Ozempic Found To Help Kids With Obesity Lose Weight. Is That Good Enough?
Let’s talk about some other measures of health.
The antidiabetic drug semaglutide — also known by the brand names Ozempic or Wegovy — has been garnering media and scientific attention as a promising medication for weight loss. Now, research shows it could also effectively treat obesity in adolescents.
In a study published by The Obesity Society, almost half of the teens who took the drug dropped below the weight threshold for being classed as clinically obese, meaning having a Body Mass Index (BMI) higher than 95% of kids their age and sex. About a quarter of American teenagers are affected by obesity, according to the U.S. Centers for Disease Control and Prevention, and having obesity can increase the risk of health issues such as cardiac disease and type 2 Diabetes.
These are historically unprecedented results for weight loss drugs in adolescents, but experts external to these first trials are suspicious it could do more harm than good.
In the experiment — which was funded by pharmaceutical company Novo Nordisk — 201 teenagers aged 12 to 18 with obesity underwent one year and three months of counseling in healthy nutrition, exercised one hour per day, and received a weekly injection in the abdomen. Of the participants, 134 adolescents were given a dose of 2.4mg of semaglutide each week while 67 received a placebo.
The way semaglutide works is that it essentially tells the brain that you’re less hungry by mimicking the hormone Glucagon- Like Peptide 1, which naturally occurs in the human body and helps regulate appetite and blood sugar spikes.
In terms of mental health, it does do something, it does improve quality of life. And that is encouraging.
Among the adolescents who took the placebo drug, 19% lost enough weight to decrease their BMI by one category, 12.1% of which lost enough weight to no longer be classed as clinically obese. Of the kids taking semaglutide, a whopping 74% dropped by one BMI category, and almost 44.9% weighed below the threshold for clinical obesity by the end of the study period.
These findings are promising and a long time coming, especially for youth struggling with additional health issues associated with obesity, according to Daniel Weghuber, MD, from the Paracelsus Medical University Salzburg, one of the researchers who worked on the experiment.
And it’s not just weight dropping — mental health also improved. “We saw for the first time in an anti-obesity medication trial in an adolescent age group, that the quality of life was substantially, significantly improved,” says Weghuber. This was assessed by questionnaires and according to a metric measuring “physical comfort score subscale”, basically honing in on whether patients feel better in their bodies.
“For the first time, they would come in with a smile on their face,” says Weghuber, who says that psychiatric disorders were also less common in the semaglutide group as compared to the placebo group. “It indicates that in terms of mental health, it does do something, it does improve quality of life,” says Weghuber. “And that is encouraging.”
Over 68 weeks just one participant dropped out of the trial. This is quite an outstanding statistic for a medical trial, suggesting that the pros must have outweighed the cons, Weghuber speculates.
One of the cons being the frequent physical side effects. Nausea, vomiting, and abdominal pain — most commonly during the first eight to 12 weeks — affected 82 teens during the trial. Similarly, 16 participants experienced skin rashes and irritated skin at the injection point, and five teens had gallstones, but the scientific jury is out on whether this last side effect is specific to the medication, or just of weight loss in general.
Semaglutide therapy is still largely unavailable to the general public because there just isn’t enough of the drug to go around, and it is also prohibitively expensive — ranging from $800 to $1300 monthly and not widely covered by insurance companies in the US. “It’ll take some time until it will be available and accessible for most patients,” says Weghuber.
We have no way of knowing whether these drugs, used so early in life for so long, could have unanticipated adverse effects.
Most glaringly, since obesity is a chronic and relapsing disease, semaglutide therapy is projected to be a continuous, lifelong treatment. Stopping medication is likely to cause a relapse. It’s unclear what will happen when kids have to take this drug for the rest of their lives and how that could potentially affect their physical and mental health.
“We now have a decade of research with millions of patient-years in it there are no signals that are concerning,” says Weghuber. Yet there still is no data on the long-term psychological impacts of the medication because just two studies have been conducted on teens and there are no longterm follow-ups.
Experts external to the research are hesitant. “We have no way of knowing whether these drugs, used so early in life for so long, could have unanticipated adverse effects,” David Ludwig, MD, PhD, an endocrinologist at Boston Children’s Hospital, tells the Atlantic. There are also questions about how this medication interacts with the very complicated changes happening in the bodies of people going through puberty, and how it affects their growth.
Some eating disorder specialists fear that supplying a weightloss drug to teenagers could perpetuate a cycle of body image issues in younger generations, soil their relationship with food, and spur disordered eating.
I am very concerned about pathologizing kids’ bodies and weights, particularly when there are no associated health concerns.
Erin Parks, PhD, co-founder of the virtual eating disorder service Equip Health, told USA Today “she would diagnose someone with an eating disorder if they came to her saying they couldn't eat because they were nauseated all the time, but they were happy about it. That sounds like anorexia.”
“I am very concerned about pathologizing kids’ bodies and weights, particularly when there are no associated health concerns,” Janna Gewirtz O’Brien, MD, MPH, a board-certified pediatrician and an adolescent medicine physician in Minneapolis, tells SELF.
Obesity is statistically associated with other health issues so dropping below the clinically obese threshold can decrease the likelihood of comorbidities. But weight is just one data point about a person’s fitness. A growing body of research suggests that BMI isn’t an accurate proxy for health, doesn’t consider differences in body type, and is an obsolete and woefully inadequate metric to use solo for assessing well-being.
In everyday clinical practice, health should be the first and foremost priority, according to Weghuber. BMI might be a starting point, but it is imperative to look at aspects beyond BMI — fat and muscle distribution, blood tests, liver function parameters, glucose metabolism, and mental health. “That's looking at the specific person in front of you, the individual with all of their individual challenges,” says Weghuber.
If semaglutide is then prescribed as a pharmaceutical intervention — usually especially in the case of people who have other related health issues — it still comes as an adjunct to changes in lifestyle, counseling, and a stable doctor-patient relationship, he says. “We need to see this as an add-on tool.”