574 - Understanding Clinician Attitudes and Decision-Making on GLP-1 Use in Adolescents

Publication Number: 4562.574

Idia B. Thurston, Northeastern University, Boston, MA, United States; Carly E.. Milliren, Boston Children's Hospital, Boston, MA, United States; Sabrina F. Balmaseda, Northeastern University, Brookline, MA, United States; Diya Singhal, Northeastern University, Plainsboro, NJ, United States; Kendrin R. Sonneville, University of Michigan School of Public Health, Ann Arbor, MI, United States; Taylor M. Cruz, Northeastern University, Boston, MA, United States; Tracy Richmond, Harvard Medical School, Boston, MA, United States

Background: The 2023 AAP obesity guidelines introduced earlier and more intensive treatment strategies for adolescent overweight and obesity, including the use of glucagon-like peptide-1 receptor agonists (GLP-1s) and other weight loss medications. However, little is known about how clinicians navigate these recommendations and balance pharmacologic treatment with equitable, stigma-free care.

Objective: This qualitative study explored clinician decision-making regarding the use of weight-loss medications for adolescents, including contextual and psychosocial factors influencing these decisions and their relationship to weight stigma.

Design/Methods: We conducted semi-structured interviews with clinicians from three types of practice sites: 1) an urban pediatric tertiary hospital, 2) affiliated community health centers (CHCs) with pediatric practices, and 3) independent, non-affiliated CHCs. Interview topics included perceptions of GLP-1s, weight stigma, and contextual factors shaping prescribing behaviors. Interviews were audio-recorded, transcribed verbatim, and analyzed via thematic analysis.

Results: We conducted interviews with 16 clinicians (7 from the tertiary hospital, 7 from affiliated CHCs, and 2 from non-affiliated CHCs). Clinicians at the tertiary hospital reported substantial familiarity and confidence in prescribing GLP-1 medications, whereas those at CHCs reported limited experience and reliance on specialized weight management clinics. Across all settings, clinicians expressed interest in increasing their knowledge of GLP-1s. Barriers to GLP-1 prescription included insurance restrictions, cost, lack of provider education, and concentration of expertise at tertiary hospitals. Facilitators included provider confidence, administrative support, onsite nutritional and behavioral consultation, and established monitoring protocols. Patient and family health literacy and capacity to navigate insurance and referral systems also influenced GLP-1 access. Discussions of weight stigma reveal nuanced views on both the risks and benefits of GLP-1 use.

Conclusion(s): Differential knowledge, experience, and resources, both individually and institutionally, shape clinicians’ confidence and capacity to prescribe GLP-1s. Educational initiatives should target these disparities through knowledge sharing between tertiary hospitals and CHCs. System-level strategies that support clinician decision-making, promote equitable access, and reduce weight stigma are essential to ensure consistent, high-quality care across practice settings for all patients.