Endocrine Abstracts

Background: A quarter of UK children now leave primary school obese. Childhood obesity is associated with significant comorbidity including obstructive sleep apnoea, type 2 diabetes, non-alcoholic fatty liver disease, hypertension and depression. We report our experience of using semaglutide, a weekly subcutaneous GLP1 receptor agonist, as a weight-loss adjunct for severely obese children in combination with dietary and lifestyle support from a multidisciplinary team.

Method: Data from all children in our tertiary weight management service treated with semaglutide 1 mg were reviewed retrospectively. Demographic data including age, gender, medical diagnoses and comorbidities associated with obesity were collected. Primary outcomes were changes in weight, BMI, BMI standard deviation score (SDS) and percentage excess weight after 6 months of treatment. Secondary outcomes were side effects and tolerability.

Results: 18 patients (9 male) between 10 and 17 years old were prescribed semaglutide. All except one had a BMI SDS >3 with at least one weight-related complication. Two patients had a confirmed genetic cause for obesity and 7 had autism. Treatment with semaglutide for 6 months produced a mean BMI SDS decrease of 0.27 and a mean weight loss of 6.1 kg (mean reduction in excess weight of 16%). Four patients completed 12 months of treatment with a mean BMI SDS reduction of 0.74. This compares to a mean BMI SDS reduction of 0.4 over 2 years in our weight management program without a GLP1 receptor agonist. Five patients reported side effects (gastrointestinal upset, fatigue and hair loss). One patient discontinued treatment due to side effects.

Discussion: Our experience shows that semaglutide is a safe and highly effective weight loss adjunct in children with co-morbid obesity, although it is not yet licensed in this age group. Currently the only GLP1 receptor agonist licensed for children with obesity is liraglutide. However, adult data demonstrated that semaglutide is better tolerated and more effective at a high dose of 2.4 mg weekly compared to liraglutide for weight. Semaglutide is also given as a weekly rather than daily injection. Further long-term studies examining whether the effect plateaus and potential rebound weight gain after stopping are needed.