To understand whether Wegovy should be used as part of the solution for childhood obesity, you first have to understand the problem.
That’s not always easy, even for a doctor, says Megan Kelsey, MD, medical director of lifestyle medicine and adolescent bariatric surgery at Children’s Hospital Colorado.
Kelsey admits that early in her career she didn’t fully understand the complexities of childhood obesity, writing it off 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 form barriers to treatment.
“If it takes me a little bit to come around, imagine the people who don’t work with these patients every day and don’t have training on physiology. It’s harder for them,” she says.
It’s an urgent problem in a country where 15 million children and adolescents have obesity.
“Many people think 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 effects can be profound: High blood pressure, diabetes, early puberty, liver disease, sleep apnea, asthma, and musculoskeletal and mental health issues, to name a few. It’s even a risk factor for premature death from any cause.
There are many treatments approved for kids, including lifestyle counseling, other weight loss medications like liraglutide and metformin, and even off-label meds like phentermine and topiramate. But aside from bariatric surgery, clinicians have few tools as effective as semaglutide.
That’s why, Kelsey says, when considering Wegovy, a doctor must weigh the benefits and risks not just against other treatments, but also against the well-known risks of failing to effectively treat the problem.
Semaglutide works by mimicking the glucagon-like peptide-1 hormone made in the intestines, which controls appetite and cravings. While our natural GLP-1 leaves the body quickly, semaglutide has prolonged effects.
In the form of Ozempic and Rybelsus, semaglutide has been used to treat diabetes for years, but its 2021 approval for weight management drew headlines. Demand has skyrocketed.
Testimonials from social media influencers and entertainers such as Tracy Morgan, Sharon Osbourne, and Oprah Winfrey did little to cool demand, and financial analysts predict weight loss drugs like Wegovy could be a $100 billion market by 2030.
There seems to be good reason for the semaglutide rush. Studies show it isn’t unusual for people taking it to sustain a 15% reduction in body weight, which is encouraging when you consider that losing just 5%-10% can lead to greatly improved health and quality of life.
As with so many diseases, treatment outcomes for obesity improve with early intervention, which is why many scientists and clinicians were eager to test semaglutide in younger people with obesity.
A December 2022 article in the New England Journal of Medicine found children injecting semaglutide weekly for 68 weeks – while receiving lifestyle counseling – reduced body mass index by an average of 16%.
They also showed improvements in waist size, cholesterol, triglycerides, and other areas. Semaglutide appears to work even better in children than in adults, the study says, noting the reason requires more research.
The only treatment more effective is bariatric surgery, a far 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 almost 45% of kids saw their weight drop below the obesity baseline.
Results are impressive enough that a month after the NEJM study, the American Academy of Pediatrics recommended doctors consider semaglutide, along with exercise and nutrition counseling, among the options for treating children 12 and older with obesity.
Side effects include nausea, vomiting, and diarrhea, but that’s fairly standard for many widely used medications, according to experts.
Doctors and parents may be more wary of reports of diminished muscle mass and bone density. In rare cases (less than 1%) patients may have serious side effects like gallstones or pancreatitis, and some doctors say more research is needed to help determine the long-term effects on a still-developing brain.
It’s incumbent on doctors to make the side effects clear, Kelly says, but ultimately, the risks must be balanced with the serious effects of untreated obesity.
Make no mistake: Semaglutide is no silver bullet, Kelly says, pointing out the AAP guidelines recommend exercise and improved diets in tandem with the drug. Rather, he says, semaglutide is more of a level set, “making the playing field a little more even” for patients to make healthy changes.
Studies show adults on Wegovy regained 2/3 of their lost weight within a year of being taken off the drug, so it’s possible, even likely, a child could be on semaglutide for life, says Amanda Velazquez, MD, director of obesity medicine at Cedars-Sinai Center for Weight Management and Metabolic Health.
People with type 2 diabetes will need insulin indefinitely. Asthma patients can use enhanced steroids for years or longer. People with high cholesterol often use statins – one of the most common prescription drugs on the market – over the long term as well.
“If you’re trying to change the biology with a medication and you take the medication away,” Velazquez says, “the body reverts to what it wants to do.”
Parents may balk at the side effects, but Velazquez says they’re “run-of-the-mill” for this type of medicine, and semaglutide’s side effects for obesity patients are no different than the side effects for diabetes patients who have been using the drug for years.
Velazquez is more worried about the $1,400-a-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 there will eventually be generic versions, and pharmaceutical companies are scrambling to develop other weight loss drugs.
Bias and ignorance regarding semaglutide and childhood obesity – among patients, parents, and even doctors – can be a serious impediment, Velazquez says. There is often a notion that children must “prove themselves” to receive medications like semaglutide, she says.
“We don’t do these prerequisites with type 2 diabetes or high blood pressure or heart attacks,” she says. “That would be malpractice to ignore and not treat.”
Even the AAP guidelines acknowledge stigma as a damaging side effect of obesity. It can keep patients out of the doctor’s office altogether for fear of being judged. To combat stigma, it’s incumbent on doctors to understand and “raise awareness of the relevance of social and environmental determinants of childhood obesity,” the guidelines say.
In consultations, Kelsey from Children’s Colorado deemphasizes weight and encourages young patients and their parents to understand obesity is a complex, chronic disease, “not a moral failing,” she says, and medications like Wegovy are one of many potential paths to good health. Determining the right course is highly personalized, she and Velazquez say.
“People beat themselves up and say, ‘I can do it.’ You can, but your body doesn’t want you to,” Kelsey tells them. “It may be useful for you to have a little bit of help in changing your health in a more permanent way.”
