Having examined in a previous blog post the active ingredients and effectiveness of new weight-loss drugs, we now focus on what these drugs mean for children and adolescents struggling with obesity. Much of the discussion around weight-loss drugs has focused on their use by adults, often for cosmetic reasons, but two of the drugs (Saxenda and Wegovy) have been approved for use in adolescents, and a third, Zepbound, is in clinical trials for use in children as young as 6 years old.
Childhood obesity is a serious problem in the U.S., affecting over 14 million children and adolescents. Analyses of BMI data for the 2021-22 school year by the Arkansas Center for Health Improvement indicate that approximately 43% of Arkansas children who attend public schools are classified as obese or overweight.
Obesity is associated with numerous health conditions during childhood and adolescence, and most children with obesity experience obesity as adults. Unfortunately, current treatment for obese children and adolescents, which tends to focus on eating and physical activity, is often difficult to access and leads only to modest improvements. However, early evidence — albeit via an industry-funded study — shows that a combination of lifestyle and weight-loss drug intervention could prove to be more effective.
Impact on Children and Adolescents
A 2022 study funded by Novo Nordisk, maker of Ozempic and Wegovy, found that for adolescents with obesity, a once-weekly treatment with semaglutide, the active ingredient in both of those drugs, in addition to lifestyle intervention — consisting of counseling on healthy nutrition and physical activity — leads to substantial weight loss when compared with lifestyle intervention alone.
Although evidence suggests these new drugs produce only minor short-term side effects, their application to adolescents is still relatively new, and therefore long-term risks are unknown. The FDA notes that long-term effects of drug treatment in children can include impacts on development, growth, and/or maturation of organ and system function. Furthermore, weight regain and loss of health benefits after discontinuing these weight loss medications are common, potentially requiring indefinite treatment.
What Authorities Are Saying
Authorities are mixed on providing these drugs to children and adolescents. Guidance released in January 2023 from the American Academy of Pediatrics (AAP) recommends that children with obesity receive intensive treatment as early as possible, including surgery and drugs if warranted, along with intensive health behavior and lifestyle treatment. The AAP does not provide recommendations for this new class of drugs specifically, but rather provides a review of currently available medications that can be used for weight management.
The United States Preventive Services Task Force issued a draft recommendation in December 2023 calling for comprehensive, intensive behavioral interventions for children and adolescents age 6 years or older with obesity, but the task force stopped short of recommending the use of drugs or surgery. Its review of available evidence found that more research is needed to fully understand the long-term impacts of these drugs.
In our next post in this series, we will explore the cost of weight-loss drugs, with a particular focus on payers and cost effectiveness.
