Access Barriers and Variable Response to Semaglutide in Severe Adolescent Obesity: A Case Series

Pediatric obesity is a worsening public health crisis, affecting 1 out of 5 youth in the United States. Once-weekly semaglutide has produced clinically meaningful BMI reduction in adolescents in randomized trials. However, trial cohorts and protocols may not reflect real-world care where patients are more diverse and may face access barriers-a factor that disproportionately affects minoritized groups. In this case report, we describe three adolescents of color with severe obesity treated in a multispecialty obesity clinic with lifestyle counseling and semaglutide. We summarize their clinical course, tolerability, access timelines, and BMI responses. All three reported improved appetite regulation and minimal side effects; however, their trajectories differed as their access and treatment courses varied, which likely affected their BMI outcomes. We will also discuss contextual factors that the general pediatrician should consider when interpreting BMI outcomes, including pubertal stage, gender and body composition, and physical activity. These cases highlight a gap in the literature between efficacy trials and real-world experience that involves access barriers and developmental factors in a diverse adolescent population.