The rate of childhood obesity has more than tripled since the 1960s, with over 20% of children affected today. In response to this growing concern, weight loss medications and even bariatric surgery are now being considered as options for some children diagnosed with obesity. These treatments' availability depends on factors like age and body mass index. While lifestyle changes remain the cornerstone of healthy weight management, weight loss medicines can offer additional support for some teens.
How Weight Loss Medicines Work
Weight loss medicines aren’t a "magic bullet" for weight loss, but when taken as directed and used along with healthy lifestyle changes, they can help some kids and teens achieve a healthier weight. Weight loss medicines work by helping a person feel less hungry, fuller for longer, or both. Some medicines change the way the body absorbs fat. These medicines work best when kids and teens also follow their doctor’s or dietitian’s advice for eating well and being physically active.
Types of Weight Loss Medications for Teens
Dr. Roche highlights several anti-obesity medications that can be used to tackle obesity in teens. These include:
GLP-1 Receptor Agonists: The newest anti-obesity medications are called Glucagon-Like Peptide-1 (GLP-1) receptor agonist medications. Liraglutide (Saxenda®) and semaglutide (Wegovy, Ozempic) are both injection medications that work like natural hormones by slowing down the process of digestion in the stomach. They also increase the release of insulin which impacts the nutrition center of the brain. PurpleLab, a health care analytics platform, estimates that in 2023, 4,000 prescriptions for semaglutide, the active ingredient in Wegovy and Ozempic, were prescribed to kids between 12 and 17.
- Wegovy® (semaglutide): A common weight loss medicine, is approved for kids ages 12 and older who have obesity.
Orlistat: Orlistat, which is approved for use in teens 12 and older, has been available for many years. It is essentially a fat blocker-instead of absorbing the fat, it exits the body through waste.
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Phentermine/Topiramate: A medication combining phentermine and topiramate has also been approved for teens 16 years and older.
Are Weight Loss Medicines Safe?
Weight loss medicines are safe when taken as directed. These medicines aren't intended for people who just want to lose a few pounds or don’t have weight-related health conditions. They're also not safe for anyone who is pregnant or breastfeeding.
Potential Side Effects
Mild side effects are common with most weight loss drugs, and usually go away over time. More serious side effects are possible but less common. According to Novo Nordisk, the maker of Wegovy, some of its most common side effects include stomach pain, nausea, vomiting and dizziness, as Demi experienced.
Kids and teens who take weight loss medicine should always let the doctor know if they have severe belly pain, mood changes, dizziness or lightheadedness, swelling, itching, or trouble breathing. Talk to your doctor if you’re concerned about side effects.
Common side effects of Wegovy include:
- Nausea
- Diarrhea
- Vomiting
- Constipation
- Stomach pain
- Headache
- Fatigue
- Upset stomach
- Dizziness
- Bloating
- Gas
- Stomach flu
- Heartburn
- Runny nose or sore throat
Serious side effects:
- Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Wegovy® and medicines that work like Wegovy® caused thyroid tumors, including thyroid cancer.
- Inflammation of your pancreas (pancreatitis). Stop using Wegovy® and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without nausea or vomiting.
- Gallbladder problems. Wegovy® may cause gallbladder problems, including gallstones. Some gallstones may need surgery.
- Increased risk of low blood sugar (hypoglycemia), especially those who also take medicines for diabetes such as insulin or sulfonylureas. This can be a serious side effect. Talk to your healthcare provider about how to recognize and treat low blood sugar and check your blood sugar before you start and while you take Wegovy®.
- Dehydration leading to kidney problems. Diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems. It is important for you to drink fluids to help reduce your chance of dehydration.
- Severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use Wegovy®.
- Increased heart rate. Wegovy® can increase your heart rate while you are at rest.
- Depression or thoughts of suicide. You should pay attention to any mental changes, especially sudden changes in your mood, behaviors, thoughts, or feelings.
- Food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sleepiness (deep sedation). Wegovy® may increase the chance of food getting into your lungs during surgery or other procedures.
Common side effects of Saxenda include:
- Nausea
- Diarrhea
- Constipation
- Vomiting
- Injection site reactions
- Headache
- Low blood sugar (hypoglycemia)
- Increased heart rate
- Pancreatitis
- Gallbladder disease
- Kidney problems
- Serious allergic reactions
- Depression or suicidal thoughts
It is not known if Saxenda® passes into breast milk. Tell your health care provider about all the medicines you take, including prescription, over-the-counter medicines, vitamins, and herbal supplements. Saxenda® may affect the way some medicines work and some other medicines may affect the way Saxenda® works.
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The Importance of a Comprehensive Approach
Dr. Roche emphasizes that exercising and eating a balanced diet is still the foundation for supporting a healthy weight. Exercise supports heart health and muscle development, which maximizes metabolism. It also supports the development of strong bones and has a positive impact on sleep and brain health. It’s recommended for teens to have one hour (60 min) of moderate-to-vigorous activity daily. Teens can start slowly and work up to this recommendation over time, if needed, advises Dr. A balanced diet provides the essential nutrients a teen’s body needs and teaches them how to maintain a long-term healthy lifestyle, even when not on medications.
Addressing Obesity with Sensitivity
When addressing obesity with your teen, it’s vital to emphasize supporting healthy, balanced eating and exercise.
- Seek professional support: If negative self-image is significantly impacting a teen’s mental health, consider seeking professional help.
- Promote media literacy: Discuss media literacy and help teens critically evaluate the images and messages they encounter on social media.
Considerations and Cautions
- Medical History: Always provide a complete personal and family medical history to your healthcare provider before starting medications. Some teens with certain medical conditions family history should avoid some medications for obesity.
- Availability and Coverage: While anti-obesity medications are effective, availability and supply may be limited. Some health plans may offer limited coverage and some may require intensive weight loss program participation before starting the medication.
- Long-Term Effects: This is one area where we still do not have clear answers, says Dr. Roche. In adults, there is often weight regain after discontinuing GLP1-agonists. We do not yet have data on the long-term effects these medications have on adolescents, and they may need to be lifelong medications.
- Over-the-Counter Supplements: Over-the-counter diet pills and weight loss supplements (the kinds you can buy without a prescription) aren’t recommended for kids and teens. Most of the claims they make are not proven, and many contain hidden ingredients and can cause unwanted side effects (like high blood pressure) and problems with the heart, kidneys, or liver.
- Thyroid Tumors: Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Wegovy® and medicines that work like Wegovy® caused thyroid tumors, including thyroid cancer.
- Pregnancy and Breastfeeding: are pregnant or plan to become pregnant. Wegovy® may harm your unborn baby. are breastfeeding or plan to breastfeed.
- Drug Interactions: Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Wegovy® may affect the way some medicines work and some medicines may affect the way Wegovy® works. Tell your healthcare provider if you are taking other medicines to treat diabetes, including sulfonylureas or insulin.
The American Academy of Pediatrics (AAP) Guidelines
At the start of 2023, the American Academy of Pediatrics (AAP) released its first new guidelines in 15 years on evaluating and treating childhood obesity. Centers for Disease Control and Prevention estimate that almost 15 million children and teens have obesity. The guidelines advise treating children with obesity as soon as it's identified with the appropriate intensity based on severity and the child's overall health, TODAY.com previously reported. In the past, a watchful waiting approach was recommended in case the child grew out of having obesity, but more research has shown that this isn't as common as was thought.
The new guidelines still prioritize lifestyle changes, but they also say weight-loss medications should be offered in addition to children over 12, when the balance of risks and benefits makes sense.
A Personal Story: Demi's Experience
Demi Buckley, 16, has always been active. Last year, Demi weighed 198 pounds at 5 feet, 5 inches tall and was considered to have obesity. She started taking weight-loss drug Wegovy and now weighs 140 pounds. She wanted to share her experience taking this type of medication - known as GLP-1 agonists because they mimic the hormone GLP-1 - to help others understand what it’s like.
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Demi started taking the medication in March 2023. She’s noticed she has fewer food cravings. Like others on the medications, Demi experienced some side effects, including stomach pain. She started taking another medication to treat her nausea and vomiting. Also, she notices she feels thirsty a lot.
The Role of Lifestyle Changes
Bolling stresses that the guidelines say the medications aren’t to be used alone and should be accompanied with lifestyle changes. “You never do medications as monotherapy,” he says. “(Not) everybody who’s at this weight status (needs) to go home with a prescription, but they need to not avoid the discussion either.”
As someone who has prescribed weight-loss medications to adolescents, Seigel emphasizes that his first intervention always involves “intensive lifestyle management.”
“If that works, it may very well be a safer route," he explains. "There’s also reason to believe with lifestyle improvement - which includes better sleep, eating better and exercise - you might wind up in a healthier state than just weight loss with the medications."
Long-Term Considerations
Weight loss medicines only help people lose weight and keep it off while they’re taking them. After a person stops taking the medicine, any weight that was lost can be gained back quickly. The effects of long-term use of these medicines in kids and teens has yet to be studied, as many were only recently approved for these age groups.