AAMC: How young is too young for GLP-1s? Bariatric surgery?
By Stacy Weiner
Frankie McGinn could not seem to lose weight no matter how hard she tried. The 16-year-old Chicago teen ate a healthy diet and played basketball seven days a week, several hours a day. Eventually, she became so uncomfortable in her body that she took to wearing baggy sweatshirts and tried to avoid mirrors and windows at the shopping mall.
Then, inspired by her mom’s success with semaglutide (Wegovy) — one of the glucagonlike peptide-1 (GLP-1) medications that’s been transforming weight-loss care — Frankie got a prescription as well. She had some nausea at times, and she’s needed to see a doctor at Lurie Children’s Hospital of Chicago monthly for monitoring. But the results have been dramatic.
“I lost 42 pounds since March. I feel healthier, and I have more energy. I used to have to take a nap after school,” says Frankie, now 17. “I’m happier, and I have more confidence. I feel better in my body. [Medication] has helped me in so many ways.”
In the United States, more than 14 million children and teenagers — roughly 1 out of 5 — are affected by obesity. That means their body mass index (BMI) is at the 95th percentile or above, increasing their risks of diabetes, heart disease, and other health problems, says Fatima Cody Stanford, MD, MPH, MPA, MBA, an obesity physician-scientist at Massachusetts General Hospital and Harvard Medical School in Boston.
Up until 2023, pediatricians were advised to apply a “watchful waiting” approach with patients diagnosed with obesity, and to recommend lifestyle treatments aimed at healthier eating and exercise habits. But that year, the American Academy of Pediatrics (AAP) released guidelines stating that providers should offer medications to patients 12 and older with obesity, alongside lifestyle treatment. Patients 13 and older diagnosed with severe obesity should be evaluated for bariatric surgery, the authors wrote.
Criticism quickly ensued. Some pointed to evidence suggesting that not everyone diagnosed with obesity needs to lose weight to stay healthy and bemoaned the use of BMI, a controversial measure that is increasingly considered inadequate unless additional factors such as waist circumference are also evaluated. Others worried about the potential long-term risks of GLP-1s, which could require lifelong use given that weight usually returns when treatment ends.
GLP-1s can have powerful effects. In one study, nearly three-quarters of teens who received semaglutide experienced a weight loss of 5% or more — compared with 18% of patients who experienced that degree of weight loss who received a placebo. The medication group experienced a BMI drop of 16%, while the control group saw just a 0.6% reduction.
“These medications can be life-changing,” says Aaron Kelly, PhD, codirector of the Center for Pediatric Obesity medicine at the University of Minnesota Medical School. Kelly helped conduct pediatric semaglutide studies.
GLP-1 medications also seem to have relatively few side effects. The most common ones — gastrointestinal issues like nausea and diarrhea — often resolve over time, says Kelly.
Still, GLP-1s are not for everyone.
“Before prescribing, providers need to consider the whole patient, including the child’s physical and emotional health and the environment they live in,” says Sarah Hampl, MD, a coauthor of the AAP guidelines, pediatrician at Children’s Mercy Kansas City, and professor of pediatrics at University of Missouri-Kansas City School of Medicine. “Typically, there is a pretty remarkable decrease in appetite, so close monitoring will be necessary to avoid inadequate nutrition and hydration.”
Read the full article via AAMC