Millions of adults worldwide are using potent drugs like Wegovy to combat obesity, and now similar treatments are being explored for children. Recent clinical trials indicate that adolescents experience substantial weight loss with the latest generation of obesity drugs, which mimic glucagon-like peptide 1 (GLP-1). Semaglutide (Ozempic, Wegovy) and liraglutide (Saxenda, Victoza) are already approved in the US and Europe for treating obesity in children as young as 12.
A new study published in The New England Journal of Medicine has provided initial data on anti-obesity drugs in children aged 6 to 11. The study revealed that liraglutide treatment resulted in a decrease in body mass index (BMI), a key measure of obesity, in this younger age group.
The Urgency of Treating Childhood Obesity
Physician Sarah Ro, who directs the University of North Carolina Physicians Network Weight Management Program, notes that most children with obesity continue to be obese as teens and adults. Many young children with severe obesity develop significant health issues, such as high blood pressure, type 2 diabetes, and advanced liver disease linked to excess weight. Current treatment options for children with obesity are limited, creating a demand for effective interventions. Pediatric obesity researcher Geoff Ball at the University of Alberta emphasizes the need for evidence-based decisions for children, as many current practices are based on adult trials.
Efficacy of GLP-1 Mimics in Children and Adolescents
The study on children aged 6–11 showed that 46% of participants receiving liraglutide experienced a BMI decrease of 5% or more, compared to only 9% in the placebo group. However, the study's population was primarily white (72%), with limited representation of Black children (6%), highlighting the need for more diverse studies.
Older children have shown similar results. A 2020 study on 12–17-year-olds found that 43% of those taking liraglutide had at least a 5% reduction in BMI, compared to 19% on placebo. In a 2022 trial, 73% of participants aged 12–17 taking semaglutide lost 5% or more of their body weight, compared to 18% taking a placebo.
Limitations of BMI as a Metric
Scientists have pointed out the disadvantages of using BMI to measure progress. Geoff Ball notes that BMI is not an ideal metric for children because they are still growing. An accompanying editorial highlighted that BMI is a poor surrogate for fat mass. Sarah Nutter, a weight stigma researcher at the University of Victoria, suggests that obesity should be defined by weight-related health problems and that the study should have used a more reliable indicator of health than BMI.
Long-Term Consequences and Ethical Concerns
There is limited data on the long-term effects of GLP-1 mimics on growth and puberty in young children, partly because these drugs are relatively untested in this age group. None of the GLP-1 mimics are approved in the US for treating obesity in children younger than 12. The children in the recent study received liraglutide for just over a year and were followed for another six months, with plans to continue data collection on the drug’s safety until January 2027.
Sarah Ro calls for prolonged monitoring to detect any signs of eating disorders, emphasizing that GLP-1 mimics are powerful drugs that require careful consideration. GLP-1 mimics are currently considered lifelong drugs, as obesity is a chronic, progressive, relapsing disease that requires ongoing treatment. However, some children may need to stop taking the drugs due to factors such as loss of insurance coverage or intolerable side effects like nausea. The exit strategy for children remains a key question for further research, as hunger and cravings return once patients stop taking the drugs, leading to weight regain.
Ethical concerns also arise regarding the use of these drugs in minors. Sarah Nutter has reservations about obesity drugs in general, especially for children and adolescents whose bodies are still developing. She is also concerned that families might make decisions based on weight stigma rather than considering whether a child is healthy at any weight. Ro counters that the risks of doing nothing, such as the effects of carrying excess weight on growth, puberty, heart, lungs, kidneys, mental health, and lifespan, must also be considered. She concludes that the risks and benefits of treatment versus no treatment must be weighed carefully.
