Researchers warn that the increasing use of weight loss drug, like Ozempic and Wegovy, in children and adolescents could trigger long-lasting health consequences.
An article accepted for the Journal of Clinical and Translational Science by the University of California, Irvine researchers highlights the potential adverse effects of using glucagon-like peptide-1 receptor agonists (GLP-1RAs) in pediatric patients.
GLP-1RAs are a class of drugs that work by mimicking the hormone GLP-1, which is released after eating. GLP-1RAs include weight loss drugs such as Wegovy and medications for type 2 diabetes, such as Ozempic and Rybelsus that are increasingly used off-label for weight loss.
In adults, these medications can help to lose up to 15% of body weight within one year but are also associated with severe side effects, such as stomach paralysis. In addition, European regulators are currently looking into reports that some GLP-1RAs may cause suicidal thoughts.
While most of these medications are administered by injection, the authors warn that due to the progress in developing oral formulations of GLP-1RAs, their increased use in children and adolescents, medically supervised or not, is inevitable.
Higher cardiovascular risks
The major concern related to using GLP-1RAs in pediatric patients is that the medications may induce "unbalanced and inappropriate reductions in caloric (energy) intake," according to the authors.
This may result in multiple long-term health risks, says Dan M. Cooper, distinguished professor of pediatrics at the UCI School of Medicine and the author of the article.
"Impaired bone mineralization and bone strength can lead to osteoporosis and pathological fractures later in life," he told Healthnews.
Moreover, the risk of cardiovascular disease increases due to extensive sedentary time and reduced physical activity. There is also a risk of some nutritional deficiencies during growth due to reduced overall caloric intake.
Because oral administration formulations of GLP-1RAs are being rapidly developed and teenagers tend to engage in risky behaviors, the authors are concerned about the potential abuse of these drugs.
They note that adolescence is a particularly vulnerable period for developing self-esteem and satisfaction with one's appearance.
According to 2010 data, 2.7% of adolescents, especially females, manifested eating disorders at some point in their lifetime. It is not uncommon among teenagers to use laxatives or appetite suppressants or engage in self-induced vomiting.
Who can benefit the most from weight loss drugs?
Cooper says that currently, there is not enough data to know which pediatric patients benefit the most from GLP-1RAs as weight-loss drugs. However, he speculates that it could be children and adolescents diagnosed with type 2 diabetes.
In children and adolescents with morbid obesity who are candidates for surgical intervention, such as gastric bypass, the GLP-1Ras might alleviate the need for surgery.
Cooper guesses the medications could also benefit adolescents taking those anti-depressants or anti-psychotics that lead to excessive weight gain. GLP-1RAs could be potentially used in children with rare genetic conditions that increase appetite and weight gain, such as Prader-Willi syndrome, but evidence supporting it is scarce.
"Again, this is conjecture," he adds.
How to fight childhood obesity
According to 2017 to 2020 data, nearly 20% of children aged two to 19 in the United States have obesity, which is linked to high blood pressure, high cholesterol, and type 2 diabetes, among other conditions.
Cooper says pediatric obesity could be addressed by providing safe, community-based venues for children and adolescents to participate in a wide variety of physical activities.
"Support high-level, high-quality physical education in schools that emphasizes each student's 'physical activity literacy:' for example, each child's learning what exercise they enjoy and how to incorporate these activities in their daily life."- Dan M. Cooper
Cooper says it is important to increase park and play space in lower socioeconomic status communities where pediatric obesity and physical inactivity are at epidemic crises, as well as to open schools for play and diet education — so-called "practice kitchen" — during after school hours so that the facilities are available to all, particularly in under-resourced communities.
As climate change is likely to remain a problem for a century, it is crucial to develop plans to support safe play in the heat, according to Cooper.
He says, "Include lessons in school curricula for students and parents to understand energy balance and to better assess inexpensive, high-calorie foods that are too available at fast food chains. And support the increased availability of fresh fruits and vegetables at supermarkets in under-resourced areas."
- Journal of Clinical and Translational Science. Unintended Consequences of Glucagon-like Peptide-1 Receptor Agonists Medications in Children and Adolescents–A Call to Action.
- CDC. Prevalence of Childhood Obesity in the United States.