GLP-1 medications have become a popular tool for weight loss. But are they appropriate for all age groups?
Short for glucagon-like peptide-1, GLP-1s are medications approved by the Food and Drug Administration that treat type 2 diabetes and now obesity. They work by mimicking a natural hormone in the gut that lowers blood sugar, simulates the feeling of fullness and slows digestion.
Both the American Academy of Pediatrics and the FDA have approved certain GLP-1s for youth ages 12 and older who experience persistent obesity after a trial of lifestyle modification. A new published review from the University of Georgia, however, suggests there is still uncertainty about how the drugs may impact adolescent development, both physically and mentally.
Emily Noble, nutritional neuroscientist and associate professor in the UGA College of Family and Consumer Sciences, answers some of the most pressing questions about the popular drug and what science says about its use in children.
Why are GLP-1s used as a possible intervention for obese youth?
Adolescents with obesity are more likely to also have obesity during adulthood. Once obesity is developed, it's very, very hard to reverse.
Despite what you may see in recommendations from TV and magazines, this idea that making different choices will promote sustained weight loss is really not correct, and the data backs that up.
The brain is what governs body weight, and there is evidence to support that once obesity develops, the brain regulates body weight differently and this makes it really difficult to lose weight and keep it off without medical intervention.
There's a biological drive toward weight regain following weight loss. I think people think about obesity as just a matter of decisions or self-control. But we know that there are neurobiological things that occur that are beyond conscious control that regulate body weight.
How are GLP-1s currently used in adolescents?
GLP-1s are typically extreme interventions for adolescent obesity and are only considered when other options fail.
This is the case for most clinicians who work with adolescents with true, severe obesity. They have really high levels of body fat, so the deleterious effects of obesity do not outweigh the potential negative risks of GLP-1s. These drugs can help kids lose up to 15% of their body weight.
The medications are actively being used in youth. They're approved for 12-year-olds and older, but sometimes people are actually prescribing them even younger in special circumstances because we're starting to see obesity and prediabetes earlier and earlier in kids.
What are some of the potential risks associated with GLP-1s in this age group?
It will be a long time before we know what the long-term effects of the medications are in this group, but the main question that we have right now is what happens to adolescents during this sensitive period of development?
These medications impact the brain by affecting the sensitivity of different circuits that make you want to eat or not, so how does that change the way their brains develop?
When these medications cause weight loss, are these kids also losing muscle mass?
Those are also really important questions, especially when you consider puberty.
Youth is also kind of a volatile age range. Everything they experience is more likely to be amplified.
When it comes to the behavioral modification that these medications could have and if adolescents lose weight and then gain weight and then lose weight and then gain weight, they could end up in a worse situation than if they never did take the medication to begin with.
What should parents consider in allowing their child to take GLP-1s?
I do think that parents should listen to their doctors, but a second opinion never hurts.
GLP-1s can be very useful tools, but it's also important to know that weight loss often rebounds when you go off the medication.
We know that obesity can also have long-term effects on brain function and susceptibility to metabolic diseases, cancer and a bunch of other things, so it is important to weigh all options.
What are alternative ways to combat childhood obesity?
Prevention is definitely where the solution has been for a long time. Exercise doesn't always help people lose weight, but it's great for weight loss maintenance, for preventing weight gain and for metabolic health.
Getting kids more opportunities to have activity in their lives, to move more in general should be a really big goal. Reducing the screen time is good but getting them to just be more naturally active is better.
Also, modeling healthy eating patterns for kids from an early age is great for obesity prevention. Cook with your kids, have dinner with your kids and choose a healthy balanced diet.
