Children as young as 10 years old are being prescribed Ozempic-like medication, and doctors have expressed concerns about its safety for minors.
Glucagon-like peptide-1 (GLP-1) receptor analogs are drugs for type 2 diabetes and weight loss that work by mimicking the fullness hormone GLP-1, stabilizing blood sugars, reducing hunger, slowing down digestion, and perhaps increasing metabolism.
The headline hitters include Ozempic and Wegovy, which use semaglutide as their active ingredient, but there are plenty of other versions on the market—some of which, including Wegovy, can be prescribed to children.
"A few of the GLP-1s have been approved for use in children as young as 12 years old who have obesity, and for children as young as 10 years old who have type 2 diabetes," Dr. Kay Rhee told Newsweek. Rhee is the Medical Director of the Medical Behavioral Unit at Rady Children's Hospital, San Diego.
"[They're] not used that widely for young children with obesity," she added. "And we don't know what the risks are for really young children because most parents and doctors don't want to use these medications in children that young.
"We really don't know what the long-term consequences are at this point."
Yet Dr. Carolyn Jasik, Chief Medical Officer at Omada Health who has specialized in obesity in young people, told Newsweek that more and more young people were being prescribed these drugs.
Citing research by healthcare tech company Komodo Health, she said that 58.7 percent of pediatric patients on GLP-1 agents in 2023 were those who had newly started the medication, despite it being approved by the Food and Drug Administration since 2019 for type 2 diabetes.
She said that this may suggest that providers were initially hesitant to prescribe GLP-1 analogs, adding that 3.2 percent of pediatric patients with diabetes were prescribed a GLP-1 analog in 2023, and just 0.58 percent of children with obesity.
Dr. Brian Erly, Medical Director of EDCare, is a doctor who specializes in treating patients with eating disorders. He also expressed misgivings about the use of these drugs on children with obesity.
"An initial concern is whether children are being thoroughly evaluated before these powerful drugs are prescribed," he told Newsweek. "Children's bodies grow and develop at different rates, and a child who develops later than his or her peers might have a high adjusted BMI [body mass index, an indicator of weight]."
Erly also said that there was much left to learn about the long-term effects of these drugs, which was particularly pertinent for children.
"Studies have shown that individuals who stop taking GLP-1s regain much of their previous weight, and so many people may take the medications for many years," he said. "The effects of long-term drug exposure in children whose bodies are still developing and growing might be different than that for fully developed adults.
"For example, there are dramatic changes in brain development that continue into the mid-20s, and our bones also don't reach their maximum strength until well into adulthood.
"We don't know how a caloric deficit caused by taking a GLP-1 would alter that development."
In the few studies involving children, GLP-1 analog drugs have been found to be effective—and Rhee told Newsweek that they could "really help" teenagers who feel overwhelmed with thoughts about food.
One study, funded by the pharmaceutical manufacturer Novo Nordisk, found that taking semaglutide Wegovy injections for 68 weeks helped overweight and obese 12- to 18-year-olds lose an average of 16.1 percent of their body weight.
However, 62 percent of the study's young participants also experienced unpleasant digestive side effects—which Rhee said parents and children should be aware of, before starting these medications.
"The most common side effects of these medications are the GI [gastrointestinal, gut] side effects: nausea, vomiting and diarrhea," said Rhee. "In some studies, up to 40 percent of participants experience these side effects and end up stopping the medication because they are so unpleasant."
Rhee warned of other side effects too: headaches, fatigue—or even pancreatitis or thyroid conditions in severe, and rare, cases.
Erly also expressed concerns about the risk of eating disorders among children prescribed GLP-1 medication.
"As someone who works with patients with eating disorders, I am additionally concerned about how use of these drugs may cause or worsen disordered eating habits," he said.
"Eating disorders can occur in people with any size bodies. One of the effects of GLP-1 drugs is to alter the reward pathways associated with food.
"Individuals with a predisposition to disordered eating might find that these drugs push them towards an eating disorder."
Yet Jasik said that it was not necessarily the case that use of these drugs would lead to eating disorders.
"It is a common misconception that obesity treatment in children can lead to eating disorders, but there isn't persuasive science behind this," she told Newsweek. "In fact, weight loss in the context of obesity improves mental health for adolescents.
"The stigma around one's weight can be a major challenge due to external pressure from peers or pop culture to lose weight or look differently.
"GLP-1s can improve how children feel about themselves and their ability to participate in a variety of activities.
"With that said, GLP-1 use is unchartered territory. This is why the medication should be prescribed along with supportive care for mental health and eating patterns."
Jasik said that she believed the biggest risk for GLP-1s among children and teenagers was the same as adults: "the risk of weight regain."
"It is unlikely that teens will want to remain on the medication for the rest of their lives," she said. "So, making sure that healthy eating and exercise patterns are in place before discontinuing is imperative."
All three doctors emphasized the importance of taking these medications only with the support and approval of a trusted pediatrician.
"I am worried about people using this medication in young children without the supervision of a physician or healthcare provider," said Rhee. "It can be hard for parents to see their kids struggle with weight and eating.
"But I would recommend that you talk to your pediatrician and find out what other options may be available for your child before you consider medication.
"It may be appropriate for some older children, but that is a decision that should be made with your healthcare provider."
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Reference
Weghuber, D., Barrett, T., Barrientos-Pérez, M., Gies, I., Hesse, D., Jeppesen, O. K., Kelly, A. S., Mastrandrea, L. D., Sørrig, R., Arslanian, S., (2022). Once-Weekly Semaglutide in Adolescents with Obesity, NEJM 387(24). https://doi.org/10.1056/NEJMoa2208601
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