Obesity in the adolescent and young adult populations

Obesity in the adolescent and young adult populations | Image Credit: © alekseyvanin - © alekseyvanin - stock.adobe.com.

In the article, “Adolescent GLP-1 prescriptions increase 6-fold from 2020 to 2023,” I found the data that one-fourth (26.4%) of all providers who prescribed GLP-1 medications to adolescents were nurse practitioners (NPs), very interesting.¹ Since the practice area of the NP prescribers was not included in the research letter cited,² I immediately began to think about the current education of NP students and/or continuing educational needs of NPs who are prescribing GLP-1 medications. Thus, the question becomes, how were the NP prescribers educated in the care of adolescents who are obese who most often have emotional problems secondary to the diagnosis of obesity?

Additional questions to consider

The article also brings to the forefront several thought-provoking questions related to prescribing GLP-1 drugs to the adolescent population:

1). What precipitated the 6-fold increase in prescribing GLP-1 drugs to the adolescent populations from 2020 to 2023?

2). What were the BMIs for the 31,000 adolescents who were prescribed GLP-1 drugs in 2023?

3). Did most of the adolescents have a concurrent diagnosis of type 2 diabetes mellitus?

4). What is the current best available evidence-based practice for prescribing GLP-1 drugs to the pediatric populations?

5). Is the potential for sides effects of the drugs considered for each individual adolescent who is prescribed the drug?

6). Are there rigorous investigations in place that are studying the possible long-term effects of GLP-1 drugs prescribed during the adolescent years?

Anticipatory guidance

Equally as important to considering the above questions, is a question that asks what anticipatory guidance is needed prior to and during the discussion between the provider, the adolescent, and the parent on the expected outcomes of the treatment plan. Are the facts discussed with the adolescent and parent: most often the drug is prescribed for 12 to 24 months, and that planned and implemented behavioral changes are equally as important as the taking the medication to achieve and then maintain the weight loss goal once the GLP-1 drugs are no longer prescribed? Current available data reveals that after 68 weeks of semaglutide injections, the average patient lost more than 15% of their body weight. However, within 12-months of stopping the GLP-1 medications, patients had regained two thirds of the weight that was lost while on semaglutide injections.³

Clinical practice guideline for children and adolescents with a diagnosis of obesity

The best available evidence-based practice for prescribing GLP-1 drugs to the pediatric populations, is addressed in the 2023 American Academy of Pediatrics (AAP) first clinical practice guideline titled, “Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity.”Current data reveal that 14.4 million children and adolescent are diagnosed as obese. In addition to detailed information about obesity management, the AAP clinical practice guideline (CPG) discusses provider qualifications in the management of children and adolescents with a diagnosis of obesity. The recommendation is for providers to be knowledgeable about “patient selection criteria, medication efficacy, adverse effects, and follow-up monitoring guidelines.”Additionally, the authors of CPG suggest considering a referral to pediatric obesity experts and/or treatment centers to assure that providers are not prescribing weight loss medications are as monotherapy.Behavioral interventions are also critically needed to achieve successful and sustainable weight loss in the adolescent populations through therapies that impact meaningful behavioral changes to achieve the outcome goal of establishing healthier life styles in the adolescent years that are sustained throughout adulthood.⁴

Research question

A research study that asks NPs about their education and prescribing practices for children and adolescents with a diagnosis of obesity is needed to determine the next best steps for educating NPs in their clinical programs and for continuing education programs.⁵ NP educators should also be asked about the current educational preparation and clinical experiences of NP students. Study results have the potential of changing the current obesity crisis.

References:

1. Kunzmann K. Adolescent GLP-1 prescriptions increase 6-fold from 2020 to 2023. Contemporary Pediatrics.May 23, 2024. Accessed July 22, 2024. https://www.contemporarypediatrics.com/view/adolescent-glp-1-prescriptions-increased-6-fold-2020-2023

2. Lee JM, Sharifi M, Oshman L, Griauzde DH, Chua KP. Dispensing of Glucagon-Like Peptide-1 Receptor Agonists to Adolescents and Young Adults, 2020-2023. JAMA. 2024;331(23):2041-2043. doi:10.1001/jama.2024.7112

3. Cox D. What happened when you stop taking weight-loss drugs? BBC.May 21, 2024. Accessed July 22, 2024. https://www.bbc.com/future/article/20240521-what-happens-when-you-stop-taking-ozempic

4. Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity [published correction appears in Pediatrics. 2024 Jan 1;153(1):e2023064612. doi: 10.1542/peds.2023-064612]. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640

5. Collins L, Costello RA. Glucagon-Like Peptide-1 Receptor Agonists. In: StatPearls. Treasure Island (FL): StatPearls Publishing; February 29, 2024.