Background: In 2023, the American Academy of Pediatrics released a clinical practice guideline that, for the first time, recommends weight-loss pharmacotherapy as an adjunct to therapeutic lifestyle changes for adolescents ≥12 years old with obesity. Obesity disproportionately impacts individuals from minoritized backgrounds, but non-white adults have lower uptake of weight-loss medications.
Objectives: In this modeling study, we investigated changes in prevalence of obesity among adolescents, assuming racial-ethnic-based disparities in uptake of weight-loss medications.
Methods: Using the National Health and Nutrition Examination Survey from 2011 to pre-pandemic 2020, we identified a nationally representative sample of 12 – 17-year-olds. We calculated the proportion with obesity (BMI ≥95th percentile for age/sex using Centers for Disease Control and Prevention growth charts) and stratified by self-reported race-ethnicity categories. To model the impact of the introduction of highly effective weight-loss medications, we used once-weekly 2.4 mg subcutaneous semaglutide as a proxy and assumed the average treatment effect and 95% confidence intervals from the STEP TEENS clinical trial (16.7% [95% CI 13.2 – 20.3%] reduction in BMI over 68 weeks). We calculated post-treatment BMI for eligible adolescents, varying percent uptake from 10 to 100%. We applied real-world race-ethnicity disparities in uptake of glucagon-like peptide-1 receptor agonists based on data from adults with diabetes (0%, 8%, 11%, and 45% lower for Other/Mixed Race, Hispanic, Black, and Asian individuals, respectively, compared to White individuals).
Results: We identified 4,442 participants who represented 26,247,384 adolescents (14.6% Mexican American, 7.9% Other Hispanic, 53.3% Non-Hispanic White, 14.2% Non-Hispanic Black, 5.0% Asian, and 5.0% Other/Mixed Race). The overall prevalence of obesity was 22.2% but varied from 11.7% for Non-Hispanic Asian adolescents to 30.1% for Mexican Americans. As increasing semaglutide uptake was modeled, overall obesity prevalence decreased markedly (e.g., 14.9% and 8.4% with 50% and 100% uptake, respectively). However, relative disparities by race-ethnicity worsened. For example, at baseline, Non-Hispanic Black adolescents had an obesity prevalence 1.4-fold higher than Non-Hispanic White adolescents, but this rose to 1.6-fold and 2.4-fold with 50% and 100% uptake, respectively.
Conclusions: Introduction of weight-loss medications to treat adolescents may reduce overall obesity prevalence but will not nullify existing inequities. This underscores the necessity of a multifaceted approach to pediatric obesity, including pharmacoequity, primary prevention, and policies to address social determinants of health.
