To understand whether Wegovy should be used as part of the solution for childhood obesity, you first have to understand the problem.
Side effects include nausea, vomiting, and diarrhea, but that’s fairly standard for many widely used medications, according to experts.
Doctors and parents may be more wary of reports of diminished muscle mass and bone density. In rare cases (less than 1%) patients may have serious side effects like gallstones or pancreatitis, and some doctors say more research is needed to help determine the long-term effects on a still-developing brain.
It’s incumbent on doctors to make the side effects clear, Kelly says, but ultimately, the risks must be balanced with the serious effects of untreated obesity.
Make no mistake: Semaglutide is no silver bullet, Kelly says, pointing out the AAP guidelines recommend exercise and improved diets in tandem with the drug. Rather, he says, semaglutide is more of a level set, “making the playing field a little more even” for patients to make healthy changes.
Studies show adults on Wegovy regained 2/3 of their lost weight within a year of being taken off the drug, so it’s possible, even likely, a child could be on semaglutide for life, says Amanda Velazquez, MD, director of obesity medicine at Cedars-Sinai Center for Weight Management and Metabolic Health.
People with type 2 diabetes will need insulin indefinitely. Asthma patients can use enhanced steroids for years or longer. People with high cholesterol often use statins – one of the most common prescription drugs on the market – over the long term as well.
“If you’re trying to change the biology with a medication and you take the medication away,” Velazquez says, “the body reverts to what it wants to do.”
Parents may balk at the side effects, but Velazquez says they’re “run-of-the-mill” for this type of medicine, and semaglutide’s side effects for obesity patients are no different than the side effects for diabetes patients who have been using the drug for years.
Velazquez is more worried about the $1,400-a-month price tag, which puts it out of reach for many families, and insurance companies are reluctant to cover semaglutide for weight loss alone. But there will eventually be generic versions, and pharmaceutical companies are scrambling to develop other weight loss drugs.
Bias and ignorance regarding semaglutide and childhood obesity – among patients, parents, and even doctors – can be a serious impediment, Velazquez says. There is often a notion that children must “prove themselves” to receive medications like semaglutide, she says.
“We don’t do these prerequisites with type 2 diabetes or high blood pressure or heart attacks,” she says. “That would be malpractice to ignore and not treat.”
Even the AAP guidelines acknowledge stigma as a damaging side effect of obesity. It can keep patients out of the doctor’s office altogether for fear of being judged. To combat stigma, it’s incumbent on doctors to understand and “raise awareness of the relevance of social and environmental determinants of childhood obesity,” the guidelines say.
In consultations, Kelsey from Children’s Colorado deemphasizes weight and encourages young patients and their parents to understand obesity is a complex, chronic disease, “not a moral failing,” she says, and medications like Wegovy are one of many potential paths to good health. Determining the right course is highly personalized, she and Velazquez say.
“People beat themselves up and say, ‘I can do it.’ You can, but your body doesn’t want you to,” Kelsey tells them. “It may be useful for you to have a little bit of help in changing your health in a more permanent way.”