Dr. Edward Lewis, a pediatrician in Rochester, New York, has seen hundreds of obese children in his medical practice over the years. He may finally have access to Wegoby, a powerful weight loss drug that treats their condition.
But that doesn't mean Dr. Lewis is prescribing it. So do most other pediatricians.
“I don't feel comfortable prescribing drugs that I don't use on a daily basis,” Dr. Lewis said. And, he added, he is reluctant to use “relatively new drugs for children.”
Both regulatory agencies and medical groups say these drugs are suitable for children as young as 12 years old. But like Dr. Lewis, many pediatricians are hesitant to prescribe Wegoby to young people, fearing that little is known about the long-term effects and keeping in mind the past. If problems arise years after the drug is approved.
22 percent Obesity among adolescents aged 12 to 19 years. According to research, Most people are unlikely to overcome this condition — Diet and exercise advice is usually ineffective. That's because obesity isn't caused by a lack of willpower, obesity researchers say. Rather, it is a chronic disease characterized by an overwhelming desire to eat.
Of particular concern to physicians, 6 percent Number of children and adolescents with severe obesity. Body mass index is defined as being at least 120 percent of the 95th percentile for height and weight.
“We're not talking about children who are mildly overweight,” said Susan Yanofsky, co-director of the Obesity Laboratory at the National Institute of Diabetes and Digestive and Kidney Diseases. Such extreme obesity in adolescence often has a “very serious course,” she says. These teens develop diabetes, heart disease, high blood pressure, kidney failure, and eye damage much earlier than obese adults.
“It's scary,” Dr. Yanofsky added.
The health implications for obese teens are so severe that the American Academy of Pediatrics has led the American Academy of Pediatrics to: Recommendation to In January, the Food and Drug Administration approved weight-loss drugs like Wegovy for adolescents 12 and older.
When that happened, obesity medicine experts were elated because they were well aware of the scope of the problem.
“We said, 'Wow, we finally have something we can offer,'” Dr. Yanofsky said.
Still, drugs like Wegoby are new, and the obstacles to their use are snowballing. Doctors are also concerned about the lack of long-term safety data. And those seeking prescriptions for Wegoby say they are plagued by serious and continuing drug shortages, as well as obstacles set up by health insurance companies.
The shortage could be alleviated, at least in part, if a similar drug, tirzepatide, sold by Eli Lilly and Co. under the name Zepbound, is approved for use in young people. The drug is being tested in adolescents with obesity, but the necessary large-scale clinical trials are not expected to be completed until 2026. Eli Lilly is also testing the drug in children ages 6 to 11. This trial is still in its early stages.
So far, pediatricians at private practices and academic medical centers say few, if any, patients are taking Wigoby. Depending on how safe the drug turns out to be, hesitance to prescribe it may be a good thing or a missed opportunity.
Physicians are well aware that the history of medicine is full of treatments, including weight loss, that seemed great but after more experience turned out to be less so.
Countering that worry are the well-known long-term risks of obesity.
“This is a trade-off with youth,” says Dr. Jeffrey Fryer, an endocrinologist and obesity and diabetes researcher at Harvard Medical School. “Childhood obesity is a big problem and it's getting worse. What do we do about it?
Pediatricians tend to be more cautious than other doctors in prescribing new drugs and are less likely to prescribe drugs outside of their usual prescriptions, medical experts say. All of this limits their proposed obesity drugs to teenagers.
Adolescents report that attempts to control obesity can seem like a losing battle made worse by frustration with diet and exercise advice and assurances that they will overcome obesity. .
This is the experience of Ann A., an 18-year-old high school student living in New York City. She asked that only her middle name be used because of the stigma that attaches to obese people. She despaired for years as her weight gradually increased, her blood sugar levels rose to prediabetic levels, and her lipid levels became abnormally high. Her hard work on diet, exercise, and summer weight loss camps was in vain. Each time, she regained everything she had lost and more.
Anne's mother took her from doctor to doctor, but Anne's advice was the same. She said, “It was always the same thing that she didn't eat well.''
Wigobee, manufactured by Novo Nordisk, reduces appetite and food cravings.in clinical trial, 132 adolescents who took the drug fared much better than adults. The incidence of side effects (primarily nausea and vomiting) was similar to that among adults taking the drug.
However, as Dr. Yanofsky pointed out, much is unknown about how the drugs work, and the long-term effects may be different if treatment is started in adolescence.
This concerns Dr. Winter Berry, a pediatrician who practices in Syracuse, New York, who worries about a “lack of data” regarding long-term use. She said she and other pediatricians do not have philosophical objections to Wegoby's prescription. But, she said, “we want to make it work.”
“Myself and my colleagues feel that we are not there yet,” she said.
For Dr. Eileen Fennoy, a professor of pediatrics at Columbia University Irving Medical Center, a big hurdle is health insurance.
For those with private insurance, doctors are often required to provide a prior authorization form, which also prevents doctors from treating adults.
“Someone has to sit down and compile the data,” Dr. Fennoy said, adding, “It's not quick or easy.” This barrier, combined with uncertainty about the drug's safety, has led some doctors to back away.
But for most of Dr. Fennoy's patients, Wegovy is out of the question because they rely on Medicaid. In New York State, as in most other states, Medicaid will not pay for his Wegovy, no matter how severely obese he is. The only exception is young people with diabetes, in which case they can get Ozempic, another drug from Nordisk.
“If you don't have diabetes but have severe hypertension, you're out of luck in New York,” Dr. Fennoy says.
Most obese adults will never face this because the number of adults with Medicaid coverage is much smaller than children.
Additionally, there are chronic drug shortages. Parents report calling dozens of pharmacies and being told Wegovy is on backorder.
One of Dr. Fennoy's teenage patients weighed 450 pounds and was so heavy that he had to undergo hip surgery. “I got him approved for Wegovy, but his parents can't find a pharmacy that carries it,” Dr. Fennoy said.
“This is the landscape we are working with,” she said.
Some who have treated adolescents with Wegovy say that it is not easy to bring up the idea of taking this drug.
Dr. Ifuoma Eneri, chief of nutrition at Children's Hospital Colorado and professor of pediatrics at the University of Colorado School of Medicine, explained the problem she said she and other pediatricians struggle with: Do we teach our kids that their weight doesn't define them, that it's just a number, and then in the next breath encourage them to take weight loss pills?
Dr. Eneri, author of the American Academy of Pediatrics guidelines, shifted the conversation to address adolescent health, “considering psychosocial health as well as physical health as a reason to consider drug therapy.'' He said he is trying to focus on that.
In some cases, the pediatrician may decide that the best solution is to avoid such problems by referring the adolescent to a pediatric endocrinologist or other specialist.
Dr. Stephanie Sisley, a pediatric endocrinologist and obesity medicine expert at Baylor College of Medicine and Texas Children's Hospital, said that doesn't solve the problem.
“It's easy to say the endocrinology department should do this, the gastrointestinal tract should do that, or we should set up an entire specialty clinic,” she says.
But she says it's not clear where patients will be sent.
“Unlike most diseases, obesity has no experts, so no one owns it,” Dr. Sisley said. “There's no place to say, 'Okay, please fix the problem.' It's easy to say, 'It's not me.'”
And with so many adolescents becoming obese, there is a shortage of professionals to help them, she added.
For Anne, a New York teenager, the outcome was a happy one. She is currently being treated by Dr. Dina Peralta Reich, a New York obesity medicine specialist who tells her that her obesity is not her fault and recommends Wegovy.
Now, Anne said, her life has changed. She lost 50 pounds, her shame associated with her weight disappeared, and her medical problems also disappeared.
“I feel better not only physically but mentally,” she said.
