A Call for Comprehensive, Equitable Adolescent Obesity Care

Between 2020 and 2023 there was a 301.7% increase in obesity medication prescriptions among adolescents in the US aged 12 to 17 years, and yet as recently as 2023, a scant 0.5% of adolescents with obesity received such a prescription. Also from these years, there is news of disparities and systemic barriers among adolescents with a recorded body mass index (BMI) in at least the 95th percentile for their age and sex.

According to the recent CDC Morbidity and Mortality Weekly Report (MMWR) in which these data are published,1 the findings highlight the necessity of continuous monitoring of obesity medication use and safety to inform the strategic development and implementation of treatment guidance that encompasses not only these therapies, but their use in conjunction with healthy behaviors and positive lifestyle adjustments.

What Drove the Prescription Spike?

For the adolescent patient population in the US, there are 4 evidence-based obesity medications approved for those who are at least 12 years old:

• Orlistat injection 120 mg (Xenical; F. Hoffmann-La Roche): approved in December 20032
• Liraglutide injection 3 mg (Saxenda; Novo Nordisk): approved in December 20203
• Phentermine and topiramate extended-release capsules (Qsymia; Vivus): approved in June 20224
• Semaglutide injection 2.4 mg (Wegovy; Novo Nordisk): approved in December 20225

Setmelanotide (Imcivree; Rhythm Pharmaceuticals), a fifth medication, was approved in November 2020 for weight management in children 6 years and older with rare genetic conditions that result in obesity, and expanded to patients at least 2 years old in December 2024.6

While these medications off critic support, the CDC emphasizes they must complement lifestyle interventions, such as reduced-calorie diets and more physical activity.

“All adolescents with obesity, including those who receive obesity medications, should receive evidence-based health behavior and lifestyle interventions,” the report authors wrote, “which can help them and their families build skills that promote healthier nutrition, physical activity, and related behaviors.”

As noted in the MMWR, the spike in use can be traced back to 2 landmark changes: the 2022 approvals of phentermine-topiramate and semaglutide—both of which were label expansions from previous adults-only use4,5—and the 2023 publication of guidance from the American Academy of Pediatrics on how to best evaluate and treat children and adolescents with obesity.7 This guidance, too, recommends that use of these medications be part of a regimen that includes lifestyle interventions.

Experts are calling for the necessity of continuous monitoring of obesity medication use and safety in adolescents to inform the development and implementation of treatment guidance that encompasses these therapies and their use with healthy behaviors and positive lifestyle adjustments.

Image Credit: kikkerdirk-stock.adobe.com

Who Is Getting Left Behind?

For this most recent MMWR,1 IQVIA ambulatory electronic medical records (EMR) data were used on adolescents who received at least 1 obesity medication prescription per year in the year that obesity was recorded for the study period (N = 526,973); this group accounted for 789,057 annual BMI measurements overall.

By 2023, in which 93,121 adolescents were diagnosed with obesity, the mean (SD) ages were 14.4 (1.7) years overall, but 15.2 (1.6) years among those prescribed obesity medication (n = 427). Most of these prescriptions (67.4%) were for adolescents aged 15 to 17 years (vs 32.6% in those aged 12-14 years), who reported female sex (62.3%), who reported a White (59.5%) or unknown (25.1%) race, and who lived in the Midwest (43.6%) or South (30.9%) regions of the US. More than half had severe obesity, or class 2 or 3 obesity (82.9%).

Semaglutide was the most common prescription (57.1%), followed by phentermine or phentermine-topiramate (37.7%), liraglutide (11.9%), and orlistat or setmelanotide (3.3%).

Key disparities emerged in 2023. Adjusted analyses produced that if the adolescent was a girl (adjusted prevalence rate [aPR], 2.05; 95% CI, 1.69-2.49), aged 15 to 17 years (aPR, 2.24; 95% CI, 1.83-2.74), and lived in the West (aPR, 2.65; 95% CI, 1.68-4.19), South (aPR, 2.35; 95% C, 1.51-3.65), or Midwest (aPR, 1.58; 95% CI, 1.03-2.43) regions, they were more likely to prescribed obesity medications. And compared with class 1 obesity, having class 2 (aPR, 4.03; 95% CI, 3.03-5.36) or 3 (aPR, 12.78; 95% CI, 9.82-16.64) obesity indicated greater chances of being prescribed obesity medications.

In addition, despite more Black or African American adolescents being diagnosed with severe obesity compared with White or Asian adolescents (50.0% vs 39.0% vs 30.4%, respectively, these adolescents were prescribed obesity medications at the same or a lower rate in 2023 (0.4% vs 0.5% vs 0.4%). These disparities persisted even after controlling for obesity class.

Barriers to Access

The study authors note that although the 301.7% increase in obesity medication prescriptions that they saw was lower compared with the 500% increase seen in results published in 2024 of glucagon-like peptide-1 receptor agonist prescriptions among a similar population,8 their results indicate “the rising use of multiple classes of obesity medications.”1

Potential contributing factors are availability of oral administration, lower out-of-pocket (OOP) costs, and a more consistent availability of phentermine or phentermine-topiramate vs semaglutide. The FDA placed semaglutide on its shortage list early 2022, removing it only on February 21 of this year,9 which stemmed from an increase in demand for its use for weight loss and its original indication, diabetes. Further, semaglutide, sold as Wegovy, has a very high OOP cost ($1349) for a 28-day supply without insurance.10

A Roadmap for Care

Speaking to why prescribing rates may have differed by sex, race, and US Census Bureau region, the authors explained that in addition to the aforementioned shortages and OOP costs, insurance issues may be to blame.1 These include a lack of coverage—as recently as 2024, just 44% of US employers with 500 or more employees and 64% with more than 20,000 employees covered weight loss drugs11—and barriers from an overly complex prior authorization process, as explained in an April 2025 report from the Institute for Clinical and Economic Review.12 Many pediatricians may also lack training, and therefore knowledge, in obesity pharmacotherapy, with data from 2024 demonstrating 34% of pediatricians who responded to a survey were unwilling to prescribe obesity medications and 24% weren’t even aware that guidance was available from the American Academy of Pediatrics on prescribing these medications.13

The CDC calls for "continued monitoring" of medication use, but health plans and providers can act now to close gaps. Prior authorization reforms could streamline access.12 Partnering with organizations, like the American Academy of Pediatrics, to educate providers7 on prescribing protocols is another potential solution. And with the CDC emphasizing that these medications should augment lifestyle interventions, integrating them into healthy weight programs could improve outcomes.

The Bottom Line

Although the 301.7% prescription increase marks progress, the low baseline means millions of adolescents still lack access to these key tools against obesity—even though they have a greater chance of having obesity as adults and are more likely to have comorbidities as a result, including hypertension and type 2 diabetes. These findings could serve as a wake-up call health care leaders: address cost, bias, and fragmentation in pediatric obesity care to not only improve overall health outcomes in these patients, but to reduce the hundreds of billions in obesity-related costs that burden the US health care system every year.

References

1. Kompaniyets L, Pierce SL, Porter R, et al. Prescriptions for obesity medications among adolescents aged 12–17 years with obesity—United States, 2018–2023. MMWR Morb Mortal Wkly Rep. 2025;74(20):337-344. doi:10.15585/mmwr.mm7420a1
2. Xenical (orlistat): phase iv pediatric study reports. FDA Office of Clinical Pharmacology and Biopharmaceutics Review. December 2, 2003. Accessed June 8, 2025. https://www.fda.gov/media/116843/download
3. FDA approves Saxenda for the treatment of obesity in adolescents aged 12-17. News release. Novo Nordisk; December 4, 2020. Accessed June 8, 2025. https://www.novonordisk-us.com/media/news-archive/news-details.html?id=39225
4. FDA approves treatment for chronic weight management in pediatric patients aged 12 years and older. News release. FDA; June 27, 2022. Accessed June 8, 2025. https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-chronic-weight-management-pediatric-patients-aged-12-years-and-older
5. FDA approves once-weekly Wegovy injection for the treatment of obesity in teens aged 12 years and older. News release. Novo Nordisk; December 23, 2022. Accessed June 8, 2025. https://www.novonordisk-us.com/media/news-archive/news-details.html?id=151389
6. Rhythm Pharmaceuticals announces FDA approval of Imcivree (setmelanotide) for patients as young as 2 years old. News release. Rhythm Pharmaceuticals; December 20, 2024. Accessed June 8, 2025. https://ir.rhythmtx.com/news-releases/news-release-details/rhythm-pharmaceuticals-announces-fda-approval-imcivreer-0
7. Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640
8. 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
9. FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize. FDA. April 28, 2025. Accessed June 8, 2025. https://www.fda.gov/drugs/drug-safety-and-availability/fda-clarifies-policies-compounders-national-glp-1-supply-begins-stabilize
10. Rosenfield L. How much does Wegovy cost without insurance? Sesame. Updated March 5, 2025. Accessed June 8, 2025. https://sesamecare.com/blog/wegovy-cost-without-insurance
11. Niasse A. Weight-loss drug coverage rises among largest US employers, Mercer survey finds. Reuters. November 20, 2024. Accessed June 8, 2025. https://www.reuters.com/business/healthcare-pharmaceuticals/weight-loss-drug-coverage-rises-among-largest-us-employers-mercer-survey-finds-2024-11-20/
12. Pearson SD, Whaley CM, Emond SK. Affordable access to GLP-1 obesity medications: strategies to guide market action and policy solutions. Institute for Clinical and Economic Review. April 9, 2025. Accessed June 8, 2025. https://icer.org/wp-content/uploads/2025/04/Affordable-Access-to-GLP-1-Obesity-Medications-_-ICER-White-Paper-_-04.09.2025.pdf
13. Chivate R, Schoemer P, Ragavan MI, et al. Primary care perspectives on prescribing anti-obesity medication for adolescents. Pediatr Obes. 2024;19(8):e13146. doi:10.1111/ijpo.13146