Kids on Weight-Loss Drugs: What We Really Know

GLP-1 medications, including semaglutide (Ozempic and Wegovy) and tirzepatide (Mounjaro and Zepbound), have transformed the approach to treating obesity and type 2 diabetes. A significant number of adults in the U.S. are currently using or have used GLP-1 treatments, and this trend is increasingly extending to adolescents and young children.

Recent research highlighted that, although the overall usage of GLP-1 drugs in young children remains low, there has been a notable increase in prescriptions over time. From 2019 to 2026, a study found that 0.6% of children aged 8 to 11 with obesity but without diabetes were prescribed GLP-1 medications off-label, with the annual percentage of prescriptions rising significantly. Other studies have indicated a similar upward trend in GLP-1 usage among teenagers and young adults.

These medications address a crucial public health concern. According to data from the Centers for Disease Control and Prevention, approximately 22% of adolescents aged 12 to 19 and 21% of children aged 6 to 11 are classified as obese. GLP-1 drugs have shown efficacy in treating obesity in children; for instance, recent trial data from Novo Nordisk revealed that 40% of children aged 6 to 12 reached a weight category no longer considered obese after 68 weeks of treatment.

In 2023, the American Academy of Pediatrics urged healthcare providers to adopt a more proactive stance on managing childhood obesity, including the consideration of GLP-1 medications. organizations such as the U.S. Preventive Services Task Force have refrained from making similar recommendations, citing insufficient data. Currently, semaglutide is approved for use in children aged 12 and older, while Novo Nordisk is pursuing approval for younger groups. In contrast, tirzepatide, another prominent GLP-1-based drug from Eli Lilly, is only approved for adults and patients over 18, although it can be prescribed to children with diabetes starting at age 10.

In this installment of Giz Asks, we consulted experts in obesity research, pharmacology, and pediatrics to gain insights into GLP-1 use among children and adolescents. What are the known long-term effects of these medications in younger populations? What unanswered questions remain? And how do children on these drugs describe their experiences? The following responses have been lightly edited for grammar and clarity.

Insights from Epidemiologist Sarah Messiah

Dr. Messiah is an epidemiologist and childhood obesity researcher at the University of Texas Southwestern Medical Center. She co-authored a recent study that documented the increasing use of GLP-1 medications among young people.

In our recent study published in JAMA, we focused on age limits at the request of reviewers due to the bariatric surgery context. We were particularly interested in the interaction between bariatric surgery and GLP-1 usage. This is significant since bariatric surgery is generally recommended only for individuals aged 13 and older. I also conducted a local analysis at Children’s Health in Dallas to better understand our prescribing trends.

From 2020 until last month, we observed nearly 2,000 children prescribed GLP-1s or GIPs. While our analysis included patients up to age 21, about 7% of those were 11 years old or younger, primarily treated for obesity and type 2 diabetes.

It appears that these younger patients often have a strong family history of obesity or type 2 diabetes. Pediatricians are increasingly opting for early off-label GLP-1 treatment when they see aggressive progression. Our findings align with recent studies indicating that pediatricians are exploring these options with the hope of achieving effective results.

Another trend we noticed is the prescription of tirzepatide to pediatric patients, likely due to inadequate responses to previous treatments.

It’s important to note that Children’s Health operates as a safety net hospital. Approximately 64% of our patients rely on Medicaid. Our patient population is diverse and not limited to affluent families. We often serve children referred from community pediatricians due to elevated BMI or blood pressure, who may require specialized care from endocrinologists or gastroenterologists. Many of these patients have class 2 or 3 obesity or related health conditions that prompt the use of these medications.

Many questions remain about the long-term effects of these therapies. What happens when a patient discontinues treatment? Do they switch to another medication, stop due to costs, or discontinue because they have lost sufficient weight? The lack of information on these issues is concerning.

Another critical consideration is the shift toward precision obesity care. The goal is to identify the most suitable medication or treatment for each individual. Are we cycling through medications, or should we initiate treatment with the most effective option available? With new medications like tirzepatide and retatrutide emerging, the pace of change in this field is rapid, making it challenging to keep abreast of developments.

Pediatric care involves two layers of influence: the child and their parent. Understanding the dynamics at play is essential. Is the parent’s perspective driving treatment decisions, or is it the child’s wishes? This complexity presents further questions in our understanding of treatment.

Our JAMA study also indicates an increase in children starting GLP-1 therapy prior to bariatric surgery. We need to explore whether these children are prescribed GLP-1s to meet surgical weight criteria or because they did not achieve desired results from the medication and subsequently opted for surgery. We also need to investigate how these medications are utilized post-surgery. These are critical areas for future research.

Interestingly, social media significantly influences this age group. The current generation is well-informed and proactive about their treatment options, often arriving at consultations with specific information from online sources. This shift promotes shared decision-making, contrasting sharply with a decade ago when discussions were predominantly one-sided, with pediatricians making unilateral decisions.

This evolution in patient engagement is encouraging, but we still have much to learn.

Research Findings from Pareeta Kotecha

Pareeta Kotecha is a graduate student at the University of Florida’s College of Pharmacy and the lead author of a systematic review examining GLP-1 effectiveness and safety in children and adolescents.

The available data on GLP-1 medications for treating obesity in children and adolescents is promising, yet still limited.

Our team performed a systematic review and meta-analysis of 18 randomized clinical trials involving over 1,400 children and adolescents aged 6 to 17. Notably, these trials encompassed various conditions: 11 focused on obesity, six on type 2 diabetes, and one on prediabetes. Overall, GLP-1 receptor agonists demonstrated significant improvements in weight-related and metabolic outcomes. Weight and BMI reductions were particularly pronounced in obesity-focused trials, while glycemic control improvements were evident in those involving young individuals with type 2 diabetes. We also observed reductions in systolic blood pressure.

It’s critical to understand that pediatric GLP-1 use encompasses various indications and age groups. In the U.S., certain GLP-1 medications are FDA-approved for treating obesity in adolescents aged 12 and older, while others are approved for type 2 diabetes starting at age 10. Since obesity often coexists with type 2 diabetes, it’s essential to consider the specific reasons for prescribing these medications when analyzing real-world prescribing trends.

The safety profile of GLP-1 medications also warrants careful consideration. Gastrointestinal side effects are common, consistent with findings in adult populations. Importantly, our analysis did not reveal significant differences in treatment discontinuation rates, depression, or suicidal thoughts between GLP-1 medications and placebo in the randomized trials we examined.

Nonetheless, the absence of significant safety signals does not eliminate the possibility of unrecognized risks. The duration and size of existing trials may not adequately capture rare adverse events or long-term outcomes. outcomes such as eating disorders were not included in the trials we reviewed, leaving a gap in understanding how GLP-1 treatment may influence disordered eating behaviors in young people. This area is ripe for further investigation.

The discourse should progress beyond a simplistic evaluation of these drugs as “good” or “bad” for children. Since obesity is a chronic disease with lifetime consequences, effective early treatment could mitigate future metabolic and cardiovascular complications. children and adolescents are in critical stages of growth and development, necessitating more comprehensive long-term evidence regarding outcomes such as growth, nutrition, mental health, eating disorders, weight trajectories post-treatment, and any rare or delayed adverse effects.

As GLP-1 usage among young individuals escalates, accumulating real-world evidence will be vital for understanding long-term safety, prescribing patterns, and outcomes for children and adolescents receiving these medications.

Clinical Perspectives from Tahniat Syed

Dr. Tahniat Syed is a clinical associate professor of pediatrics at the University of Pittsburgh School of Medicine and the clinical director for the Center for Adolescent and Young Adult Health at UPMC Children’s Hospital of Pittsburgh.

We have accumulated a considerable amount of knowledge regarding obesity treatment in young populations.

The definitions of being overweight or obese are well-established in pediatrics. We utilize growth percentiles to track weight, identifying individuals above the 95th percentile as obese, unlike adults, who use a body mass index greater than 30. It’s essential to ensure an accurate obesity diagnosis in children, considering their rapid growth and development during puberty. Various anti-obesity medications, including GLP-1s, are available.

GLP-1, or GLP-1 receptor agonist, interacts with specific receptors throughout the body. By stimulating these receptors, these medications enhance insulin secretion, slow gastric emptying, and help individuals feel satiated. They also influence brain functions related to hunger and may impact metabolism and impulse control.

Many of my patients report that these medications significantly reduce what they describe as “food noise.” Research conducted since 2021 demonstrates that GLP-1 receptor agonists effectively promote weight loss, which can improve metabolic conditions in individuals who already experience them.

It’s important to clarify that GLP-1 medications are specifically indicated for obesity treatment and are not intended for eating disorders. individuals with obesity often exhibit disordered eating patterns, which may manifest as food noise.

Eating disorders come in various forms. Anorexia nervosa involves severe calorie restriction leading to undernourishment, driven by distorted perceptions of body image. Another form is binge eating disorder, which can overlap with obesity. Hyperphagia, characterized by an overwhelming urge to eat, can also coexist with obesity.

Recently, I consulted with a patient seeking weight management who also has binge eating disorder. My approach involves treating both the eating disorder and any underlying anxiety while we work towards stabilizing her weight.

Expert Insights from Alaina Vidmar

Dr. Alaina Vidmar serves as the medical director of obesity medicine and bariatric surgery at Children’s Hospital Los Angeles.

It is essential to recognize that pediatric obesity is a complex, chronic disease. It is not a reflection of personal failings on the part of the child or their parents but rather a biological difference that affects how hunger and satiety are regulated and how calories are utilized for energy. We now have a diverse array of tools to support young individuals in achieving better health over time. Our focus is not solely on weight but on preventing conditions like diabetes, high blood pressure, and high cholesterol from developing.

This toolkit has expanded significantly in recent years, incorporating both oral and injectable medications, which continue to evolve. Our approach emphasizes shared decision-making, enabling families to collaborate in determining the best treatment options for their child, considering the varying efficacy and side effect profiles of different medications.

While we’ve gathered substantial data in recent years, we still aim to refine our understanding of how best to utilize these medications across different age groups. Ongoing research will help us identify which patients respond best to specific treatments and predict potential side effects.

Acknowledging the complexity of pediatric obesity is crucial, as is recognizing that disordered eating may also coexist. We must carefully screen for multiple chronic conditions that a young person may be facing and tailor our treatments accordingly. Comprehensive patient histories can reveal valuable insights into both personal and family histories, guiding our approach to treatment.

Understanding the long-term implications of these medications is vital. Some young individuals may require long-term treatment into adulthood, prompting questions about maintenance dosing and treatment algorithms. Establishing effective strategies for supporting patients and families throughout this journey will be critical.

Giz Asks is a recurring series from Gizmodo where experts address significant questions in their own words, providing diverse perspectives on ideas, discoveries, and debates that impact our lives and shape our understanding of the world.