Indications and experiences
All doctors can prescribe liraglutide 3.0 mg as a supplement to lifestyle treatment for adolescents with obesity. In total, more than 100 young patients with severe obesity attending one of our obesity clinics were given supplementary treatment in the form of liraglutide. Our interdisciplinary teams first reached a consensus on the indication for medicinal treatment, then the doctor initiated the treatment and increased it to the maximum tolerable dose over the course of five weeks. Due to the relatively high frequency of side effects, primarily nausea and abdominal pain, but also reflux and vomiting, patients were followed up every week by our healthcare personnel during this period.
In order to be able to continue treatment beyond an introductory period of 12 weeks at the maximum tolerable dose, patients are required to reduce their BMI or BMI z-score by at least 4 % from the start of treatment. In our experience, most meet this requirement. However, the doctor and patient also take into account the side effect profile in the (shared) decision on whether to continue or terminate the treatment. Although there is no evidence of increased risk of eating disorders with liraglutide, adolescents with obesity are a vulnerable group, and psychosocial factors are given particular attention in the clinical follow-up.
We have experienced that knowledge of caloric restriction and specific dietary changes are needed to achieve the desired additional effect of liraglutide. It is therefore recommended that adolescents with severe obesity take part in a lifestyle change programme of at least 6 months before supplementary medicinal treatment be considered.
In cases of severe obesity (isoBMI ≥ 40, or isoBMI ≥ 35 and < 40 with at least one weight-related comorbidity), individual reimbursements can be sought under the reimbursable prescription scheme (7).