“I’m just very concerned about how we’re using these medications as a quick fix for a complex
problem,” said Dr. Dan Cooper, a pediatrician at UC San Diego about GLP-1RA use in obese
children [1].
1 in 5 children are obese in the United States, which is defined as a BMI over 30 kg/m2 or
weight over 60kg [2]. Childhood obesity can lead to type II diabetes and insulin resistance which
affects how the body processes sugar, high cholesterol and high blood pressure which can lead to
heart disease, and heart attacks, hyperlipidemia, kidney disease, sleep apnea, joint pain from
excess weight, breathing problems like asthma, and nonalcoholic fatty liver disease [3]. Socially,
those who experience childhood obesity may suffer from increased risk of anxiety, depression,
and bullying [3].
GLP-1RAs have become a new popular phenomenon originally intended for diabetes treatment,
but now are being used for weight loss treatment in conjunction with lifestyle interventions.
These drugs can be given to children as young as 8-11 [3]. From 2020 to 2023, prescriptions for
injectable GLP-1RAs have jumped six fold (by 594%) for adolescents and young adults [1].
Generally, these drugs bind GLP-1 receptors in pancreatic beta cells that produce insulin,
pancreatic ducts, and gastric mucosa, which stimulates insulin release while decreasing glucagon
secretion which increases blood glucose [3]. These drugs also slow gastric emptying to promote
satiety to reduce the amount of food people eat (less caloric intake helps to reduce body weight),
as well as increasing lipolysis, which is fat breakdown and metabolism [3].
The three FDA approved drugs include exenatide, semaglutide, and liraglutide.
Extenatide and semaglutide (sold under the names “Ozempic” and “Wegovy”) work in
conjunction with diet and exercise for those who have type II diabetes [3]. These drugs improve
glucose tolerance and lower appetite by activating GLP-1 receptors in the pancreas [3]. Side
effects of these medications include nausea, vomiting, diarrhea, hypoglycemia, dizziness,
headaches etc. Concerns with semaglutide use include thyroid C-cell tumors, pancreatitis,
gallbladder disease, and kidney injury [3].
Liraglutide is specifically approved for children with type II diabetes, which should be used with
diet and exercise. This has a similar sequence to human GLP-1 and functions like endogenous
(made by humans) GLP-1 by binding to the receptor [3]. This medication is particularly effective
because it is resistant to degradation leading to a longer half life. Unfortunately, liraglutide has
more adverse effects such as vomiting, nausea, hypoglycemia, diarrhea, constipation, headache,
dizziness, lessened appetite, pain, tiredness, tumors, pancreatitis, gallbladder disease, and renal
dysfunction [3].
In a 56-week trial testing liraglutide on 82 children ages 6-12, they found that those who
received daily injections experienced a 5.8% decrease in BMI, while the placebo group
experienced a 1.6% increase [4]. The treatment group also experienced reduced blood pressure
and blood sugar, but, they reported more gastrointestinal issues like nausea and vomiting. 12%
experienced a serious adverse reaction, and 11% discontinued treatment due to severe side
effects [4].
Based on this data, using GLP-1RAs can be remarkable in preventing long term effects due to
obesity and are successful in younger age groups at reducing overall BMI. Reducing a
comorbidity like obesity can drastically change self esteem in developing children, as well as
protect them for their future development to live long and healthy lives. Using this perspective,
this would be advantageous to try and use a combination of medications and lifestyle changes.
However, there are a number of challenges that would push back against giving the drug to
younger children. Socioeconomic status is correlated with obesity rates, so the root of childhood
obesity may often come from a lack of availability of fresh, quality foods [5]. Additionally, those
who are low-income may not have the time or income to regularly cook and go to the grocery
store—relying more heavily on processed foods. In the United States, spatial inequalities may
also contribute to lack of fresh food accessibility with fewer grocery stores being accessible to
low-income individuals [5].
This begs the question—should we systematically change how we educate those about healthy
eating, as well as provide more affordable and accessible food to low income communities? This
would address the root of childhood obesity compared to the overuse and potential abuse of
prescription medication that are also only truly effective long term if they are used in conjunction
with a healthy and balanced diet and exercise. There should be a larger emphasis on health
literacy and education for children and adults on how to maintain healthy lifestyles. This would
also help to address the perpetual problem of United States healthcare aiming to address
symptoms rather than investing in the prevention of health conditions that may come from
obesity. FDA approval of these drugs being relatively new may pose additional ethical questions
related to their safety and their unknown long term effects.
Additionally, it is important to think about the accessibility of these medications. Although
Medicaid covers prescriptions for GLP-1RAs for those with type II diabetes, younger children
who may use them for weight loss may not have the same accessibility or experience restricted
quantities [6]. Therefore, those most affected by childhood obesity due to income disparities may
not be able to benefit from these medications due to their cost that may accumulate over time to
add additional financial strain.
Lastly, bullying and self esteem concerns related to obesity stem from the societal meaning and
emphasis on thinness. The lack of social support and value given to those who are overweight
and obese would rightly be solved if they lost weight using GLP-1RAs. However, as a society
we should consider making various social currencies more accessible for those who are
overweight, as opposed to making them conform to societal standards of thinness.
Overall, although obesity is a chronic health problem that can result in various severe health
issues for children, injecting GLP-1RAs into children poses various ethical issues related to
systemic challenges of food accessibility, poor drug access for low-income individuals, and
societal standards of beauty.
1. Carpenter, K. G. (2024, September 18). Use of injectable GLP-1 weight-loss drugs
skyrockets among teens. Science News Explores.
https://www.snexplores.org/article/teen-use-of-glp-1-weight-loss-drugs
2. Ryan, P. M., Seltzer, S., Hayward, N. E., Rodriguez, D. A., Sless, R. T., & Hawkes, C. P.
(n.d.). Safety and Efficacy of Glucagon-Like Peptide-1 Receptor Agonists in Children
and Adolescents with Obesity: A Meta-Analysis. The Journal of Pediatrics, 236,
137-147.e13. https://doi.org/10.1016/j.jpeds.2021.05.009
3. Alorfi, N. M., & Alshehri, F. S. (n.d.). Usage of Glucagon-Like Peptide-1 for Obesity in
Children; Updated Review of Clinicaltrials.gov. Journal of Multidisciplinary Healthcare,
Volume 16, 2179–2187. https://doi.org/10.2147/jmdh.s419245
4. Chen, E., & Cooney, E. (2024, September 11). Obesity drug worked in children ages 6 to
12, study says, raising hopes and concerns. STAT.
https://www.statnews.com/2024/09/10/weight-loss-drugs-for-children-nejm-study-shows-
efficacy-raises-questions/
5. How obesity relates to socioeconomic status. (n.d.). PRB.
https://www.prb.org/resources/how-obesity-relates-to-socioeconomic-status/#:~:text=The
y%20found%20that%20obesity%20rose,less%20likely%20to%20be%20obese.
6. Morris, M. (2024, February 28). Does Medicaid cover Ozempic, Wegovy, and other
medications taken for weight loss? GoodRx.
https://www.goodrx.com/insurance/medicaid/weight-loss-drug-coverage#
7. O’Leary, K. (2024). GLP-1 analogs and childhood obesity. Nature Medicine.
https://doi.org/10.1038/d41591-024-00071-9