Weight Loss Medications in Youth: Decision-Making Experiences, Eating Behaviors, and Uncertainty About Endpoint

PURPOSE: To examine decision-making and experiences with use of weight loss medications by adolescents and young adults (AYAs) with obesity. METHODS: Participants included AYA 12-22 years old with obesity who were considering starting (PRE) or were using weight loss medications (POST), including semaglutide, liraglutide, tirzepatide, or phentermine ± topiramate. Caregivers of AYA participants were also invited to participate. Semistructured interviews were audio recorded on a video conferencing platform by trained research team members. A rapid qualitative analysis approach was used to summarize themes. RESULTS: A total of 29 AYA (9 PRE, 20 POST; 55% female; mean age 16.7 ± 2.5 years) and 23 caregivers (7 PRE, 16 POST; 22 mothers, 1 grandmother) participated. Themes included: decision-making: family, peers, doctors, media, finances, and risk-benefit considerations were influential, with AYAs emphasizing weight loss and caregivers emphasizing health; appetite and eating behaviors: high appetite was a key reason for use, "binges" were reported by PRE AYA and POST AYA pretreatment, and medications reduced appetite and food noise; physical, mental, and social experience: improved AYA well-being was reported, yet stigma about medication usage was a concern; parental role: parents provided key practical and emotional support for use; and thinking about future use: AYA and caregivers expressed positive experiences overall and uncertainty over discontinuation decisions. DISCUSSION: A shared decision-making approach leveraging caregiver support for initiation, ongoing use, and discontinuation is needed for AYA considering weight loss medications. Future research should investigate strategies to assess for disordered eating in this population.