A small but growing proportion of children under the age of 12 with obesity are being prescribed GLP-1 drugs to help them lose weight. There are signs that this successfully treats obesity, but there are also concerns about the drugs’ long-term effects. So, is this trend likely to continue, and should it?
Earlier this month, a study led by Babak Orandi at New York University found that 9.3 per cent of children in the US aged 8 to 11 with obesity but without diabetes are being prescribed GLP-1 medications like semaglutide (Wegovy) and tirzepatide (Zepbound) – up from 0.03 per cent in 2019. Will muscle-boosting meds be the next big thing after GLP-1 drugs? The following week, Novo Nordisk, the maker of Wegovy, reported that 40 per cent of children aged 6 to 12 with severe obesity who received weekly injections of the drug during a 68-week clinical trial were no longer classified as having obesity.
GLP-1 drugs are only approved for use in people aged 12 and older in the UK, US and Australia, but they are sometimes prescribed off-label to children as young as 8 in the US, in line with guidance from the American Academy of Pediatrics. Orandi found that those under 12 were more likely to receive these off-label prescriptions if they had severe obesity or related complications, such as pre-diabetes, sleep apnoea, high blood pressure or high cholesterol. Their families also tended to be richer.
The number of young children in the US taking GLP-1 drugs will probably continue to climb because “if you look at the numbers, there are still a lot of kids with complications of obesity who are not getting them”, says Orandi. There is a growing view among healthcare practitioners that withholding GLP-1 drugs from these children might be riskier than prescribing them, he says. This is because childhood obesity is associated with depression and low self-esteem, and it increases the risk of conditions such as heart disease, type 2 diabetes and liver disease later on.
Severe obesity before the age of 4 has been estimated to cut life expectancy by up to 42 years. Guidance on healthy eating and physical activity is recommended as the first-line treatment for obesity, but it doesn’t work for some children, says Longmore. At this stage, we don’t know what the long-term effects might be of children taking GLP-1 drugs while their bodies are growing or going through puberty.
A recent study found that the medications increased the risk of children developing iron and other nutrient deficiencies due to their reduced food intake. Could there be implications for pregnancy and menopause later on? We haven’t really thought that far ahead.” Nevertheless, Longmore believes there is a case to be made for countries like the UK and Australia to extend GLP-1 drug access to children under the age of 12 if their obesity is severe.
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