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