Wegovy Pediatric Eligibility

Wegovy — Pediatric Eligibility Screener

Purpose

Binary yes/no decision for Wegovy initiation in a 12-to-17-year-old. Three hard criteria + one exclusion — fail any, and the patient is not a Wegovy candidate per the Canadian label.

Activation

Trigger when:

• A patient aged 12–17 y with obesity is being considered for Wegovy.
• Clinician asks about Wegovy in adolescents / pediatric semaglutide 2.4 mg.
• Screening before initiation.

Required Inputs

• Age (years, to 0.5 y precision)
• Sex (male/female)
• Height + weight → calculate BMI
• Cause of obesity (exogenous vs secondary)
• History of diet/activity trial

Step 1 — Check BMI Cutoff (≥ 95th percentile)

Patient's BMI must be ≥ the cutoff for their age and sex. (Source: US CDC growth references.)

Step 2 — Weight Threshold

Body weight > 60 kg (132 lb). Absolute.

Step 3 — Inadequate Response to Lifestyle

Must have documented inadequate response to a reduced-calorie diet + increased physical activity trial alone.

Step 4 — Exclusion: Secondary Obesity

NOT studied / not recommended in:

• Hypothalamic obesity
• Monogenic obesity (e.g., MC4R, leptin pathway, POMC, PCSK1)
• Endocrine causes (e.g., Cushing, hypothyroidism — treat the cause)

If secondary obesity is suspected → refer for genetic/endocrine workup first (see monogenic-obesity-diagnosis, pediatric-obesity-etiology-screener).

Decision

• ALL 3 criteria met + exclusion ruled out → ELIGIBLE
• ANY criterion failed → NOT ELIGIBLE per Canadian label

If Eligible — Initiation Notes

• Same 16-week escalation schedule as adults (0.25 → 0.5 → 1 → 1.7 → 2.4 mg).
• If 2.4 mg not tolerated → may remain on 1.7 mg as maintenance.
• If 1.7 mg not tolerated → discontinue (adolescent-specific rule).
• Reassess at 12 weeks on maintenance — discontinue if no meaningful BMI improvement.
• Pediatric GI AE rates: nausea 42%, vomiting 36%, diarrhoea 22%, abdominal pain 15%.
• Pediatric cholelithiasis rate higher: 3.8% vs 0% placebo — counsel on RUQ pain.

Hard Stops

• Pregnancy-capable adolescent: contraindicated in pregnancy AND breastfeeding. Discuss contraception.
• MTC / MEN-2 personal or family history → absolute contraindication.
• Active suicidal ideation or history of suicidal attempts → do not use.

Reference

WEGOVY Product Monograph, Novo Nordisk Canada, revised 2024-03-22. Table 1 (BMI cutoffs), §1.1 (Pediatrics), §4.2 (Pediatric dosing).