For a long time, if Dr. Emily Breidbart, a pediatric endocrinologist at NYU Langone Health, wanted to put one of her patients on a weight-loss drug, she often chose metformin. It wasn’t a perfect option. The drug is approved to treat diabetes, not obesity, and typically leads only to “very modest” weight loss, she says. But Breidbart had few other choices for her adolescent patients. “Medications that have been approved for obesity really have been few and far between” for kids and teenagers, she says.
That changed in late 2022, when the U.S. Food and Drug Administration approved Novo Nordisk’s obesity treatment Wegovy for kids as young as 12. That approval was a “game changer” for kids with a medical need to lose weight, says Dr. Susma Vaidya, a pediatric obesity specialist at Children’s National Hospital.
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But the approval was also somewhat controversial. Wegovy—an injected semaglutide medication, like its even buzzier sibling Ozempic—slows digestion and mimics a hormone that regulates appetite, leading people who take the drug to eat far less than before they started taking it. For some people, the idea of putting still-growing kids on an appetite-suppressing drug, potentially for life, raised alarm bells about physical and psychological long-term effects.
Wegovy promises potentially dramatic benefits for some of the roughly 20% of U.S. kids and teenagers with obesity, who may experience fatty liver disease, Type 2 diabetes, hypertension, and sleep apnea linked to their disease. But it’s also a powerful new drug that doctors are learning about in real time.
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Ozempic’s skyrocketing popularity can make it seem like the drug is everywhere. For adults, it is relatively easy to get a prescription for semaglutide, either to treat Type 2 diabetes (which is Ozempic’s primary use) or for weight loss. Some people even get prescriptions at medical spas or online. But Dr. Raquel Hernandez, director of the Healthy Weight Initiative at Johns Hopkins All Children’s Hospital, stresses that doctors are not handing out pediatric Wegovy prescriptions to every kid who’s a few pounds overweight.
In its latest guidelines for treating pediatric obesity, the American Academy of Pediatrics (AAP) says weight-loss medications, including semaglutide, can benefit children with severe obesity, particularly those who have already developed complications related to their weight. Medication should always be accompanied by lifestyle changes, like nutrition and exercise plans, and family and physician support, the guidelines say. Such guidelines help narrow down the potential patient pool. Breidbart says she’d be much more likely to consider Wegovy for a child who is already experiencing weight-related health complications.
Plus, some insurers do not cover obesity treatments, and some semaglutide medications are currently in shortage. As a result, both Hernandez and Dr. Claudia Fox, a pediatric obesity specialist and executive committee member of the AAP’s section on obesity, estimate no more than 5% of their pediatric obesity patients are currently using the drug. Fox says she’d like that number to be a bit higher, since shortages and insurance hassles are making it hard to access, but she emphasizes that Wegovy is neither a cure-all nor a one-size-fits-all treatment.
When it’s a fit, however, “it’s the best [option] we’ve had since I’ve been doing this,” Fox says.
A 2022 New England Journal ofMedicine study found that 62% of kids with obesity lost at least 10% of their body weight after about a year on semaglutide. A separate analysis of data from the same trial, published in Obesity in May, found that almost half of the teens using semaglutide were no longer considered clinically obese after about a year. About three-quarters of treated kids dropped at least one BMI category.
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Those data are promising, but limited. The trial included only 201 kids and lasted about a year, which raises questions about long-term safety and efficacy data. Most people regain weight when they stop using semaglutide, so someone who starts the medication as a teenager might be on it for many decades. The drug has been shown to be safe in the short-term, though it can come with gastrointestinal side effects, but it’s not clear how it affects the body if taken for life. (Adult and pediatric patients with a personal or family history of thyroid cancer or certain endocrine issues shouldn’t use semaglutide, since research shows a potential link between high doses of the drug and thyroid tumors in rodents.)
But, Fox says, it’s not uncommon for a drug trial to last only a year, and that’s rarely controversial. “It is just sort of odd that we should be questioning the duration of a clinical trial for a treatment for obesity,” she says. “Is there a double standard?”
Hernandez has a hunch: there’s a lingering and incorrect perception that obesity can always be treated with diet and exercise, and that using anti-obesity medications is somehow “a cop out.”
“The skepticism around this medication reflects some very deep-rooted societal biases around how we see obesity,” Hernandez says. “If you were to think about any other condition, where a new medication could change the lives of kids who otherwise had no options, we would not be discussing whether we should use this medication or not.”
Suzie Jimenez, who is 49 and lives in Texas, started Wegovy about six weeks ago. She says the drug diminished her appetite enough that it’s easier to make healthier decisions about food. She hopes Wegovy could do the same for her 14-year-old son, whose self-esteem and mental health have suffered due to weight gain. “I think he’s in the mindset of, ‘I’m ready [to lose the weight] now,’” Jimenez says.
Jimenez and her son are currently waiting for an appointment with an endocrinologist, since her son’s pediatrician wasn’t comfortable prescribing Wegovy. She says she’s open to either bariatric surgery or Wegovy for her son, but she’d have fewer concerns about Wegovy—even though it’s new—because it’s less invasive and the two could work on improving their lifestyles together while using the medication.
“I know Wegovy is not going to be a solution to all things,” Jimenez says. “By going the medical route, I’m hoping he can connect the physical to the mental and the spiritual as well.”
It’s crucial that kids approach weight loss with a holistic mindset, research suggests. Some weight-loss interventions, such as dieting, are linked to eating disorders among young people—but other research finds that weight-loss efforts do not raise the risk of eating disorders if they focus on total health and are done with family support.
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For Dr. Shellie Yussman, chief of adolescent medicine at the University of Rochester Medical Center, there are outstanding questions about where Wegovy will fit into that picture. There’s not yet data about whether medically scaling back teenagers’ appetites and food intakes may have long-term effects on their bodies or minds.
“As eating-disorder specialists, when we hear all of this, we get really nervous,” Yussman says. “[The concern is] something else is going to make people feel bad about their body weight, shape, or size.”
The existing research on Wegovy suggests it does not raise the risk of mental-health disorders among kids and leads many teenagers to self-report improvements in quality of life, at least as it relates to their weight. But it’s not totally clear how using semaglutide could affect body image or risk for disordered eating over time, Yussman says.
Yussman doesn’t deny that some patients can benefit from Wegovy. Her concern is that not all doctors are trained to screen patients for signs of disordered eating before starting them on weight-loss medications—or even to decide which patients can benefit and make sure kids are getting proper support as they go through treatment.
Vaidya, from Children’s National, understands that concern, and says she shares some of the worry about long-term data. But she also says Wegovy is one of the most exciting advances in pediatric weight management she’s seen in her career and feels that shouldn’t be discounted.
“We need to look at it carefully and monitor and see what happens over time,” Vaidya says. “But it makes such a difference in some of our patients’ lives that I don’t think [remaining questions] should prevent us from using it.”
