[b]A 14-year-old girl with biliary colic comes into your clinic. Upon review of her record, her BMI is 30, but this is her only complication to date from obesity. Her mother and father both have undergone bariatric surgery and suffered significant complications. She is currently on a diet and exercise plan through her primary care provider’s office, but has not lost weight. She is discouraged and wants treatment, but does not want bariatric surgery. You recommend

 

a Continued focus on diet and exercise alone

 

b Consideration of a GLP-1 Agonist

 

c Bariatric surgery

 

d Delay surgery to age 18 years[/b]

B

B

[b]A 14-year-old girl with biliary colic comes into your clinic. Upon review of her record, her BMI is 30, but this is her only complication to date from obesity. Her mother and father both have undergone bariatric surgery and suffered significant complications. She is currently on a diet and exercise plan through her primary care provider’s office, but has not lost weight. She is discouraged and wants treatment, but does not want bariatric surgery. You recommend

 

a Continued focus on diet and exercise alone

 

b Consideration of a GLP-1 Agonist

 

c Bariatric surgery

 

d Delay surgery to age 18 years[/b]

B

B

correct answer

[b]b Consideration of a GLP-1 Agonist

 

The GLP-1 agonists liraglutide and exenatide have both been studied in adolescents and shown significant effects, although modest, on weight loss compared to diet and exercise alone. They have also shown improvements in glucose tolerance and blood pressure. GLP-1 agonists act to increase feelings of satiety and slow gastric emptying. They were initially prescribed as a therapy for type II diabetes in adults, and were shown to cause significant improvement in weight loss as well. Liraglutide is also FDA approved for weight loss in adolescents. Side effects mainly include gastrointestinal symptoms, including nausea and constipation. Phentermine/topiramate is another drug which was approved for treatment of obesity in adolescents in 2022. The exact mechanism is not well elucidated, but likely is due to sympathomimetic activity causing central appetite suppression and increased metabolism.

 

Medical improvements in weight loss management highlight the need for multidisciplinary weight loss programs, so that patients can be counseled regarding all options for treatment and to have treatment individualized for each patient considering physiologic, psychological and social factors.[/b]