How doctors are using it

(NewsNation) — Doctors are using medications like Ozempic and Wegovy to address obesity in children and teens as the drugs continue to gain popularity for their weight loss effects.

Dr. Susma Vaidya, associate medical director at the IDEAL Clinic at Children’s National Hospital, says the approval of Wegovy for pediatric obesity in particular has been “groundbreaking.” Recommended for children as young as 12, results so far have been encouraging, adding to professionals’ toolbox of treatment options, she said.

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Vaidya has been working in pediatric obesity medicine since 2006 and has witnessed firsthand the changing landscape of obesity treatment. She recently spoke with NewsNation about how doctors are recruiting the drug to help address obesity and comorbidities in children and the barriers they’ve encountered so far.

The following conversation has been edited for clarity and brevity.

Is Ozempic, Wegovy safe for children?

NewsNation: How do we know if these drugs are safe and effective for young people?

Vaidya: The STEP Teens study is the study that led to the approval of Wegovy for children down to 12 years of age … and that paper was pretty groundbreaking. Until then (2022), we did not have a lot of pharmacotherapeutic options to offer our patients with more severe obesity.

When they did a post-hoc analysis of the data from the STEP Teen study that was published in May of 2023, what they found was 44.9% of (patients) no longer had obesity, or had a BMI diagnostic of overweight. That’s groundbreaking. I really never had anything that I could offer patients to achieve that type of success.

Ozempic, Wegovy concerns

NewsNation: What concerns do your patients come to you with?

Vaidya: In my clinic, we tend to see patients with more severe obesity. There are three categories … and we tend to see more patients with Class 2 and Class 3 obesity who also have comorbidities.

So when we are thinking about these medications, we’re thinking about these medications in the context of how can we address these comorbidities, whether it’s fatty liver disease, pre-diabetes, etc., so that these younger individuals can go on to have healthy futures, and not to have to deal with worsening complications, for example, developing diabetes, or developing irreversible liver disease, etc.

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Success with weight loss drugs

NewsNation: What are some of the factors that determine whether a young person will have success with a medication like Wegovy?

Vaidya: It’s really important to consider two things. These kids were also getting dietary counseling and physical activity counseling. Additionally, there was demonstrated significant improvement in metabolic parameters. So when they were looking at these patients and their comorbidities, for example, pre-diabetes, hemoglobin … normalized, their lipids were improved. So there was really a significant health improvement, not just this BMI improvement.

NewsNation: We hear a lot about celebrities taking these drugs to lose weight very quickly. What kinds of steps do you take with young people to make sure their results are sustainable long-term?

Vaidya: When we do start patients on this medication, I always explain the data and the efficacy of this medication was tested in the context of lifestyle change. I think that’s really important. That’s what the medical literature shows us.

And then we follow patients very closely. I see patients, usually in my clinic, every four to six weeks when I start medications, and that is to check for side effects … and that’s also to continue to work on lifestyle change and to identify barriers, applaud successes and really help kids on this journey.

NewsNation: What other kinds of professionals might a young patient be consulting with during this process?

Vaidya: We have three or four dieticians, and they see all the patients at the same time as their medical visit. So they will go through and look back and see OK, well, these were the goals we made last time, were you able to accomplish these goals? What can we do to maybe have some success? Or do we move forward and make more goals? So that is definitely part of what we’re doing.

NewsNation: Some people think of weight loss as a cosmetic goal. Can you explain the medical side of weight loss and how it can impact a patient’s life?

Vaidya: There’s a lot of controversy and discussion about the use of these medications, especially when we’re talking about children. But I will say that when we are considering medications, it is truly in the context of a child’s health. A 12-year-old or a 14-year-old may come in and have pre-diabetes, and maybe that doesn’t mean as much to them as it just does to their parents or to me. But I will say that we are really cognizant of the fact that this is a powerful tool to improve health. It truly is. It’s a really amazing tool to improve health if we can overcome some of the barriers that are currently present in starting these medications.

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Obesity in children

NewsNation: One of the things we hear people worry about is whether it’s OK to tell a child that they need to lose weight. But your patients are coming to you with weight loss in mind. Can you explain what that dynamic is like?

Vaidya: We really only get referrals of patients who have Class 2 or Class 3 obesity — obesity that’s in the severe range. Additionally, I would say 90% of our kids have some comorbidity. That would either be that they have dyslipidemia (abnormally elevated levels fats or cholesterol in the blood), they have evidence of fatty liver disease, they have evidence of pre-diabetes, some type of metabolic dysfunction, sleep apnea, or something.

These are young kids who have pretty significant comorbidities that portend worsening health in the future. I’m not seeing patients frequently who come with some sort of cosmetic desire. We’re all very aware of that, and that is a discussion in itself. We know that obesity is a disease, and we’re addressing this disease, and we actually finally have some tools.

NewsNation: What results are you seeing? Do you have any concerns?

Vaidya: I would say that, overall, we’ve had good success when we’re actually able to get the medication. Not everyone responds, though.

The two barriers that we have, one is having a hard time getting the medication. I’ve had families who reach out to me, and unfortunately, it is a fluid thing. You can go to a CVS one day, and they won’t have it and two weeks later, they may have it. Parents are definitely having to call different pharmacies. It’s very frustrating once you start because then you have that lapse in treatment.

The other barrier to this medication is access not merely because it’s not in the pharmacies but because the insurance won’t cover it. That one has been probably, for me, been the biggest struggle, because there already are a lot of inequities and disparities in obesity prevalence in the United States. And the coverage of these medications can contribute to an increase in these inequities.

Anti-obesity medications tend to be excluded by many insurance companies, not just Medicaid. It’s rooted in bias and the thought that obesity management is strictly diet and physical activity and willpower, etc. And we know that’s absolutely not true.

We need to take away that blame. We really do because genetics, their microbiome, so many things go into the way their body treats or processes food and what has happened to their body over time.

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