Childhood obesity impacts 1 in 5 kids putting them at risk for health conditions, bullying, and self-esteem issues. But are weight loss drugs the answer?
Fact checked by Sarah Scott
In January 2023, the American Academy of Pediatrics (AAP) changed its guidelines on treating childhood obesity to include the use of weight-loss drugs for children ages 12 years or older. They also recommended screening kids 13 and older for bariatric surgery. These changes are the first they have made in 15 years that address the treatment of the 14.4 million U.S. children and teens with chronic obesity.
Now, at least one drugmaker—Novo Nordisk A/S, the makers of Saxenda, Ozempic, and Wegovy—has started conducting trials with children as young as 6 years old, to see if they could benefit from weight loss medications, too. Through the use of a two-year clinical trial, they hope to determine if Saxenda would be useful in younger kids.
Saxendra was approved in 2020 for use in kids 12 and older, and if approved for younger kids, it could become the first medication of its type available to kids that young anywhere in the world. But do kids—even those 12 and older—really need weight loss medications?
According to Natasha Agbai, MD, a board-certified pediatrician in San Francisco who specializes in childhood weight management and a diplomat on the American Board of Obesity Medicine, the answer is not a simple yes or no.
"For a significant portion of children, adopting lifestyle modifications can indeed make a difference," Dr. Agbai says. "Data indicates that approximately 75% of intensive healthy behavior and lifestyle therapy (IHBLT) programs lead to a meaningful improvement in BMI. However, it's also clear that lifestyle changes alone aren't the solution for everyone, especially given the time commitment these programs require and their limited availability."
Is There Even a Need for Weight Loss Drugs for Kids?
Childhood obesity in the U.S. is a growing problem. In fact, the Centers for Disease Control and Prevention (CDC) indicates nearly 20% of America's kids are obese. What's more, obesity is not without consequences.
Being obese can lead to potentially life-threatening complications including diabetes, high blood pressure, elevated cholesterol, sleep apnea, fatty liver disease, and polycystic ovarian disease in girls, says Kirk W. Reichard, MD, MBA, FACS, FAAP, the medical director of perioperative services and surgical director of the Bariatric Surgery Program at Nemours Children’s Health, Delaware Valley.
But some experts worry that drugs like Ozempic, Wegovy, and Saxenda may not be the answer. They say trying to get weight loss drug approval for younger kids is too much, too soon—especially given that the AAP has only recently recommended the use of these drugs in children 12 and older.
Meanwhile, others point out there is a real need in some cases for weight loss medications suitable for children—especially when their weight is putting their health at risk and nothing else seems to be working.
"There's a specific trend I've observed in my practice," Dr. Agbai says. "A child's weight may increase steadily over time and then suddenly accelerate at a rate outpacing their height growth, making them climb higher on the growth chart. For these children, weight loss becomes a particularly tough challenge. Medications can sometimes provide the breakthrough they need, acting as the critical component in their weight management journey."
However, she stresses any decision regarding weight loss medication should take into account the specific indications, risks, and benefits of the medication. "It's also essential to use these drugs in conjunction with healthy behavior and lifestyle treatments. The use of weight loss medications as a sole treatment strategy is not supported."
Potential Benefits for Kids Who Are Obese
According to Dr. Agbai, childhood obesity is a pressing concern due to the profound impact it can have on individual lives. "Children with obesity face many challenges. They are vulnerable to a range of health issues...But the consequences don't stop there. The societal lens often views obesity negatively, perpetuating harmful stereotypes about laziness and willpower."
This stigmatization can lead to increased bullying, diminished self-esteem, and a skewed self-perception, she says. "[A] child with obesity is 5.5 times more likely to experience impairments in quality of life than normal weight children."
But, addressing obesity with weight loss medications could potentially turn the tide on some of these consequences. "Achieving a healthier weight can bolster self-esteem and reduce the psychosocial challenges often faced by children with obesity...Early and effective weight management [also] can prevent a multitude of long-term health complications, reducing the risk of chronic illnesses in adulthood," Dr. Agbai says.
Beyond the health benefits, she adds that effective weight loss can even enhance a child's overall well-being. "It [also] can lead to increased energy levels, better sleep, and improved physical mobility, allowing children to participate more fully in activities they enjoy," explains Dr. Agbai.
Related: How to Talk to Kids About Body Image
Risks and Side Effects to Consider
According to Dr. Reichard, during the clinical trials of the newer drugs, the side effects were mostly gastrointestinal symptoms such as nausea, vomiting, and diarrhea. These were generally mild or moderate and short-lived, he says.
"Three children developed symptomatic gallstones—likely due to weight loss—and there were no deaths," he says. "[Still], it is important to monitor for adequate nutritional intake during the treatment, especially if weight loss is rapid."
What About the Risk of Eating Disorders?
Some eating disorder experts are not convinced that weight loss drugs are the answer. The Collaborative of Eating Disorder Organizations has been vocal about the potential risks of weight loss drugs and the development of eating disorders.
In January, they sent an open letter to the AAP arguing the use of weight loss drugs in kids could contribute to eating disorders later in life. They also referenced a study that found young people who had bariatric surgery were five times more likely to commit suicide.
However, Dr. Agbai says the relationship between weight loss drugs and the potential development of eating disorders in the future is not yet known. "To date, there's no solid evidence to suggest that anti-obesity medications, when prescribed correctly and monitored diligently, contribute to the onset of eating disorders," she explains. "However, it's crucial to approach this area with caution and continuous research."
There also is the perspective that providing children with careful, age-suitable, and non-stigmatizing weight management strategies might actually reduce the risk of future eating disorders. "This approach offers children effective tools and guidance, potentially reducing their dependence on untested or potentially harmful weight loss tactics," Dr. Agbai adds.
A more significant concern, she says, is the potential misuse of weight loss drugs by people without excess weight. "In essence, these medications might become an inappropriate tool for those already grappling with eating disorders."
Overall, it may be too early to tell what the long-term risks—or benefits—of these drugs are. "But reducing the burden of obesity in children and adolescents will positively impact their physical and emotional health," Dr. Reichard says.
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