Real‐World Use of Subsidised Semaglutide in Icelandic Children With Obesity: A Nationwide Retrospective Cohort Study
Sigrun Thorsteinsdottir, Berglind Jonsdottir, Anna S. Olafsdottir, Helena B. Arnarsdottir, Sigrun Hallgrimsdottir, Berglind Brynjólfsdóttir, Tryggvi HelgasonABSTRACT
Background
Real‐world evidence of subsidised semaglutide in children with obesity is scarce.
Objectives
To describe clinical outcomes (%IOTF30 change) in a nationwide cohort of Icelandic children prescribed subsidised semaglutide, describing outcomes across treatment settings and examining treatment response in children with and without neurodevelopmental disorders (ND).
Methods
Retrospective, population‐based cohort study using longitudinal anthropometric measurements, March 20, 2021–June 6, 2025. Children aged ≥ 12 with grade 2 obesity were eligible for subsidised semaglutide under a universal reimbursement policy. Main outcomes were changes in %IOTF30 (BMI expressed as a percentage of the age‐ and sex‐specific IOTF obesity threshold), modelled using piecewise linear mixed‐effects regression.
Results
Among 113 participants (44% female; mean [SD] age 15.2 [2.0] years), pre‐treatment %IOTF30 rose at 0.29 percentage points (pp)/month (95% CI, 0.26, 0.33). Semaglutide was associated with trajectory reversal at −0.86 pp/month (95% CI, −1.06 to −0.66); estimated reductions were 5.17 (95% CI, 3.98, 6.36) and 10.33 (95% CI, 7.96, 12.71) pp at six and 12 months. On‐treatment slopes were numerically similar across settings but not interpretable as evidence of equivalent response. ND‐status did not significantly modify treatment response among 56 Pediatric Obesity Center participants (interaction p = 0.83; underpowered). Overall, 63% achieved %IOTF30 reductions exceeding 10 pp.
Conclusions
Semaglutide was associated with reversal of a longstanding upward weight trajectory in children with obesity. ND‐status did not significantly modify treatment response; analysis was underpowered. Universal subsidisation policy enabled high treatment persistence and may inform reimbursement policy in other countries, though generalisability to settings without universal coverage remains uncertain.