SAHM Webinars

Session Description: Weight loss pharmacotherapy, particularly GLP-1 receptor agonists, have been explicitly recommended by the American Academy of Pediatrics in their 2023 Clinical Guideline on the Management of Pediatric Obesity. GLP-1 receptor agonists undoubtedly carry great potential for benefit among youth with cardiometabolic risk factors. They may also be a lifeline for youth who lack equitable access, or the developmental capacity to respond, to lifestyle-based intervention. However, their benefits must be balanced with the risks of reduced energy availability on growth and development during adolescence, increased eating disorder thoughts and behaviors (known to be a neuropsychiatric consequence of rapid weight suppression), and perpetuation of weight stigma.

In this workshop, a multidisciplinary team of eating disorder and obesity medicine experts will recommend a thoughtful, individualized, and evidence-informed clinical approach through a weight-inclusive lens when considering GLP-1 receptor agonist therapy for an adolescent, which includes:

• Obtaining informed consent and assent prior to initiating therapy, acknowledging that the ideal duration of therapy, safe rate of weight loss, and long-term risks and benefits of medication are largely unknown in children and adolescents
• Clearly defining therapeutic endpoints, which should focus on improvement of relevant cardiometabolic indicators (e.g. blood pressure, A1c, lipid concentrations) rather than weight-based goals, and discussing a plan to monitor relevant targets
• Screening patients for disordered eating thoughts and behaviors before, during, and after medication therapy, with appropriate referrals to eating disorder professionals
• Proactive identification of patients who may be more vulnerable to neuropsychiatric consequences from weight suppression (e.g. a personal or family history of depression, OCD, autism, or eating disorder)
• Ensuring normal progression of linear growth, cognitive development, and puberty during therapy
• Monitoring for cardiovascular complications suggestive of excessive weight loss and poor energy availability such as bradycardia, hypotension, or orthostasis
• Assessment of body composition, micronutrient deficiency, and reduced bone density before, during, and after therapy
• Frequency of follow-up with a multidisciplinary team
• Considering when medication dose could be reduced in response to adverse events
• Approach to medication discontinuation once cardiometabolic targets have been reached.

While not all of the presenters directly prescribe GLP-1RA medications, they increasingly provide care and consultation for youth who are receiving them, including youth who have obtained them illicitly. Recommendations will be based on recent publications by the presenters in Lancet Child and Adolescent Health and the Journal of Adolescent Health. This workshop is intended for a multidisciplinary audience of clinicians who care for adolescents of all shapes and sizes, enabling them to shift focus away from weight and towards overall health.

Speakers

• • Maya Kumar, MD, University of California San Diego
  • Nicole Cifra, MD, MPH, MHPEd, Children’s Hospital of Philadelphia
  • Abigail Donaldson, MD, Alpert Medical School of Brown University
  • Sharon Enujioke, MD, MPH, Naval Medical Center Portsmouth
  • Lauren Hartman, MD, Aspen Grove Adolescent & Young Adult Medicine
  • Melissa Hopper, PsyD, University of Kansas School of Medicine
  • Laura Kester Prakash, MD, UC Davis Health System
  • Rebecka Peebles, MD, Monte Nido and Affiliates