568 - Feasibility of Pharmacotherapy Treatment of Obesity in a Primary Care Underserved Clinic: A Pilot Study

Publication Number: 4556.568

Jose Morales Moreno, University of Utah School of Medicine, Salt Lake City, UT, United States; Kim Hansen, University of Utah School of Medicine, Salt Lake City, UT, United States; Joni Hemond, University of Utah School of Medicine, Salt Lake City, UT, United States

Background: Pediatric obesity affects 1 in 5 U.S. children. The American Academy of Pediatrics recommends offering obesity pharmacotherapy for patients ≥ 12 y with BMI ≥ 95th percentile. Barriers, including cost, insurance coverage, provider knowledge, and limited sub-specialist care, may limit access, particularly in underserved settings.

Objective: We sought to evaluate the feasibility of implementing an obesity pharmacotherapy care pathway in an academic primary care clinic serving a medically underserved population.

Design/Methods: A convenience sample of participants ≥ 12 and < 18 years of age with BMI ≥ 95th percentile was asked to participate in a primary care pilot obesity intervention during visits at an academic primary care clinic. Interested patients were referred to a general pediatrician within the clinic with experience in obesity pharmacotherapy. Patients followed up 3 times in 1-month intervals, and every 3 months for 3 more visits. Patients received lifestyle modification counseling and motivational interviewing; were offered dietician referrals; and counseled on obesity pharmacotherapy. If patients chose to pursue pharmacotherapy, a GLP-1 agonist was prescribed. If not covered by insurance and/or cost prohibitive, topiramate and phentermine were prescribed instead. Intervention pharmacotherapy rates, changes in weight and BMI, out-of-pocket medication cost, and barriers to pharmacotherapy were documented.

Results: From August 2024 to October 2025, 25 patients were referred (Table 1). Of these, 10 declined pharmacotherapy. Reasons included needle phobia, side effects, not wanting to start a chronic medication, preference for lifestyle modification, feeling happy in their own body, and cost. 8 patients were prescribed medication but did not return, and 7 are receiving medication and have attended at least 1 follow-up visit. Of the latter, none received a GLP-1 due to cost and were prescribed topiramate and phentermine. Early weight loss data is mixed after a median of 3 follow-up visits in this group (Table 2). Notably, two patients lost 7.1 kg and 12.1 kg after 2 and 3 follow-up visits, respectively. The monthly cost of topiramate and phentermine was $20-40 dollars.

Conclusion(s): Early data shows that obesity pharmacotherapy in primary care may be an alternative to specialist referral, particularly for those with low socio-economic status. Barriers and facilitators to treatment must be assessed prospectively to support the development of a generalizable primary care treatment model. Broader GLP-1 insurance coverage may increase effectiveness and equity of obesity management.

Table 1: Patient Demographics


Table 2: Change in Weight and BMI Percentile at Last Follow-up Visit in Patients Receiving Obesity Pharmacotherapy