Prescriptions for Obesity Medications Among Adolescents Aged 12-17 Years with Obesity - United States, 2018-2023

Abstract

Obesity affects approximately one in five U.S. adolescents. Although an increasing number of medications are approved for adolescent obesity as an adjunct to health behavior and lifestyle treatment, national data on the prevalence and correlates of obesity medication prescribing for adolescents are sparse. Ambulatory electronic medical record data were analyzed to assess trends in the proportion of U.S. adolescents aged 12-17 years with obesity (body mass index ≥95th percentile) who were prescribed Food and Drug Administration (FDA) -approved obesity medications during 2018-2023. Log-binomial models were used to estimate characteristics of adolescents associated with receiving an obesity medication prescription in 2023. The proportion of U.S. adolescents who were prescribed obesity medications increased substantially in 2023 (by approximately 300% compared with 2020), the year after FDA expanded its approval of two obesity medications to include adolescents and after publication of the 2023 American Academy of Pediatrics clinical practice guideline. Despite this substantial relative increase, 0.5% of adolescents with obesity were prescribed an obesity medication in 2023, with a majority (83%) of prescriptions received by adolescents with severe obesity. Semaglutide (Wegovy, indicated for persons aged ≥12 years with obesity), and phentermine or phentermine-topiramate were most commonly prescribed. Prescribing prevalence was higher among girls than among boys (adjusted prevalence ratio [aPR] = 2.05), among adolescents aged 15-17 years than among those aged 12-14 years (aPR = 2.24), and among those with severe (class 2 or class 3) obesity than among those with class 1 obesity (aPR = 4.03 and 12.78, respectively). Prescribing prevalence was lower among Black or African American adolescents than among White adolescents (aPR = 0.61). Continued monitoring of the use of these medications could help guide strategies to ensure that all adolescents with obesity have access to evidence-based obesity treatment, including medications and health behavior and lifestyle interventions.

FIGURE 1

Crude percentages (A) and adjusted percent differences in prevalence compared with 2020 (B) of adolescents aged 12–17 years with obesity who received an obesity medication prescription — IQVIA Ambulatory Electronic Medical Records, United States, 2018–2023 Abbreviations: AAP = American Academy of Pediatrics; BMI = body mass index; FDA = Food and Drug Administration. * Adjusted percent differences in prescription prevalence in each year (compared with 2020) were obtained from a generalized linear model with log link and binomial distribution. The adjusted model controls for sex, age category, and obesity class. Obesity was defined as BMI ≥95th percentile for age and sex. 95% CIs indicated by bars. ^† In November 2020, FDA approved setmelanotide (Imcivree) for treating obesity in persons with monogenic or syndromic obesity aged ≥6 years. In December 2020, FDA approved liraglutide (Saxenda) for treating obesity in adolescents aged ≥12 years. In June 2022, FDA approved phentermine-topiramate (Qsymia) for treating obesity in adolescents aged ≥12 years. In December 2022, FDA approved semaglutide (Wegovy) for treating obesity in adolescents aged ≥12 years. In January 2023, a new AAP clinical practice guideline recommended that clinicians offer obesity medications as part of evidence-based multicomponent treatment for adolescents aged 12–17 years with obesity (AAP Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity). ^§ The sample included 526,973 U.S. adolescents aged 12–17 years with obesity who had a total of 789,057 annual BMI measurements during 2018–2023.

FIGURE 2

Adjusted prevalence ratios for receiving an obesity medication prescription among adolescents aged 12–17 years with obesity, by selected demographic characteristics and obesity class — IQVIA Ambulatory Electronic Medical Records, United States, 2023 Abbreviations: BMI = body mass index; Ref = referent. * 95% CIs indicated by bars. ^† Obesity was defined as BMI ≥95th percentile for age and sex. ^§ A generalized linear model with log link and binomial distribution (model 1) was used to estimate characteristics associated with the outcome of receiving an obesity medication prescription in 2023: age (12–14 years [Ref] and 15–17 years), sex (male [Ref], female), obesity class (class 1 [Ref], class 2, and class 3), and U.S. Census Bureau region (Northeast [Ref], South, Midwest, and West). Model 2 was restricted to adolescents who were Black or African American (Black) or White and included the same covariates as model 1, with an additional covariate of race (Black/White). Obesity classes were as follows: class 1 obesity or BMI ≥95th percentile to BMI <120% of the 95th percentile [Ref], class 2 obesity or BMI of 120% to <140% of the 95th percentile, and class 3 obesity or BMI ≥140% of the 95th percentile. Classes 2 and 3 represented severe obesity. Estimates of association from the model were expressed as adjusted prevalence ratios and plotted on a log(10) scale.