Should Children Be Prescribed Anti-Obesity Drugs?

 With access to unhealthy food soaring and physical activity levels declining, the World Obesity Federation predicts that between 2020 and 2035, Europe and Central Asia will experience a 61% increase in obesity among boys and a 75% increase among girls.

The childhood obesity epidemic across Europe has left experts wondering: What is the best approach to treat this chronic disease?

In recent years, there’s been an explosion in the popularity of GLP-1 agonists to treat obesity. They work by acting on the brain to reduce appetite and increase feelings of satiety while simultaneously slowing down gastric emptying.

In some parts of Europe, several of these drugs, including liraglutide (Saxenda), semaglutide (Wegovy), and orlistat (Xenical), are approved for use in adolescents aged 12 years or older.

However, liraglutide could soon be available for children aged 6-11 years, after the drugmaker, Novo Nordisk, applied for regulatory approval for this age group in Europe and the US.

In a phase 3 randomized trial, children aged 6-12 years with a BMI ≥ 95th percentile for their age and sex who received 3 mg liraglutide plus behavioral therapy for 56 weeks saw a 5.8% BMI reduction vs a 1.6% increase with placebo. However, 80% of those who received liraglutide experienced gastrointestinal side effects.

Should these drugs be used in children? And should medical professionals — and society more broadly — rely on pharmaceutical interventions when there are other proven methods to tackle the epidemic?

Safety, Equity, Food Environment

Malta has one of Europe’s highest rates of childhood obesity and overweight, driven by its unhealthy food environment, high levels of physical inactivity, and socioeconomic and cultural factors, Renald Blundell, PhD, associate professor of physiology and biochemistry at the University of Malta, Msida, Malta, told Medscape Medical News.

Renald Blundell, PhD

He is concerned about the possible long-term effects of GLP-1 agonists on growth, puberty, fertility, mental health, and lifelong health. He added that he was particularly concerned about mental health and mood changes and stressed that it was essential to screen and monitor for anxiety, depression, and/or behavioral changes.

“Drugs don’t fix the unhealthy food environment, car dependency, poverty, or school systems that drive obesity. If relied on as the main solution, they risk overlooking prevention,” he said.

“But for children already suffering from severe obesity and related illnesses, medication can be life-changing and may give them a better chance to engage with lifestyle changes.”

He does not agree, however, with their potential widespread use in children younger than 12 years.

“We don’t yet know their long-term safety in young children. There are ethical concerns about medicalizing children, and their high costs and limited access to specialist care could cause inequities,” he said.

“The bottom line is that GLP-1 drugs may be appropriate as an adjunct treatment for some children with severe obesity, but their use in 6- to 11-year-olds should be limited, cautious, and tightly monitored. The bigger priority is to change the environment, policies, and support systems so fewer children develop obesity in the first place.”

Christina Vogel, PhD, director of the Centre for Food Policy, nutritionist, and professor of food policy at City St George’s, University of London, London, England, expressed similar concerns.

“I don’t believe we have sufficient evidence to be able to confidently say they are good to use among children. Children’s bodies are growing, and we don’t know the long-term physical effects,” she said.

“We have a responsibility to look after children. There’s both a government and pharmaceutical responsibility. We need to get the school food environment right. We need to protect them against heavy marketing of high in fat, sugar, and salt. And we need to promote the availability, accessibility, and appeal of fruit, vegetables, and whole grains.”

She added that she was concerned about the nutritional quality of children’s diets while on these drugs, asking: Will children continue to eat unhealthy foods because marketing hasn’t disappeared? Could children on these drugs face a higher risk for malnutrition and have more vitamin deficiencies?

Support for Cautious Use

Julian Gomahr, MD, from the Department of Pediatrics and the Obesity Research Unit at Paracelsus Medical University, Salzburg, Austria, has researched the costs and potential of anti-obesity medications among children and adolescents. He told Medscape Medical News that the treatment of obesity was “frustrating” before the availability of effective medications, which should be pursued using an interdisciplinary approach.

“We finally have effective medications available that can truly make a difference in treatment — especially when metabolic comorbidities are already present early on and lifestyle interventions have been exhausted. It is crucial that children are treated by an experienced team, particularly during the initial phase of pharmacological therapy,” he said. He added that he was supportive of their “cautious” use in younger children who are at risk for metabolic deterioration.

“In addition to the benefits at the individual level, [the drugs] could also help reduce associated follow-up costs, which represent a significant burden on healthcare systems.”

Gomahr added that policymakers should commit to not only to paying for treatment but also to establishing childhood obesity centers that offer interdisciplinary care to ensure that barriers to treatment — such as unaffordability and inaccessibility — are overcome.

No Silver Bullet

Annemarie Bennett, PhD, assistant professor of dietetics in the Department of Clinical Medicine at Trinity College Dublin, Dublin, Ireland, told Medscape Medical News that there was “no silver bullet for weight management in childhood,” saying that if the treating doctor and parents or caregivers felt that GLP-1 agonists were appropriate, such medication would form just one part of the treatment plan.

Annemarie Bennett, PhD

“Alongside food-based and exercise supports, therapies such as cognitive-behavioral therapy, dialectical behavioral therapy, and family therapy may be considered,” she said.

“These approaches can help address some of the root causes that lead to overeating, which is often a maladaptive coping strategy used to deal with a source of distress. Sources of distress can include difficult relationships at home or in school, experiencing inappropriate methods of discipline, or bereavement, for example.”

Upcoming regulatory decisions on the use of GLP-1 agonists in children younger than 12 years, along with the anticipated arrival of daily pills for weight loss in the next few years, signal a potentially shifting treatment landscape. For now, the debate centers on how best to balance access to medications with prevention and comprehensive care for children living with obesity.

Blundell, Vogel, Gomahr, and Bennett reported having no relevant financial relationships.

https://www.medscape.com/viewarticle/should-children-be-prescribed-anti-obesity-drugs-2025a1000ptg