Ozempic in teens is a mess

One way or another, America’s desire for Ozempic is only growing. The drug’s active ingredient, semaglutide, is sold as an obesity drug under the brand name Wegovy. It has become so popular that its manufacturer, Novo Nordisk, recently deliveries limited to the United States And advertising on hiatus to avoid shortages. His promise appealed to potential patients and sparked a pharmaceutical arms race to create more powerful drugs.

Some of the interest stems from Ozempic’s potential in adolescents: in December, the FDA approved Wegovy as a treatment for obese teenagerswhat affects 22 percent 12-19 year olds in the United States. The drug’s ability to boost weight loss in adolescents has been described as “breathtaking.” In January, in its new guidelines for the treatment of childhood obesity, the American Academy of Pediatrics (AAP) recommended that doctors are considering adding weight-loss drugs such as semaglutide as a treatment for some patients.

But although many doctors and obesity experts adopted semaglutide as a treatment for adults, some worry that taking it at such a young age – and at such a precarious stage of life – could pose serious risks, especially because the long-term effects of the drug on physical and mental health are still unknown. Others, however, believe that not use of this drug in adolescents is more risky because obesity makes adolescents vulnerable to serious health problems And premature death. Partly because of doctors’ apprehension, semaglutide prescriptions for teenagers are not taking off like they are for adults. At this point, it remains deeply uncertain whether these drugs will ever become a treatment for adolescents.

Semaglutide is not only effective for teenagers; it’s possible even more effective than in adults. In a major project funded by Novo Nordisk study Posted in The New England Journal of Medicine, “the degree of weight reduction in adolescents was better than what was seen in adult trials,” Aaron S. Kelly, co-director of the Center for Pediatric Obesity Medicine at the University School of Medicine, told me. ‘University of Minnesota. In another project funded by Novo Nordisk study published last week, a team led by Kelly showed that the drug, combined with counseling and exercise, nearly halved the number of obese teenagers after receiving 68 weeks of treatment. For both teens and adults, the weekly injection doesn’t “magically melt away body fat,” Kelly said; instead, it works by triggering a feeling of fullness and calming hunger pangs.

Adolescents’ experience with obesity is different – ​​in some ways more intense – than that of older adults. Puberty is a time of intense growth and development, so the body fights attempts to lose weight “with all the mechanisms at its disposal,” Tamara Hannon, a pediatric endocrinologist at Indiana University School of Medicine, told me. Medical. Teenagers may also have less control than adults over what they eat or how much activity they do, as these are largely circumscribed by family and school, as well as social pressure to conform to the way their peers eat. “Making good choices means doing something different from the majority of other kids,” Hannon said. “On every corner, there is something that directly opposes weight loss.”

Because obesity is a chronic disease, its early development can be devastating. In many cases, this can lead to diseases such as type 2 diabetes and fatty liver disease at a young age. Obese children are five times more likely than their peers to have it as adults; When obese adolescents become obese adults, they can “develop a very, very aggressive disease,” Fatima Stanford, an obesity physician at Massachusetts General Hospital and Harvard Medical School, told me. Weight-loss drugs allow doctors to intervene before the snowball effects of obesity, she said, which is why the new AAP Childhood Obesity Guidelines advocate their use as part of early and aggressive treatment, along with many hours of in-person health and lifestyle therapy. Used early enough, semaglutide or other drugs could eventually reorient the trajectory of a teenager’s entire life.

But semaglutide could also disrupt a teenager’s trajectory. Because treatment is considered a lifelong endeavor – quitting usually results in rapid weight regain – teenagers who start treatment will take it for many decades. “We have no way of knowing if these drugs, used so early in life for so long, might have unintended adverse effects,” David Ludwig, an endocrinologist at Boston Children’s Hospital, told me. Although adults face many of the same unknowns, the risks for teens could be more serious because their bodies and brains are constantly changing. Of particular concern are the drug’s potential impacts on physiological changes specific to adolescence. “We need to keep an eye on girls’ pubertal development and menstrual history,” Hannon said. In addition, medications can cause unpleasant side effects such as gastrointestinal issues and may have other impacts including significant muscle loss And rewiring the reward circuitry of the brain. Scientists are just beginning to understand these effects; at this point, only two major studies have been done on semaglutide in adolescents, and none have involved a long follow-up period.

Even less is known about the impact of semaglutide treatment on mental health, an important aspect of obesity management. Teenagers are “more likely than an adult to have intermittent access to medications,” Kathleen Miller, an adolescent medicine specialist at Minnesota Children’s Hospital, told me, and skipping multiple doses in a row could pose physical and psychological risks. Another concern is that the overall effect of taking semaglutide – a decrease in appetite, which leads to eating less – is essentially the same as dieting. When teens follow very restrictive diets, whether or not they involve weight-loss drugs, “we know it can be harmful to their mental health and promote eating disorders,” Hannon said. Because their brains are so plastic during puberty, “there’s a risk of entrenching these patterns in adolescence,” Miller said.

With so many unknowns, would obese teens be better off avoiding semaglutide? At least for now, many pediatricians are reluctant to prescribe it. “The idea of ​​using anti-obesity drug therapy was difficult even in adults a few years ago,” says Angela Fitch, assistant professor at Harvard Medical School and president of the Obesity Medicine Association; acceptance of its role in pediatric care is even further behind. But denying teens drugs, she told me, is the biggest risk: Teens develop an unhealthy mindset about their bodies when they don’t get help losing weight. Explaining to a teenager that obesity isn’t their fault, and correcting the underlying biological problem with medication or other treatment, helps them develop “a better body image of themselves,” a- she declared.

None of the experts I spoke with said that semaglutide should never be used in the treatment of adolescents. Even those wary of the drug acknowledged that it might be medically appropriate for teenagers who are really struggling with their weight and have little success losing it by other means. This argument can only grow stronger as more convenient drugs — or ones with fewer side effects — are approved for teens. This week, Novo Nordisk and Pfizer announced that pill versions of these drugs were success in the first trials.

Even without all the answers about how this drug might affect adolescents in the long term, Fitch predicted that “the adoption of semaglutide and other anti-obesity drugs into pediatric clinical care will be slow and gradual.” Eventually, they may end up being considered one of many weight loss tools to help kids lead healthier lives. Treating adolescent obesity shouldn’t be an “either-or” choice, Ludwig said, “It’s all-and.” He proposed that combining semaglutide with a low carbohydrate diet, for example, could have synergistic effects on weight loss in adolescents.

For the foreseeable future, semaglutide isn’t about to take off for teens like it did for adults. Despite all the hype around Ozempic, experts and their patients are left with a stark choice based on differing risk assessments: what might happen if teens are treated with drugs, and what might happen if they don’t. are not. Either way, teenagers have the most to gain and the most to lose.