Telehealth companies hesitate to bring GLP-1s to kids

The popularity of glucagon-like peptide-1 agonist drugs, known as GLP-1s, has led to a slew of telehealth companies prescribing the weight loss medications to patients.

Many companies are willing to prescribe the compounded versions of GLP-1s, which use similar ingredients despite uncertain side effects, or are dramatically shifting their business model to cash in on the growing popularity of the drugs. The change in strategy is helping telehealth companies increase revenue. 

Related: GLP-1 costs drive employers to specialty benefits vendors

But even though GLP-1s like Novo Nordisk’s Wegovy are approved for patients age 12 and older, most telehealth companies do not prescribe them to children, citing uncertainty over long-term side effects.

The ones that prescribe them to young patients say they do so carefully. Knownwell, a virtual and in-person care provider, thoroughly examines kids before potentially prescribing a GLP-1 medication, said CEO Brooke Boyarsky Pratt. She said the company has access to a patient’s full medical record, works directly with their pediatrician and can provide a support system that includes dietitians and health coaches.

“If a child is seeing us, they’re in pretty dire need,” Boyarsky Pratt said. “We're not seeing a teen who's 10 pounds overweight and is downloading an app. This patient is going to an obesity medicine specialist with their parents…We have an hourlong session where the doctor is going through their full medical history.”

Knownwell, which opened a clinic Austin, Texas, last week to go along with a clinic in the Boston area, is an exception. Purely virtual companies Noom, Hims & Hers, Ro, Found and WeightWatchers said they do not offer weight loss services including GLP-1 medication prescriptions to patients under the age of 18.

The evidence to support the use of the drugs by children is too limited for some companies. Dr. Rekha Kumar, chief medical officer of Found, said the company is keeping an eye on the research. 

“Our approach has been to first master our current model focused on adults with the understanding that expanding to support entire families could help prevent health complications and improve outcomes across generations,” Kumar said in an email.

Novo Nordisk’s Saxenda, approved for patients age 12 and older, is effective in reducing weight for kids as young as six, according to a study published in September from researchers at the University of Minnesota Medical School. Still, the researchers said the medication’s safety and efficacy has not been established in children.

Young patients seem to be getting their hands on weight loss drugs regardless. From 2020 to 2023, there was an almost sixfold increase in the number of patients between the ages of 12 and 17 who received GLP-1s, to 60,567 children in 2023, according to a study published in May from researchers at Ann Arbor-based Michigan Medicine. There has been a 3% decrease in the dispensing of all other medications to children, according to the researchers.

“There is increased uptake, there is an increased demand,” said Dr. Joyce Lee, is a pediatric endocrinologist at Michigan Medicine and author of the study. “It's not clear whether patients who are getting the medication truly qualify based on [body mass index] criteria.”

Telehealth companies are adamant their screening processes safeguard children. A spokesperson for Ro said the company uses an identity verification platform to confirm a patient's identity, including their date of birth, against public and proprietary data sources. Hims & Hers, Noom, Found and WeightWatchers also said they have identity verification processes.

There is debate among researchers whether virtual care can align with obesity treatments. Telehealth is important for improving access to care, but it can’t replace in-person medicine for weight loss, especially when it comes to children, said Dr. Vibha Singhal, director of pediatric obesity at Los Angeles-based UCLA Mattel Children’s Hospital.

“It’s a great boon for managing weight loss but it has its challenges,” Singhal said. “I need my patients’ weights and heights. I need these measurements to make a judgment as to how they are doing. I need to monitor their blood pressure with these medications. So telehealth is helpful but we still have to figure out how to make it truly complete.”