Considerations for Using Wegovy (Semaglutide) in Pediatric Patients
Wegovy (semaglutide) is FDA-approved for weight management in pediatric patients aged 12 years and older with a BMI at or above the 95th percentile (obesity) and should be used as an adjunct to lifestyle modifications including diet and physical activity. 1
Indications and Eligibility
- Approved population: Children and adolescents aged 12-17 years with:
- BMI at or above the 95th percentile for age and sex (clinical obesity)
- At least one weight-related comorbidity (such as insulin resistance, type 2 diabetes, metabolic-associated fatty liver disease, obstructive sleep apnea, or hypertension) 2
Efficacy in Pediatric Patients
In clinical studies, pediatric patients treated with semaglutide for 6 months showed:
- Significant decrease in BMI standard deviation score (0.32±0.27, p<0.001)
- Mean weight loss of 7.03±7.50 kg (p<0.001)
- Mean percentage total weight loss of 6.4±6.3% (p<0.001) 2
For patients with 12-month data available:
- Further decrease in BMI standard deviation score (0.54±0.52, p<0.001)
- Mean weight loss of 9.7±10.8 kg (p<0.001)
- Percentage total weight loss of 8.9±10.0% (p<0.001) 2
Dosing and Administration
- Starting dose: Begin with the lowest available dose and gradually titrate to minimize gastrointestinal side effects 3
- Recommended titration schedule:
- Initial dose: 0.25 mg once weekly for 4 weeks
- Increase to 0.5 mg once weekly
- Further increase to 1.0 mg once weekly as tolerated 3
- Administration: Subcutaneous injection once weekly
Safety Considerations
Common Adverse Effects
- Gastrointestinal effects: Most common and typically mild to moderate 2
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
Serious Adverse Effects to Monitor
- Gallbladder disease: Cases of gallstones have been reported 2
- Pancreatitis: Requires careful monitoring, especially in patients with risk factors 3
- Hypoglycemia: Particularly when used with insulin or sulfonylureas 3
- Mental health concerns: Monitor for suicidal ideation (limited long-term data in adolescents) 4
- Disordered eating: Requires monitoring, especially in adolescent population 4
Contraindications
- Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 3
- Pregnancy or planned pregnancy (discontinue at least 2 months before planned pregnancy) 5
- Active acute pancreatitis 3
- Severe hypersensitivity to semaglutide 3
Monitoring Recommendations
Baseline assessment:
- Complete history and physical examination
- Weight and BMI calculation
- Assessment of weight-related comorbidities
- Screening for eating disorders
- Baseline metabolic parameters (glucose, lipids, liver function)
Follow-up monitoring:
- Regular weight and BMI assessment
- Monitoring for gastrointestinal side effects
- Assessment of comorbidity improvement
- Screening for gallbladder disease and pancreatitis symptoms
- Mental health assessment
Integration with Comprehensive Management
- Semaglutide should be used as an adjunct to, not a replacement for:
- Dietary modifications
- Regular physical activity (30-60 minutes of moderate-to-vigorous activity at least 5 days/week) 6
- Behavioral counseling
Special Considerations
- Long-term data: Limited information on long-term safety and efficacy in pediatric patients beyond 68 weeks 4
- Cost and access: Significant cost barriers may exist, potentially worsening socioeconomic disparities in pediatric obesity management 4
- Discontinuation effects: Weight regain is likely if medication is discontinued, suggesting the need for long-term therapy 6
Clinical Pearls
- Semaglutide represents an important advance in pediatric obesity management but should be part of a multidisciplinary approach
- Start with the lowest dose and titrate slowly to minimize side effects
- Emphasize the importance of concurrent lifestyle modifications
- Monitor closely for both physical and psychological adverse effects
- Consider the long-term nature of therapy when initiating treatment