“Our brain tells our body to maintain a certain amount of energy storage as body weight,” says Mona Sharifi, MD, MPH, section chief of general pediatrics and associate professor of pediatrics (general pediatrics) and of biostatistics (health informatics). “This set point becomes altered to a degree where we’re holding onto more body fat than we need or that’s healthy for our bodies.” GLP-1 agonists help to reset this point, reducing the body’s drive to consume and store excess energy.
A pediatrician, Sharifi is especially interested in studying the use of these drugs and their effects in adolescents and young adults. The FDA approved Saxenda and Wegovy for patients as young as 12 in 2020 and 2022, respectively.
Sharifi and her collaborators at Yale’s Bright Bodies program — which offers exercise and nutrition education for parents and children between the ages of 7 and 16 — have seen firsthand the positive effects the medications can have on youth struggling with obesity. Many participants become more committed to engage in the program after seeing results that lifestyle changes alone didn’t provide. “The patient reports are very compelling,” she says. “For the first time, they don’t hear that constant food chatter and are seeing more progress.”
Sharifi was on the committee that created the 2023 American Academy of Pediatrics guidelines, which included such significant updates for pediatric obesity treatment as the use of medications for eligible adolescents as an adjunct to lifestyle interventions. Since the guidelines’ release, Sharifi’s team has conducted surveys and interviews with primary care clinicians across the country to better understand their attitudes and practices, including the usage of anti-obesity medications following the release of the new recommendations. “Not surprisingly, the vast majority are not comfortable with prescribing or discussing medications because they are so new in their approval for teenagers,” she says.
This hesitation in regard to GLP-1 agonists is not the first time pediatricians have expressed initial reluctance in regard to prescribing a new medication. There was similar hesitancy to prescribe medications like antidepressants and drugs for attention-deficit/hyperactivity disorder when they first became available for young people, but that eased over time, Sharifi says. “We can learn from these past experiences and try to support primary care clinicians to increase their comfort with prescribing these medications.”
In another study, Sharifi and her colleagues estimated the number of adolescents and young adults who are eligible to receive a GLP-1 agonist. Their finding was staggering — nearly 17 million met the FDA criteria for eligibility. Only a tiny fraction of eligible people actually receive treatment, however. Sharifi and her team’s study, led by Yale medical student Ashwin Chetty, found that one in five eligible young adults are uninsured, and a third reported that they lack routine health care. In ongoing research, her team is investigating how factors including lack of insurance coverage and the changing landscape of coverage might be worsening known disparities in obesity. “We’re really interested in dissecting whether these barriers are differentially impacting people and putting us at risk of worsening obesity disparities instead of making them better.”
In future trials, the team plans to investigate whether combining lifestyle intervention programs like Bright Bodies with anti-obesity medications might lower the dosage needed to achieve the desired benefits.
Read more on Yale School of Medicine
