P2.198: Perceptions of Weight Management Medications Among Adolescents, Caregivers, and Pediatricians in the Southwest

Background: Adolescent obesity remains a prevalent chronic condition, especially among Hispanic and American Indian populations in the Southwest, where access to specialized obesity care is often limited. The 2023 clinical guidelines from the American Academy of Pediatrics recommend a multidisciplinary approach to treatment, including pharmacologic interventions. However, barriers such as limited availability, lack of provider familiarity, and concerns about specific medications persist. Phentermine, an FDA-approved, low-cost medication for adolescents aged 16 and older, may still be affected by its association with the 1990s recall of “Fen-Phen,” complicating its acceptance among families and providers.

Methods: Objective was to explore how adolescents with obesity, their caregivers, and community pediatricians perceive weight loss medications, with a focus on knowledge, concerns, and barriers to use.

Thirty semi-structured interviews were conducted with 10 adolescent–caregiver dyads and 10 pediatricians in the Southwest . Interviews were audio-recorded, professionally transcribed, and analyzed in NVivo. A constructivist grounded theory approach guided the analysis. Coding was completed using a constant comparison method.

Results: Adolescents and caregivers expressed a strong preference for lifestyle changes such as healthy eating and exercise but described barriers including transportation, limited time, emotional stress, and difficulty avoiding unhealthy foods. While some were open to medications, concerns included potential side effects, general mistrust of medications, and a belief that they were “not natural.” Dyads had limited or no awareness of phentermine. Pediatricians overwhelmingly reported limited knowledge of phentermine and discomfort with prescribing it. Many said they had never used it in practice and would defer to specialists or use it only as an adjunct to lifestyle counseling. Common concerns regarding phentermine included stimulant properties, cardiovascular effects, and the lack of long-term safety data in adolescents. Across all groups, participants emphasized the importance of consistent provider support, culturally grounded education, and progress tracking to build trust and improve engagement.

Conclusion: This study underscores the complex interplay between limited awareness, cultural beliefs, and provider uncertainty that shapes how pharmacologic treatments for adolescent obesity are received in the Southwest. Rather than outright rejection, participants expressed conditional openness, willing to consider medications when trust, transparency, and support were present. For pediatricians, discomfort stemmed not only from lack of training but from broader concerns about safety, clarity of guidelines, and the residual stigma from past medications like Fen-Phen. Moving forward, improving the acceptability of evidence-based treatments like phentermine will require more than just education. It will demand culturally grounded outreach, clearer clinical pathways, and engagement strategies that reflect the lived experiences of families. These insights offer a roadmap for designing equitable recruitment efforts for clinical trials and ensuring broader access to the full spectrum of obesity care.