What are the next steps for a 14-year-old female patient with a history of childhood obesity, currently on Wegovy (semaglutide) 0.5 mg weekly via subcutaneous injection and Vitamin D2 (ergocalciferol) 1,250 mcg (50,000 units) orally once a week, with a current weight of 151 lbs and BMI of 27.6, and no reported side effects?

Follow-Up Management for 14-Year-Old Female on Wegovy and Vitamin D Supplementation

Continue Current Wegovy Dose and Monitor Progress

Continue Wegovy 0.5 mg weekly subcutaneously and do not advance the dose at this visit. 1 The patient is demonstrating excellent response with no side effects, and her BMI has decreased from baseline to 27.6, indicating effective treatment. For adolescents with obesity, pharmacotherapy should be evaluated after 12 weeks at the maximum dose, and treatment should be discontinued if BMI or BMI z-score reduction is <4%. 1 Since this patient is tolerating the medication well and showing progress, continuation at the current dose is appropriate while awaiting the endocrinology consultation.

Assess Weight Loss Progress and Treatment Response

• Calculate percentage weight loss from baseline to determine if the patient has achieved ≥5% weight loss, which predicts continued benefit from GLP-1 receptor agonist therapy. 1, 2
• Measure current BMI z-score (not just BMI) as this is the primary metric for assessing treatment response in adolescents. 1
• Document any improvements in weight-related comorbidities such as blood pressure, lipid profile, or glucose metabolism if baseline values were abnormal. 1

Monitor for Adverse Effects

• Screen specifically for gastrointestinal symptoms including nausea, vomiting, diarrhea, and constipation, which occur in 17-22% of patients on GLP-1 receptor agonists. 2
• Ask about persistent severe abdominal pain to rule out pancreatitis, a rare but serious adverse effect. 1, 2
• Inquire about symptoms of gallbladder disease including right upper quadrant pain, as GLP-1 receptor agonists increase risk of cholelithiasis and cholecystitis. 1, 2
• Assess for signs of dehydration from gastrointestinal side effects, particularly important in adolescents. 1

Vitamin D Supplementation Management

• Continue Vitamin D2 50,000 units weekly as prescribed for vitamin D deficiency. 3, 4
• Recheck 25-hydroxyvitamin D level after 8-12 weeks of supplementation to assess response to therapy. 3, 4
• Target 25(OH)D level >30 ng/mL for sufficiency, as vitamin D deficiency is associated with insulin resistance, atherogenic dyslipidemia, and hypertension in obese adolescents. 3
• Once vitamin D sufficiency is achieved, transition to maintenance dosing of 600-1000 IU daily. 3, 4

Reinforce Lifestyle Modifications

• Verify adherence to reduced-calorie diet with approximately 500-kcal deficit below daily requirements, as all clinical trials of GLP-1 receptor agonists incorporated hypocaloric dietary intervention. 1, 2
• Confirm minimum 150 minutes per week of physical activity including both aerobic and resistance training to preserve lean body mass during weight loss. 1, 2
• Involve the entire family in lifestyle changes, as family-centered approaches are essential for successful treatment of childhood obesity. 1
• Emphasize small, gradual behavior change goals rather than rapid weight loss, promoting long-term permanent changes in behavior patterns. 1

Coordinate Endocrinology Follow-Up

• Ensure pediatric endocrinology appointment is scheduled as recommended in the previous visit summary. 1
• Provide endocrinology with complete medication history including current Wegovy dose, duration of therapy, weight loss achieved, and any adverse effects. 1
• Discuss long-term treatment plan with endocrinology, including when to advance Wegovy dose and eventual tapering strategy once BMI goal of 25 is achieved. 1

Laboratory Monitoring

• Order fasting lipid panel if not recently checked, as obesity in adolescents is associated with dyslipidemia and vitamin D deficiency correlates with atherogenic dyslipidemia. 3, 4
• Check fasting glucose and HbA1c to screen for insulin resistance or type 2 diabetes, particularly given the association between vitamin D deficiency and insulin resistance in obese adolescents. 1, 3
• Obtain comprehensive metabolic panel including liver enzymes (ALT, AST) and renal function, as GLP-1 receptor agonists can affect these parameters. 1, 2
• Recheck 25(OH)D level after 8-12 weeks of high-dose supplementation. 3, 4

Counseling on Long-Term Treatment

• Explain that GLP-1 receptor agonists require long-term use to maintain weight loss benefits, as significant weight regain occurs after cessation (11.6% of lost weight regained after 52 weeks). 2, 5
• Discuss the plan to taper medication once BMI goal is reached, but emphasize that this must be done gradually with close monitoring to prevent weight regain. 1, 2
• Counsel that lifestyle modifications must continue indefinitely, even after medication is discontinued, to maintain weight loss. 1, 2

Schedule Next Follow-Up

• Schedule follow-up in 3 months (or sooner if endocrinology recommends), as patients on GLP-1 receptor agonists should be assessed at least every 3 months for weight loss progress, adverse effects, and medication adherence. 1, 2
• Plan to reassess treatment efficacy at the next visit, with consideration for dose advancement if weight loss plateaus and the patient continues to tolerate the medication well. 1, 2

Critical Contraindications to Monitor

• Screen for personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2, which are absolute contraindications to GLP-1 receptor agonist therapy. 1, 2, 5
• Monitor for signs of pancreatitis including persistent severe abdominal pain, nausea, and vomiting. 1, 2
• Watch for gallbladder disease symptoms as GLP-1 receptor agonists increase risk of cholelithiasis and cholecystitis. 1, 2