials underway for children ages 6 – 12. Drawing on multiple randomized controlled trials, semaglutide and liraglutide demonstrated significant weight reductions of 16.1% and 4.29%, respectively versus placebo (p < 0.001 for both). Both agents also improved obesity-related comorbidities with tolerable side effect profiles and drop-out rates of 5-10%, similar to the adult population.
These findings support GLP-1RAs as effective pharmacologic adjuncts to lifestyle therapy in pediatric obesity management. Behavioral health is recommended due to increased incidence of psychosocial issues in children with obesity. The article highlights the risk of exacerbating nutritional deficiencies and restrictive eating, necessitating screening for ARFID and disordered eating behaviors prior to use, and voices concern about worsening health disparities, given the high cost and variable insurance coverage. The only information that I feel is missing from this review is an overview of long-term side effect profile, long-term maintenance of weight loss, and long-term maintenance of healthier lifestyle practices while on these drugs.
How will this change my practice?
I’m so happy the authors recommend a multi-disciplinary treatment program with a hefty focus on behavioral health when using these medications, and I’m excited to see how effective these treatments can be at inspiring healthy lifestyle changes.
Source
GLP-1 Receptor Agonists in Pediatric and Adolescent Obesity. Pediatrics. 2025 Apr 1;155(4):e2024068119. doi: 10.1542/peds.2024-068119. PMID: 40031990
