New Research Letter Reveals GLP-1 Access Deficits for Adolescents and Young Adults

Glucagon-Like Peptide-1 Receptor Agonist medications (GLP-1RAs) are an effective new class of weight-loss medications getting a lot of attention in health care and in the news. You may even know a friend or family member who is taking one. Now, Yale researchers have discovered that 17 million adolescents and young adults in the United States—about a quarter of all adolescents and young adults in the country—are eligible for GLP-1RA therapy.

In JAMA Pediatrics, medical student and lead author Ashwin Chetty explained that GLP-1RAs are approved to treat pediatric obesity and type 2 diabetes (T2D), but only a small number of eligible patients are receiving them, due in part to their access to care and insurance coverage.

Using data for adolescents ages 12-17 and young adults ages 18-25 from the National Health and Nutrition Examination Survey, the researchers found that Medicaid and private insurance are the largest insurers, covering about 80% of those in these age groups who met the criteria for GLP-1RA eligibility. This might include adolescents or young adults with diagnoses of T2D, obesity, or overweight with weight-related conditions like hypertension or dyslipidemia.

Around 7% of adolescents and 19% of young adults reported being uninsured. And while over 90% of adolescents said they had a routine place for health care, only about 68% of young adults reported the same—a barrier to receiving care that could determine eligibility and help prevent, identify, or treat cardio-kidney-metabolic diseases.

"Only a fraction of state Medicaid programs cover GLP-1RAs for weight management, but this research shows that broad anti-obesity medication coverage through Medicaid could substantially expand access to GLP-1RAs for adolescents and young adults," says Chetty. "However, even with coverage expansion, high levels of uninsurance and lack of routine care are barriers to GLP-1RA access in this population."

Only a fraction of state Medicaid programs cover GLP-1RAs for weight management, but this research shows that broad anti-obesity medication coverage through Medicaid could substantially expand access to GLP-1RAs for adolescents and young adults. However, even with coverage expansion, high levels of uninsurance and lack of routine care are barriers to GLP-1RA access in this population.

-Ashwin Chetty

For young adults, increasing access to care may help more eligible patients gain access to GLP1-RAs and, for all age groups, assuring private insurance plans and Medicaid include coverage for GLP1-RA medications may mean more eligible patients can benefit from them.

James Nugent, MD, MPH, who helped author the letter, adds, "Addressing the public health crisis of pediatric obesity requires a combination of individual- and population-level strategies for treatment and prevention. Anti-obesity medications are one aspect of a comprehensive management plan for children with obesity, particularly those with more severe obesity and associated comorbidities."

Mona Sharifi, MD, MPH, section chief of general pediatrics and associate professor of pediatrics and health informatics at Yale School of Medicine, also helped author this research letter.