Pediatric Use of Compounded GLP-1 Agents: Benefits, Risks, and Equity

The American Academy of Pediatrics recently revised its guidelines on pediatric obesity treatment to recommend that primary care providers offer anti-obesity medications to patients based on age and body mass index. Anti-obesity medications like glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are efficacious in lowering body mass index (BMI) and improving metabolic health, including in children. However, although the landscape for medication production and insurance coverage is rapidly evolving, these medications can be difficult to access due to cost, lack of insurance coverage, and supply chain issues. Compounded versions of GLP-1 RAs offer the benefits of providing lower cost and higher availability alternatives to FDA-approved versions. But they include risks associated with less regulated medications. This paper identifies the risks and benefits of compounded GLP-1 RA use in the pediatric population, particularly considering structural inequities in obesity burden and treatment, and offers recommendations for pediatricians to ethically and equitable address compounded GLP-1 RA use with their patients and their families.