by Dr.Karla, ActivistMD | Dec 9, 2025 | Parenting and Teens
Lizzie is a 13-year-old with a great sense of humor.
She tells it like it is, especially to her Mom, Jackie, who admits to being a bit of an Almond Mom (parent who is stuck in weight-focused diet culture). Jackie leads a very healthy lifestyle and has never had to deal with being overweight. Jackie is different from other Moms I work with because she isn’t telling me that information because she doesn’t want to be affiliated with being overweight. She genuinely wants to help her daughter, and every action she takes to help she recognizes comes from her own experience.
Also, Lizzie is a very picky eater and Jackie blames herself because she has accommodated the pickiness. She wants her to be happy and feels like a burger and fries for dinner is better than trying to force Lizzie to eat something she’s not going to touch and then binge on whatever processed foods are in the house later.
Lizzie also has insulin resistance which hasn’t been diagnosed, and Jackie hadn’t heard of it until she found me on TikTok. She thought this made so much sense. “Obesity is hormonal. It’s not simply caloric.”
“We’ve tried everything from personal trainers, dietitians, gone low-carb, and even gone to specialists and functional medicine doctors. Lizzie’s labs showed creeping Hemoglobin A1c, cholesterol levels have always been off, and her doctor said she has fatty liver disease. I feel so ashamed, and like the pediatrician keeps saying the same thing. Portion control and more exercise. I’m constantly in her lane when she’s eating and can see that she’s also started to eat in secret in her room.”
“My Mom gives me looks all the time if I go for seconds.”
“Lizzie, are you sure you want to eat that?”
Jackie is also starting to notice that Lizzie complains about her clothes not fitting and they are getting into arguments about it. Jackie feels like it’s more than Lizzie’s health that’s at stake. If their interactions keep going like they are, their relationship is at stake too.
Lizzie has a strong genetic predisposition for insulin resistance and type 2 diabetes, metabolic syndrome, and obesity on the paternal side. I reviewed prior laboratory studies which were indicative of insulin resistance. Her starting BMI was 32.5, and her waist circumference was 45 inches. On exam, Lizzie has acanthosis nigricans, abdominal obesity, striae, and acne.
The results of the STEP TEENS phase 3 trial of once-weekly subcutaneous semaglutide 2.4mg (Wegovy) in adolescents aged 12 up to 18 years old with obesity are very promising.
Published in November of 2022 in the NEJM, the study showed that patients who received semaglutide vs. placebo had greater reductions in body weight, improvements in waist circumference, A1c, lipids (except HDL cholesterol), and ALT. Quality of Life measures were better in the semaglutide group. Adverse gastrointestinal events were greater with semaglutide compared with placebo.
GLP-1 exerts its main effect by stimulating glucose-dependent insulin release from the pancreatic islets, slows gastric emptying, inhibits post-meal glucagon release, and reduces food intake.
GLP-1 RA medications work by reducing the appetite and feelings of hunger, slowing the release of food from the stomach, and increasing feelings of fullness after eating. Some, like tirzepatide, have the added action of “quieting the mind” or stopping food noise through receptors in the brain.
Along with nutrition, behavior, and physical activity, medication options were discussed. Lizzie met the criteria for Wegovy. It was an uphill battle to get the Prior Authorization and then the appeal approved through the pharmacy plan. Then, the national shortage of Wegovy starting doses created another daunting obstacle. Jackie called around to what seemed like 100 pharmacies to find the starting dose before she finally found a pharmacy who had it.
Lizzie tolerated the medication well with minimal side effects. Over the next few months, the dose was titrated up to the maximum dose of 2.4mg. Her weight stayed the same.
First, I coached Lizzie and Jackie to manage disappointment and reset expectations.
Next, let’s reassess all causes, comorbidities and contributing factors. I did another Review of Systems.
Is Lizzie a non-responder? Or is the medication working and just not showing up on the scale? Are there metabolic health improvements that can be measured?
Is the medication bioavailable? Does Lizzie have PCOS? Is Lizzie taking other medications that are contributing? Does she need a sleep study? What about binge or loss-of-control eating?
Lab studies showed metabolic biomarkers were markedly improved. Her fasting lipid panel was normalized as were AST and ALT levels. HgbA1c had decreased. I considered other contributing factors and noted that her free testosterone level was elevated.
What changes had she made to her nutrition? She was eating 1300 calories a day, the same as before starting the medication. Her body was stuck in metabolic adaptation.
I told them about the thermogenic effects of food and they became more intentional about a balance of Protein/Fat/Fiber. Lizzie started having slow weight loss over the next few months.
Lizzie’s BMI has gone from 32.5 to 27.5 and her waist circumference has decreased by three inches. I will see Lizzie for a follow-up telehealth visit in three months with updates in the interim from Jackie.
GLP-1 RA medications as approved by the FDA may be a helpful adjunct in your adolescent patient’s treatment plan, but require a whole approach to metabolic health.
See my videos on TikTok @DrKarlaMD or @imecommunity to learn more about insulin resistance and my metabolic health approach.
https://kevinmd.com/2024/04/glp-1-medications-like-wegovy-are-effective-metabolic-health-tools-for-teens-with-insulin-resistance.html
by Dr.Karla, ActivistMD | Dec 9, 2025 | Teen Health and Wellness
Will a telehealth model effectively engage adolescents with obesity and their parents to participate in their treatment plan?
Do GLP-1 agonist medications work to improve weight status and reduce or eliminate comorbidities in adolescents?
I’ve worked for over two decades as a community pediatrician to address the childhood and adolescent obesity epidemic. I can say with full certainty, when it comes to adolescents, we aren’t getting anywhere. With the COVID-19 pandemic, the rates of adolescents with obesity, eating disorders, mental health diagnoses, and health disparities have increased. It’s imperative that we adopt a new approach.
As a medical director of a weight management program at a Children’s Hospital, I found it was difficult to engage adolescents due to high attrition, low program adherence, and low attendance rates. There were no effective treatments offered other than bariatric surgery, but it is drastic and not feasible for most adolescent patients. When I was told to refer adolescents to the bariatric pathway at their first visit, I knew my values and vision didn’t align with a corporate profit-only driven system.
Approximately 14.4 million U.S. children and adolescents have obesity.1 The TODAY2 Study showed the incidence of type 2 diabetes in youth increased in parallel with obesity.2 In 2022, the FDA approved once-weekly semaglutide for adolescents with obesity.3
In 2023, the AAP released the Clinical Practice Guidelines (CPG) for the evaluation and treatment of children and adolescents with obesity.4 Pediatricians are called to integrate: comprehensive obesity treatment; comprehensive patient history; family-based treatment; Intensive Health Behavior and Lifestyle Treatment (IHBLT); and longitudinal care.
Due to a lack of obesity training, time, and minimal reimbursement for obesity services, it is not feasible for most pediatricians to implement the AAP Clinical Practice Guidelines. Many pediatricians will not prescribe GLP-1 medications for adolescents because of a lack of experience and the time it takes to write prior authorizations and file appeals. Access issues should also include the lack of physicians who prescribe GLP-1 medications for adolescents.
When clinical obesity programs are available within communities, there are barriers that impact outcomes. Weight stigma, time out of school and work, and travel distance result in poor patient retention in clinical obesity programs.5 A telehealth model has the potential to mitigate some of the barriers to treatment and improve weight management outcomes for children and adolescents.
Methods:
To address access and to determine positive treatment outcomes, I founded metabolic telehealth for children and adolescents ages 5 to 21 years in 2022. The practice is licensed in 15 states. The model includes initial telehealth consultation, follow-up appointments, and medication checks. The initial consultation includes a comprehensive patient history and a treatment plan. The Health Yourself group coaching course supports family-centered behavior change as the IHBLT component. Program evaluation is measured using a database to evaluate demographics, accessibility, and treatment outcomes.
Results:
Demographics:
- Of the 44 patients seen for consultation, 34% are from rural areas (population less than 10,000). 77% of patients identify as female and 23% identify as male.
- Of the different classes of obesity, 43% Class I obesity (BMI 30 – 34.9), 21% Class II obesity (BMI 35-39.9), and 16% Class III or severe obesity (BMI 40 or higher).
- 7% of patients had a BMI of 27 to 30 with a comorbidity, meeting the FDA criteria for prescribing semaglutide.
- The most common comorbidities are prediabetes and dyslipidemia.
Accessibility:
- 34% had one visit; 20% had two visits; 46% had three or more visits
Treatment/outcomes:
-
- 38 (86.4%) patients were prescribed GLP-1
- 20 of the 38 (53%) Prior Authorization was denied by their insurance plan.
- 11 of the 20 denied (55%) opted to pay out of pocket for the GLP-1 medication.
- 20 patients with GLP-1 had 3 or more follow-up visits
- 6 (30%) patients on GLP-1 had 20% or more BMI reduction
- 4 (20%) had between 10 and 20% BMI reduction
- 9 (45%) had between 1 to 10% BMI reduction
- 1 (5%) patient increased BMI
Almost all patients are managed on semaglutide. One patient has been treated with tirzepatide. The two most common side effects are nausea and constipation. Follow-up laboratory data is currently being gathered to determine the reduction of comorbidities.
Conclusion:
There is a need to develop novel approaches to treat children and adolescents with obesity and comorbidities. A telehealth model shows that barriers to treatment are reduced, weight status is improved, and comorbidities are reduced. The limitations with telehealth are that measurement of vital signs is self-reported, and the physical examination is limited. The benefits showing improved health far outweigh the limitations.
Telehealth decreases weight stigma, a key factor when helping adolescents struggling with obesity and insulin resistance.
GLP-1 agonist medications are effective medications to treat adolescents with obesity and insulin resistance. They are not a singular fix, but should be considered an adjunct in the treatment plan, which also includes nutrition, physical activity, behavior, and other medications. The long-term risk of using these medications has not been studied in adolescents.
Future questions to study:
Are there harms that are caused by treating adolescents with GLP-1 agonist medications?
What are the obstacles to access?
What are the ethical considerations of starting a potentially lifelong medication in an adolescent?
I do not prescribe compounded GLP-1 medications for adolescent patients. I have no conflicts with the pharmaceutical industry to disclose.
References:
- Centers for Disease Control and Prevention. Prevalence of childhood obesity in the United States. 2021.
- TODAY Study Group. Long-Term Complications in Youth Onset Type 2 Diabetes. N Engl J Med 2021; 385:416-426.
- Weghuber D, Barrett T, Barrientos-Perez M, et al. Once Weekly Semaglutide in Adolescents with Obesity. N Engl J Med 2022; 387:2245-2257.
- Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity. Pediatrics 2023; 151 (2): e2022060640.
- Hampl SE, Borner KB, Dean KM, et al. Patient Attendance and Outcomes in a Structured Weight Management Program. The Journal of Pediatrics 2016; Volume 176: 30-35
- https://kevinmd.com/2025/06/an-effective-treatment-using-an-effective-care-delivery-model-using-telehealth-to-treat-adolescents-with-obesity-with-glp-1-medications.html
