Dr. Edward Lewis, a pediatrician in Rochester, New York, has seen hundreds of obese children over the years in his medical practice. He might finally have a treatment for his health problem: the powerful weight loss drug Wegovy.

But that doesn’t mean Dr. Lewis prescribes it. Most other pediatricians aren’t either.

“I’m reluctant to prescribe medications that we don’t use on a daily basis,” Dr. Lewis said. And, he added, he’s not inclined to use “a drug that’s a relative newcomer on the scene in children.”

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

Twenty-two percent of adolescents aged 12 to 19 suffer from obesity. Research shows that it is unlikely that most of them will be able to overcome this disease — diet and exercise advice generally didn’t help. According to obesity researchers, the reason is that obesity is not caused by a lack of willpower. Rather, it is a chronic illness characterized by an irresistible desire to eat.

Doctors are particularly concerned about 6 percent children and adolescents with severe obesity, defined as having a body mass index equal to or greater than 120% of the 95th percentile for height and weight.

“We’re not talking about children who are slightly overweight,” 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 adolescents develop diabetes, heart disease, high blood pressure, kidney failure and eye damage much earlier than obese adults.

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

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

When this happened, obesity medicine experts were notified, knowing full well the scale of the problem.

“We said, Wow, we finally have something to offer,” Dr. Yanovski said.

Yet drugs like Wegovy are new, and the barriers to their use are snowballing. Doctors also worry about the lack of data on long-term safety. And those who want to prescribe Wegovy say they face obstacles from health insurers as well as severe and persistent drug shortages.

The shortages could be at least partially alleviated if a similar drug, tirzepatide, from Eli Lilly and sold under the name Zepbound, was approved for young people. It is being tested in obese adolescents, but a large clinical trial won’t be completed until 2026. Eli Lilly is also testing the drug in children ages 6 to 11. This study is in its first phase.

For now, pediatricians in private practice and at academic medical centers say few, if any, of their patients take Wegovy. Depending on how safe the medication is, this hesitancy to prescribe it could be a good thing or a lost opportunity.

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

This concern is countered by the well-known long-term risks of obesity.

“It’s a trade-off with adolescents,” said Dr. Jeffrey Flier, an endocrinologist and obesity and diabetes researcher at Harvard Medical School. “Pediatric obesity is a major and growing problem. What are you doing about it?”

Medical specialists say pediatricians tend to be more cautious than other doctors when prescribing new medications and less likely to prescribe drugs outside their usual armamentarium. All this limits the suggestion of obesity medications to adolescents.

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

This is the experience of Ann A., an 18-year-old high school student from New York, who asked that only her middle name be used because of the stigma anyone who is obese faces. For years, she despaired as her weight increased, her blood sugar reached pre-diabetic levels, and her lipid levels rose abnormally. Her intense efforts at diet and exercise, and even her summer at a weight-loss camp, were unsuccessful. Each time, she regained everything she had lost, and more.

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

Wegovy, made by Novo Nordisk, reduces appetite and cravings. In a clinical test, 132 adolescents who took this drug had significantly better results than their adult counterparts. The incidence of side effects – mainly nausea and vomiting – was similar to that seen in adults taking this medication.

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

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

“My colleagues and I think we’re not there yet,” she said.

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

For those with private insurance, doctors are often required to submit pre-approval forms — a hurdle that also hampers doctors who treat adults.

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

However, for most of Dr. Fennoy’s patients, Wegovy is out of the question because they rely on Medicaid. In New York, as in most other states, Medicaid does not cover Wegovy, regardless of the severity of the obesity. The only exception is adolescents who also have diabetes, in which case they can get another drug from Novo Nordisk, Ozempic.

“If you’re not diabetic but have severe hypertension, you’re out of luck in New York,” Dr. Fennoy said.

This is a barrier that most obese adults do not face, because there are far fewer adults insured by Medicaid than there are children.

Then there are the persistent drug shortages. Parents say they have called dozens of pharmacies, only to be told that Wegovy is out of stock.

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

“This is the landscape we face,” she said.

Some who have treated teens with Wegovy say it’s not easy to broach the idea of ​​taking this medication.

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 do we reconcile the message when we tell a child that weight doesn’t define them, that it’s just a number,” and then, in the next breath, suggest the child take a weight-loss medication?

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

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

That, said 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 the endocrine system should do this, or the gastrointestinal system should do this, or that we should have an entirely special clinic,” she said.

But, she said, it’s not clear where to send patients.

“Unlike most diseases, there is no specialized home for obesity and, therefore, no one person owns it,” Dr. Sisley said. “There’s no place to say, ‘OK, you solve the problem.’ It’s easy to say, “Not me.”

And, she added, so many teens suffer from obesity that there simply aren’t enough specialists available to help them.

For Ann, the New York teenager, the outcome is happy. She is currently 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 says, her life has changed. She lost 50 pounds and the shame that came with her weight disappeared, as did the medical issues.

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

Leave a Reply

Your email address will not be published. Required fields are marked *