To understand whether Wegovy should be used as part of the solution to childhood obesity, you must first understand the problem.
That’s not always easy, even for a doctor, says Megan Kelsey, MD, medical director of lifestyle medicine and bariatric surgery for adolescents at Children’s Hospital Colorado.
Kelsey admits that early in her career she did not fully understand the complexities of childhood obesity and attributed it to personal choices that could be reversed with willpower and exercise.
It took time to understand how genetic, physiological, socioeconomic and environmental factors contribute to childhood obesity and how misconceptions stigmatize the disease and create barriers to treatment.
“If it takes me some time to recover, imagine the people who don’t work with these patients every day and don’t have training in physiology. It’s harder for them,” she says.
It is an urgent problem in a country where 15 million children and adolescents are obese.
“A lot of people think that kids will grow out of it, and… we now have many years of research to show that that’s not the case,” she says.
Without treatment, the health consequences can be profound: high blood pressure, diabetes, early puberty, liver disease, sleep apnea, asthma, and musculoskeletal and mental health problems, to name a few. It is even a risk factor for premature death from any cause.
There are many treatments approved for children, including lifestyle advice, other weight loss medications such as liraglutide and metformin, and even off-label medications such as phentermine and topiramate. But outside of bariatric surgery, doctors have few tools as effective as semaglutide.
That’s why, Kelsey says, when considering Wegovy, a doctor must weigh the benefits and risks not only against other treatments, but also against the known risks if the problem is not treated effectively.
Semaglutide works by mimicking the glucagon-like peptide-1 hormone produced in the intestines that controls appetite and cravings. While our natural GLP-1 leaves the body quickly, semaglutide has long-lasting effects.
In the form of Ozempic and Rybelsus, semaglutide has been used for years to treat diabetes, but its 2021 approval for weight management grabbed headlines. Demand has skyrocketed.
Testimonials from social media influencers and entertainers like Tracy Morgan, Sharon Osbourne and Oprah Winfrey have done little to cool demand, and financial analysts predict that weight-loss drugs like Wegovy could be a $100 billion market by 2030.
There appears to be a good reason for the semaglutide rush. Studies show that it is not uncommon for people who take it to achieve a weight loss of 15%, which is encouraging when you consider that losing just 5% to 10% can lead to greatly improved health and quality of life.
As with many diseases, treatment outcomes for obesity improve with early intervention. That’s why many scientists and doctors were eager to test semaglutide in younger people with obesity.
A December 2022 article in the New England Journal of Medicine found that children who injected semaglutide weekly for 68 weeks – while receiving lifestyle advice – reduced body mass index by an average of 16%.
They also showed improvements in waist size, cholesterol, triglycerides and other areas. Semaglutide even seems to work better in children than in adults, the study says, noting that the reason requires more research.
The only treatment that is more effective is bariatric surgery, a much more invasive and risky procedure, says Aaron Kelly, PhD, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota Medical School. He and his colleagues analyzed the NEJM findings last year and found that almost 45% of children saw their weight drop below the obesity baseline.
The results are impressive enough that a month after the NEJM study the American Academy of Pediatrics recommended doctors consider semaglutide, together with exercise and nutrition advice, as one of the options for the treatment of children aged 12 years and older with obesity.
Side effects include nausea, vomiting and diarrhea, but experts say that’s fairly standard for many commonly used medications.
Doctors and parents may be more wary of reports of decreased muscle mass and bone density. In rare cases (less than 1%), patients can experience serious side effects such as gallstones or pancreatitis, and some doctors say more research is needed to help determine the long-term effects on the developing brain.
It’s the job of doctors to make the side effects clear, Kelly says, but ultimately the risks must be balanced with the serious consequences of untreated obesity.
Make no mistake: Semaglutide is not a miracle cure, says Kelly, noting that the AAP guidelines recommend exercise and improved diets in combination with the drug. Rather, he says, semaglutide is an equal system, which “levels the playing field a little bit” for patients to make healthy changes.
Research shows that adults who took Wegovy regained two-thirds of their lost weight within a year of stopping the drug, so it’s possible, even likely, that a child could take semaglutide for life, says Amanda Velazquez, MD, director obesity medicine at Cedars-Sinai Center for Weight Management and Metabolic Health.
People with type 2 diabetes need insulin indefinitely. Asthma patients may use enhanced steroids for years or longer. People with high cholesterol also often use statins — one of the most common prescription drugs on the market — long-term.
“If you try to change biology with a drug and you take the drug away,” says Velazquez, “the body goes back to what it wants to do.”
Parents may object to the side effects, but Velazquez says they are “commonplace” for these types of medications, and the side effects of semaglutide for obese patients are no different than the side effects for diabetic patients taking these types of medications. the drug for years.
Velazquez is more concerned about the $1,400 per month price tag, which puts it out of reach for many families, and insurance companies are reluctant to cover semaglutide for weight loss alone. But generic versions will eventually come, and pharmaceutical companies are rushing to develop other weight loss drugs.
Prejudice and ignorance about semaglutide and childhood obesity – among patients, parents and even doctors – can be a serious barrier, Velazquez says. There’s often a perception that children have to “prove themselves” to get drugs like semaglutide, she says.
“We don’t meet these requirements for type 2 diabetes, high blood pressure or heart attacks,” she says. “It would be malpractice to ignore and not treat.”
Even the AAP guidelines recognize stigma as a harmful side effect of obesity. It can keep patients out of the doctor’s office altogether for fear of being judged. To combat stigma, it is up to physicians to understand and “raise awareness” of the relevance of social and environmental determinants of childhood obesity, the guidelines say.
During consultations, Kelsey of Children’s Colorado emphasizes weight and encourages young patients and their parents to understand that obesity is a complex, chronic disease, “not a moral failure,” she says, and that medications like Wegovy are one of the are many potential paths to good health. Determining the right course is deeply personal, they and Velazquez say.
“People beat themselves up and say, ‘I can do it.’ You can, but your body doesn’t want you to do that,” Kelsey says. “It may be helpful for you to get a little help changing your health in a more permanent way.”