287 - Evaluating GLP-1 receptor agonists in treating pediatric obesity within the context of social determinants of health: A systematic review and meta-analysis

Publication Number: 287.5081

Nikki Delgado, Washington State University Elson S. Floyd College of Medicine, Pasco, WA, United States; Destiny Vaisberg, Washington State University Elson S. Floyd College of Medicine, Richland, WA, United States; Kimberly M. Najera, Universidad Autonoma de Guadalajara Medical School, Las Vegas, NV, United States; Valerie N. Almeida, Universidad Autonoma de Guadalajara, Laredo, TX, United States; Eduardo Smith-Singares, Washington State University Elson S. Floyd College of Medicine, Richland, WA, United States; Izaskun M. Iglesias, Washington State University Elson S. Floyd College of Medicine, Kennewick, WA, United States

Background: Pediatric obesity is a significant public health challenge in the United States, heavily influenced by social determinants of health (SDoH). This condition leads to suboptimal long-term outcomes, which could be improved with effective weight loss interventions. However, barriers to treatment—such as limited healthcare access—disproportionately affect underserved populations. Although two glucagon-like peptide-1 receptor agonists (GLP-1RAs) are currently Food and Drug Administration (FDA) approved for adolescents aged 12 and older, there remains a notable gap in pediatric research regarding the efficacy of GLP-1RAs.

Objective: To investigate the effectiveness of GLP-1RAs in managing obesity among children and adolescents under 21 years of age.

Design/Methods: We conducted a comprehensive search of electronic databases for randomized controlled trials (RCTs) meeting these criteria: 1) participants under 21; 2) body mass index (BMI) ≥ 30 kg/m²; 3) registered on clinicaltrials.gov; 4) evaluated a GLP-1RA intervention; 5) assessed BMI. Exclusion criteria included obesity due to secondary causes, crossover studies, and diagnoses of type 1 or 2 diabetes. Effect sizes for estimated treatment differences in BMI, BMI-SDS, and weight change were calculated using Hedges’ g, with an overall Hedges’ g computed for summary effect sizes across studies. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO).

Results: Eight RCTs were included in this review (N = 711; ages 6-19). The combined Hedges’ g values were: -0.32 (95% confidence interval: [−0.49, −0.15]) for BMI, -0.34 (−0.51, −0.18) for BMI-SDS, and -0.35 (−0.50, −0.19) for weight change, indicating small to moderate reductions in these measures for treatment groups.

Conclusion(s): This meta-analysis highlights a significant treatment effect of GLP-1RAs on pediatric obesity. While these medications offer a promising option, bariatric surgery is also effective for certain patients. However, SDoH—such as race, socioeconomic status, and neighborhood characteristics—exacerbate pediatric obesity and disproportionately impact specific populations. Although Wegovy (semaglutide) and Saxenda (liraglutide) have been FDA-approved, public insurance programs like Medicaid do not cover their costs. Addressing barriers is essential for equitable treatment. Given the rising rates of pediatric obesity, further research into effective and accessible treatment options is urgently needed to enhance guidelines for managing this pressing public health issue.

Table 1. Characteristics of clinical trials and estimated treatment differences of GLP-1 receptor agonists.
BMI, body mass index; BMI-SDS, body mass index standard deviation score; CI, confidence interval; GLP-1, glucagon-like peptide-1; NCT, National Clinical Trial.

Table 2. Effect sizes of GLP-1 receptor agonist interventions on BMI, BMI-SDS, and weight change.
BMI, body mass index; BMI-SDS, body mass index standard deviation score; CI, confidence interval; GLP-1, glucagon-like peptide-1; n/a, not available; NCT, National Clinical Trial.

Figure 1. Forest plots of Hedges' g for BMI, BMI-SDS, and weight change.