As the number of weight loss drugs on the market has increased, so has confusion about the appropriate time for doctors to suggest someone begins using them – especially when it comes to children. Now, conflicting advice offered by two major US healthcare organisations is muddying the water even more.
Last year, the American Academy of Pediatrics (AAP) shocked people by recommending the use of weight loss medications in children as young as age 12 in an effort to address soaring rates of childhood obesity. These include semaglutide, which has been approved by the US Food and Drug Administration (FDA) to treat adolescent obesity, and is sold under the brand name Wegovy or Ozempic. The have also approved these drugs for adolescents.
But newly published guidelines from the US Preventive Services Task Force (USPSTF), an advisory panel composed of independent health experts, contradict that suggestion, finding there is insufficient evidence to make a recommendation on weight loss drugs for adolescents.
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Determining when or if it is safe and effective to use these drugs in children is crucial. The global prevalence of childhood obesity has quadrupled since 1990, placing an ever-growing number of children at an increased risk of developing obesity-related conditions such as heart disease, type 2 diabetes and liver disease. It is a complex epidemic that will require complex solutions, but the conflicting guidance from the AAP and USPSTF underscores just how little we understand about treating childhood obesity.
A clinical trial run from 2019 to 2022 in children age 12 to 18 with obesity found that semaglutide decreases body mass index (BMI) by about on average. It was subsequently approved for adolescents 12 years and older with obesity.
“Once the FDA came out with these approvals – and several of [them] came as we were working on the process of writing the guidelines – we really had no hesitation about including [weight loss drugs] as part of the guidelines,” says at the AAP.
She and her colleagues recommend doctors offer weight loss medications to children with obesity starting at 12 years old, alongside behavioural interventions focused on diet and exercise.
“We really take a whole-child approach, and that means really understanding all of the ways we can help families. And as part of the toolbox, there is a time and place for obesity medications,” says Barlow.
However, the USPSTF came to a different conclusion. It found insufficient evidence to make a recommendation on weight loss medications in adolescents, particularly when it comes to long-term effects. Only eight trials totalling fewer than 1500 children have assessed these drugs, and each medication had just one trial lasting at least a year, according to a USPSTF report.
“Teenagers are not just small adults. They’re growing and developing,” says at Stanford University in California. “What are the effects on the developing brain? On bone development and strength? There’s a lot of open questions.”
These weight loss medications must be used indefinitely, or there is a risk of regaining lost weight, so long-term studies are key. at the USPSTF says the task force is calling for more research on all of these drugs with at least two or more years of follow-up in children.
Even in the absence of this data, Barlow believes it is appropriate to treat children with weight loss drugs given the harmful effects of obesity. For instance, a of more than 1.5 million adolescents found children with obesity were 1.4 times more likely to have prediabetes, 4.4 times more likely to have high blood pressure and 26.1 times more likely to have liver disease than those of a healthy weight.
Whether weight loss medications meaningfully lower these risks isn’t clear though. The USPSTF found just one medication, Qsymia, reduced blood pressure in children, while semaglutide was the only one to lead to small improvements in quality of life, such as physical comfort. No long-term evidence shows that reducing BMI in childhood lowers the risk of chronic disease later in life, either.
“I think a lack of evidence doesn’t mean that the evidence is against it,” says Robinson.
The obesity epidemic has been spreading for years, and it is understandable that people may be relieved to see the early signs of semaglutide’s success at instigating weight loss. But without more data, we can’t know if rushing to use this or other weight loss drugs in children could be trading in one epidemic for another that we can’t yet see.
JAMA
