Associate Professor UICOMP Peoria, Illinois, United States
Background: Pediatric weight management programs (PWMPs) in POWER, a national PWMP registry, report an increase in anti-obesity medicine (AOM) prescribing in the past 5 years. AOM prescription patterns in real-world settings may be influenced by patient socio-demographic characteristics, body-mass-index (BMI), and comorbidities. . Objective: The aim of this study is to describe PWMP AOM prescription patterns and to compare patient characteristics between those prescribed AOM and those not. Design/Methods: Data on AOM prescriptions for 3676 patients, 6-18 year old, seeking PWM at 16 POWER sites between October 2018 and October 2022 were extracted from the POWER database. Frequency of prescribed AOM and patient obesity severity, age, race/ethnicity, insurance type, laboratory result-based cardio-metabolic risk profiles, and other relevant health diagnoses were analyzed. Comparisons between AOM and non-AOM patient groups were performed using logistic regression, adjusting for site. Results: 17.7% of patients were prescribed AOM with metformin (53%) and topiramate (25%) being the most frequent; 10% received a GLP-1 agonist and 25.6% of patients received >1 AOM. Compared with non-AOM patients, AOM patients were older, p<.0001(12-15 aOR=2.4 and 16-18 aOR=2.99 vs. 6-11 year old group), and had severe obesity, p<.0001 (Class 3 aOR=3.1 and Class 2 aOR=1.7 vs. class 1; Class 3 aOR=1.8 vs. class 2). AOM patients were also more likely to have metabolic dysfunction-associated steatohepatits (aOR=2.76), diabetes mellitus (aOR=41.6), asthma (aOR=1.53), and obstructive sleep apnea (aOR=2.23), but not hypertension or dyslipidemia. AOM patients had more mental health conditions (attention deficit disorder aOR=3, depression aOR=3.33, anxiety aOR=2.75, ODD aOR=2.84) and developmental delays (aOR=2.16). Differences in race/ethnicity, insurance type, and sex were not significant after adjusting for site.
Conclusion(s): Prescribing patterns were not influenced by demographic characteristics as has been recently published; however, the timing of this data precedes an increase in FDA-approved AOMs not paid for by many insurances. The greater likelihood of AOM in the presence of comorbidities was an interesting finding and raises the question about whether clinicians should be prescribing earlier to prevent comorbidities. As more pediatric FDA-approved AOMs become available and insurance coverage improves, further study is needed to better characterize the patients who receive more available AOMs and assess heterogeneity of outcomes among youth seeking care from PWMPs.
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