276 - Inequities in Prescribing Anti-Obesity Medications in Pediatric Populations: A Narrative Review

Publication Number: 276.5553

Morenikeji Ojubanire, University of Michigan Medical School, Farmington Hills, MI, United States; Susan Woolford, University of Michigan Medical School, Ann Arbor, MI, United States

Background: The rising prevalence of pediatric obesity is a major public health concern, requiring comprehensive treatment approaches. Anti-obesity medications (AOMs) such as glucagon-like peptide-1 receptor agonists (GLP-1RA), have emerged as a valuable addition to lifestyle and behavioral interventions, particularly for children with severe obesity.

Objective: This narrative review aims to (1) evaluate current prescribing practices and perceptions regarding AOMs in pediatric populations, (2) assess whether inequities exist based on race, ethnicity, socioeconomic status, and healthcare access, and (3) identify gaps in the literature for future research.

Design/Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted using PubMed and Google Scholar. Articles published in the last 5 years that focused on children (0-18 years old), and addressed AOM prescribing practices were included. Out of 431 initially identified articles, 14 met inclusion criteria after title, abstract, and full article review. These were analyzed and themes identified.

Results: Aim 1- Three key themes emerged from the 14 articles that addressed factors influencing AOM prescribing: high medication costs (especially GLP-1RA), primary care provider (PCP) preference for lifestyle changes over use of AOMs, and limited PCP familiarity with treatment guidelines including AOM use, leading most to believe that subspecialists should manage AOMs for children.
Aim 2- Racial and socioeconomic disparities were evident, with Black and Hispanic/Latino children less likely to receive AOMs compared to non-Hispanic Whites. Most patients who received a prescription for AOMs were White and privately insured. Among non-primary English speakers (who were less likely to receive AOMs as a group) higher prescription rates were demonstrated when interpreters were used versus when they were not, highlighting the role of language barriers in these inequities.
Aim 3- Significant gaps remain in understanding these inequities, including whether they arise from patient choice, clinician bias, or deficits in provider knowledge of AOMs. Comprehensive data across racial, ethnic, and socioeconomic groups are still lacking.

Conclusion(s): This review suggests that inequities in AOM prescribing exist in pediatrics. Clinician education about AOMs and policy changes to improve access for underrepresented populations may help to reduce inequities in obesity care. Future research should explore potential factors contributing to inequities in medication use for the treatment of pediatric obesity.