Thursday, May 23, 2024

Dr. Edward Lewis, a pediatrician in Rochester, N.Y., has seen hundreds of children with obesity over the years in his medical practice. He finally may have a treatment for their medical condition – the powerful weight loss drug Wegovy. But that does not mean Dr. Lewis is prescribing it. Nor are most other pediatricians. “I am reluctant to prescribe medications we don’t use on a day-to-day basis,” Dr. Lewis said. And, he added, he is disinclined to use “a medicine that is a relative newcomer to the scene in kids.”
Regulators and medical groups have all said that these drugs are appropriate for children as young as 12. But like Dr. Lewis, many pediatricians hesitate to prescribe Wegovy to young people, fearful that too little is known about long term effects, and mindful of past cases when problems emerged years after a drug was approved.
Twenty-two percent of adolescents age 12 to 19 have obesity. Research shows that most are unlikely to ever overcome the condition – advice to diet and exercise usually has not helped. The reason, obesity researchers say, is that obesity is not caused by a lack of will power. Instead, it is a chronic disease characterized by an overwhelming desire to eat.
Of particular concern to doctors are the 6 percent of children and adolescents with severe obesity, which is defined as having a body mass index at or above 120 percent of the 95th percentile for height and weight. “We are not talking about kids who are mildly 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 really severe course.” These teenagers develop diabetes, heart disease, high blood pressure, kidney failure and eye damage much earlier than adults with obesity. “It is terrifying,” Dr. Yanovski added.
The seriousness of health outcomes for obese teenagers motivated the American Academy of Pediatrics to recommend weight loss drugs like Wegovy for adolescents in January, after the Food and Drug Administration approved it for people age 12 and older. When that happened, experts in obesity medicine were elated, knowing full well the scope of the problem. “We said, Wow, we finally have something we can offer,” Dr. Yanovksi said.
Still, drugs like Wegovy are new, and the impediments to using them are snowballing. Doctors also worry about the dearth of data on long-term safety. And those who want to prescribe Wegovy say that they are beset by roadblocks put up by health insurers along with severe and continuing drug shortages.
The shortages might be at least partly alleviated if a similar drug, tirzepatide, by Eli Lilly and sold under the name Zepbound, is approved for younger people. It is being tested in adolescents with obesity, but a necessary large clinical trial will not be completed until 2026. Eli Lilly is also testing the drug in children age 6 to 11. 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 taking Wegovy. Depending on how safe the drug turns out to be, that hesitation to prescribe it could be good, or a lost opportunity. Doctors are all too aware that the history of medicine is replete with treatments, including for weight loss, that seemed wonderful until, with more experience, they weren’t. Countering that worry are the well-known long-term risks of obesity.
“This is the trade-off with adolescents,” said Dr. Jeffrey Flier, an endocrinologist and obesity and diabetes researcher at Harvard Medical School. “Pediatric obesity is a big and increasing problem. What do you do about it?”

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