Nearly 17 Million US Youth Found Eligible for GLP-1 RA Therapy and Most Because of Obesity

Nearly 17 million adolescents (5.8 million) and young adults (11.1 million) in the US meet criteria for treatment with a glucagon-like peptide-1 receptor agonist (GLP-1RA) for management of obesity or type 2 diabetes (T2D), according to a new nationally representative study published online August 4 in JAMA Pediatrics.

However, researchers from the Yale School of Medicine found that 1 in 5 youth eligible for treatment are uninsured, and 1 in 3 lack a routine place for care, factors that could limit access to the pluripotent medications, which may reduce long-term cardiometabolic risk, the authors stated.

Semaglutide (Wegovy) was approved for chronic weight management in adolescents aged 12 and older in December, 2022, marking the first GLP-1RA approved for pediatric obesity treatment but data on the size and profile of the eligible population are limited, according to lead author James T Nugent, MD, instructor of pediatrics at the Yale School of Medicine, and colleagues.

Nugent et al conducted a cross-sectional analysis of NHANES data covering 2 intervals, January 2017 to March 2020 and August 2021 to August 2023, to identify adolescents aged 12 to 17 and young adults aged 18 to 25 who met FDA criteria for GLP-1RA treatment. Eligibility included type 2 diabetes or obesity (for adolescents), or in young adults, either obesity (BMI of 30 or greater) or BMI of 27 or greater with a weight-related condition such as dyslipidemia, hypertension, cardiovascular disease, or diabetes.

FINDINGS

Based on 572 adolescents and 590 young adults in the sample, the weighted estimates showed that 5.8 million adolescents and 11.1 million young adults met GLP-1RA eligibility criteria.

Population-weighted estimates revealed that 99.2% of eligible adolescents and 88.2% of eligible young adults qualified for the incretin-based therapy as a result of obesity, whether or not they had T2D, according to the study. Nugent and colleagues reported that less than 1% (0.8%) of adolescents and 11.8% of young adults qualified based on a BMI of 27 or greater and a weight-related condition. Having T2D alone did not count as eligibility, however, young adults with T2D (1.4%) all had either obesity or a qualifying BMI with comorbidities.

The researchers found that insurance status varied widely across the age groups. Among adolescents eligible for treatment, 40.3% were covered by Medicaid, 40.5% had private insurance, and 7.2% were uninsured. In contrast, among eligible young adults, just 20.8% had Medicaid, 49.0% had private insurance, and 19.4% were uninsured. While more than 90% of adolescents reported a regular source of care, only 68.1% of young adults did. Young adults were less likely to report a routine place for health care (68.1%) compared with the cohort of adolescents.

Of significant concern was the prevalence of cardiorenal and metabolic risk factors identified in both cohorts. Nugent and colleagues found the following among GLP-1RA eligible adolescents (12-17 years):

• Dyslipidemia 35.1%
• Hypertension 10.1%
• Reduced renal function 74.7%

Among treatment-eligible young adults (18 to 25 years), proportions were more pronounced:

• Dyslipidemia 44.5%
• Hypertension 26.7%
• Reduced renal function 71.9%

In addition, more than 4 in 10 (42.0%) of young adults were classified as likely having obstructive sleep apnea.

Although expanded insurance coverage, both private and from the Centers for Medicare and Medicaid Services, may increase access to GLP-1 RAs in the future, overall payment barriers and access to primary health services may be remain key determinants of whether GLP-1RAs are used optimally in the 2 young populations, authors said.

Among the study's limitations the authors note reliance on self-reported data and potential misclassification of diabetes subtype due to NHANES survey design.

The authors emphasized that GLP-1RAs should be used alongside behavioral, lifestyle, and—in some cases—surgical interventions as part of a comprehensive obesity treatment strategy. As access to these medications grows, attention to care continuity and equitable delivery will be critical to improving health outcomes for youth with obesity and related conditions, they suggested.