Real -world experience with anti-obesity medications treatment in children and adolescents with overweight and obesity in Israel.

Abstract

Background: Childhood obesity is a major public health concern, associated with early-onset comorbidities and a high likelihood of persisting into adulthood. Anti-obesity medications (AOMs) may serve as an adjunct to lifestyle modifications for managing pediatric obesity.

Objective: To evaluate prescribing patterns, weight outcomes, and cardiometabolic impacts of AOMs among children and adolescents aged 10-18 years within Clalit Health Services (CHS), the largest health maintenance organization in Israel.

Subjects/methods: This retrospective observational study analyzed data from CHS's electronic database (2017-2024). The study cohort included 307 208 children with BMI measurements exceeding World Health Organization (WHO)-defined thresholds for overweight or obesity. Among these, 2236 (0.7%) were prescribed AOMs (metformin, GLP-1 receptor agonist, or orlistat). A secondary analysis assessed longitudinal changes in BMI z-scores and cardiometabolic parameters among individuals who purchased at list two prescriptions of AOMs.

Results: AOMs prescriptions were more common among females, younger patients, those with higher BMI z-scores, and medium-to-high socioeconomic position (SEP) levels. Children prescribed AOMs exhibited a higher prevalence of obesity-related comorbidities and greater engagement with dietitians and endocrine specialists. Metformin was the most commonly prescribed medication (73.8%), followed by GLP-1 receptor agonist (24.5%) and orlistat (1.7%). Females demonstrated higher rates of medication adherence and longer treatment durations than males. Among the 1717 participants with ≥2 AOMs purchases, BMI z-scores significantly declined during treatment, accompanied by reductions in blood glucose, HbA1c, triglycerides, and total cholesterol, and increases in HDL cholesterol. BMI z-scores and cardiometabolic parameters partially regressed after treatment cessation but remained improved compared to baseline.

Conclusions: AOMs demonstrate potential for weight management and cardiometabolic improvement in children with obesity, particularly among those with severe obesity and comorbidities, within real-world settings. However, the modest utilization rate highlights the need for improved accessibility and further real-world evidence to optimize treatment strategies for pediatric obesity.