Yes, yes, and yes. Already to the point that the AAP is potentially recommending doctors give these medications to children and family's that want them in place of actual treatment for binge eating disorder (I've already had 1 case personally). I am sure folks with AAN will be using these sooner rather than later. I would sincerely hope that anyone who can prescribe the medication is not giving it to someone with a normal A1C and normal to low body weight but I'm prepared to be disappointed.
You're seeing people give it for binge eating specifically, without a corresponding medical diagnosis of obesity or diabetes? I'm shocked an insurance company would cover it for that.
Yes just for obesity (no DM or preDM) with an underlying binge eating disorder that family did not want to support pt in getting real treatment for. There's huge uproar from the ED community around the very recent AAP guidelines recommending treatment of obesity with these medications. Like Vyvanse, even if the medication is approved, it will suppress appetite without addressing the reasons behind the binge eating or learning to structure a day to not engage with binge eating behaviors.
How does one get boarded in obesity?
obesity, so often rooted in cognitive and behavioral maladaptation is in the psychiatrist's wheelhouse more so than many other docs.
www.abom.org
Absolutely agree with you. The only specialty that might have more of a claim to obesity is primary care.
Absolutely, atypical anorexia nervosa is just as dangerous as anorexia nervosa from an acute death scenario and the medical establishment is often encouraging this type of weight loss rather than raising red flags. It's also much easier to come by non-controlled medications than Vyvanse.
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov
I am most excited about these medications for exactly those populations. Anyone in the ID/severe ASD w/ hyperphagia or genetic disorders w/ hyperphagia and particularly when using antipsychotics where we often need appetite stimulating meds to keep kids/family's safe.
The question is not just does the patient lose weight or have less binge eating episodes, I have little doubt that will be the case.
There's no morality to the outrage and I don't have any expectation of needing higher dosages. I do think as a field we run significant risks when we use medication in place of psychotherapy/behavioral interventions and I have already seen this being the case in the very short amount of time these medications have been around. This is being labeled the miracle weight loss drug the world has been waiting for and this carries with it significant impact, particularly in the case for eating disorder patients (which my practice specializes in).
I share your concern about these meds in pta with restrictive eating disorders, but in patients with pure binge eating and no restriction or purging, why do you think the analogy is to benzos and not to MAT to opioid use disorder? The latter strikes me as more apt. Weve lost a lot of lives and continue to do so by underutilizing MAT. MAT doesnt remove the need for psychosocial interventions, but it can provide pts with very needed cognitive space to engage in them.
Because pure binge eating disorder is not a disorder of addiction circuitry. It's a problem of eating to excess as a maladaptive coping skill or as part of restrict/binge cycles that relate to underlying body image/self-esteem rooted core problems. Food or sugar addiction you can certainly argue is an addiction circuitry problem, I could conceive of this being potentially useful in those patients. I'd also be open to their use as part of a comprehensive treatment program for BED if they were used in a time-limited manner if this was shown to actually be more effective than the program without the GLP-1a.
Keep in mind that the first GLP-1 hit the market 18 years ago. Not exactly life long, but pretty good long term data so far.
The problem is a focus on weight alone as a measure of health, about telling kids that you should be considering daily to weekly injections because of this or even bariatric surgery and how this can directly do harm by promoting fat phobia/weight stigma which in turn promote eating disorders.
Are you kidding me?The problem is a focus on weight alone as a measure of health, about telling kids that you should be considering daily to weekly injections because of this or even bariatric surgery and how this can directly do harm by promoting fat phobia/weight stigma which in turn promote eating disorders.
The subsidy of sugar, ultraprocessed foods, income inequality, etc are all huge underpinnings to the raise in adolescent weight, we are not finding our way out of this problem with more GLP-1a's or lap bands in kids.
Here are some mainstream news articles that have arisen to give you people's opinion that are more experienced than I:
Opinion | Why the New Obesity Guidelines for Kids Terrify Me (Published 2023)
The guidelines are rooted in a premise that should have been rejected long ago: that weight loss is the best path to health and happiness.www.nytimes.com
The problem is a focus on weight alone as a measure of health, about telling kids that you should be considering daily to weekly injections because of this or even bariatric surgery and how this can directly do harm by promoting fat phobia/weight stigma which in turn promote eating disorders.
The subsidy of sugar, ultraprocessed foods, income inequality, etc are all huge underpinnings to the raise in adolescent weight, we are not finding our way out of this problem with more GLP-1a's or lap bands in kids.
Here are some mainstream news articles that have arisen to give you people's opinion that are more experienced than I:
Opinion | Why the New Obesity Guidelines for Kids Terrify Me (Published 2023)
The guidelines are rooted in a premise that should have been rejected long ago: that weight loss is the best path to health and happiness.
That was one of the top 3 google links that came up, I see that you are referencing that and not the ones that are posted by physicians and ED organizations. Since you seem to be very knowledgeable about the space, I am sure you aware ERC is one of the largest ED treatment centers in the country and their leadership includes some of the top folks in the field.
Except prior to ozempic, us PCPs had basically no good tools for obesity. We have lots of other tools for everything else you mentioned.
I think my concern is some of the testimonials I've read, where people have lost the weight they planned to lose, look like they're clearly in the range of <20 or so BMI, and state they want to stay on it forever and they only eat a meal a day. We may unintentionally be manufacturing anorexics through pharmaceutical means. Really wish I could find the couple of articles I'd read on this, if you swapped it ozempic for anorexia, they were basically describing many of the same desires, eating patterns, and weight trajectories. As someone who has worked on 3 eating disorder services over the years, it set off mega red flags.
I don't think the 20-30 minutes I can afford an outpatient once every 4-6 weeks is going to shake them out of their eating habits. A psychologist that can see them weekly, or a psychiatrist taking cash that can afford to spend the extra time, perhaps
You'd probably be able to get it approved if they meet any of the metabolic syndrome criteria and a BMI of ≥ 27 and have tried 6 months of lifestyle/diet. It's probably more worthwhile to try topiramate after metformin for AP weight gain and if that doesn't work then try for a GLP-1 agonist.
This is not the same at all. You don't go into your pediatrician's office and get diagnosed with or referred to treatment because of a number on scale (yes even high PHQ 9's). They are still looking for functional impairment to be started on an SSRI or referred to psych. If you come in with a BMI of 27 with normal vitals/blood workup, you are still being told that something is wrong with you. Who that conversation is with and how it is handled matters.
This is so logically inconsistent I don't know what to say, it feels very unlike you. This is THE treatment guidelines for children throughout the US. If you make sweeping guidelines that suggest talking to 12 year olds about weigh lose medications based on their weight number alone is to be recommended, one would hope that is based on significant studies, including longitudinal studies when we specifically know of risks associated with this. I have read the guidelines and the discussion of weight loss medication shows a dearth of these studies. This has nothing to do with "begging the question", it's a request for evidence to support controversial guidelines.
Many of these patients do have sugar addiction or binge eating. Some don't and instead use eating as a maladaptive coping strategy that does not meet criteria for either of those conditions in which case it should have a diagnosis like self-harm, I agree, but we typically don't have DSM diagnosis exclusively based on the maladaptive coping skill (just v codes).
I'm sorry, but where are you getting the impression that pediatricians are going around throwing metformin and GLP -1 agonists at 12 year olds whp have a BMI of 27 and are otherwise healthy without talking about lifestyle factors?
That's the whole point. They are absolutely not doing that right now, I think most doctors who spend all day with kids can see the folly in that. When you then change the equation by adding it as a step of care in a treatment guideline, the whole purpose of that is to get said doctors to think about it.
Plus counseling on lifestyle isn’t effective
Eh, I disagree, personally. I think that lifestyle interventions should be a significant focus and that obesity is a major issue that is easier to interrupt in its earlier stages.
bmcendocrdisord.biomedcentral.com
