Perceptions of GLP-1 RA Use for Children With Obesity Among Caregivers With Food Insecurity: A Qualitative Study

Area of Science:

• Pediatric Endocrinology
• Obesity Medicine
• Health Services Research

Background:

• Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now approved for pediatric obesity, prompting interest in pharmaceutical treatments alongside lifestyle changes.
• Caregiver decision-making regarding these medications, especially in food-insecure populations, remains understudied.
• Food insecurity may impact the feasibility of lifestyle interventions and the potential benefits of adjunct therapies.

Purpose of the Study:

• To explore how caregivers make decisions about using GLP-1 RAs for pediatric obesity treatment within the context of food insecurity.
• To identify factors influencing caregiver choices regarding pharmacotherapy for their child's metabolic disease.

Main Methods:

• Qualitative study involving semi-structured interviews with caregivers of children (aged <18) with obesity and metabolic dysfunction-associated steatotic liver disease and food insecurity.
• Participants were recruited from pediatric gastroenterology clinics.
• Interviews were thematically analyzed to identify decision-making themes.

Main Results:

• Twenty caregivers participated, with most being mothers, immigrants, and facing educational and language barriers.
• Twelve caregivers (60%) desired adjunct pharmacotherapy for their child.
• Key decision-making themes included prior experience with lifestyle change, trust in GLP-1 RA safety and efficacy, and values regarding children's optimal care.

Conclusions:

• Caregivers experiencing food insecurity are open to both lifestyle and medication-inclusive approaches for pediatric obesity.
• Decisions are influenced by lived experiences, safety perceptions, and personal values.
• Shared decision-making that acknowledges these factors and addresses treatment barriers can improve care equity and effectiveness.