- Weight loss medications like Ozempic and Wegovy can have side effects.
- Semaglutide medication for weight loss may be needed for an entire lifetime.
- 11 questions to ask your doctor before accepting a prescription.
During a regular visit to the doctor, a friend’s pediatrician advised her 15-year-old to take semaglutide (e.g., Wegovy, Ozempic, GLP-1, or similar drugs). Let’s call the teenager “Leslie” for privacy reasons.
Leslie trains for something analogous to gymnastics or competitive dance. They’re active, doing cardio-fitness for three to five hours, three to four days a week. And the activity level has been like this for years.
Leslie’s BMI category lands above the “healthy/normal” range. That alone seemed to trigger the doctor’s recommendation to put Leslie on weight loss shots. (No laboratory blood work was performed, and no inquiry about how Leslie felt about their weight, whether it was a problem for Leslie, or even if Leslie wanted to change their weight.)
I have been hearing the same types of stories from friends and other clinicians, too. So, this aligns with experiences out there. To me, this is alarming.
Helpful questions if you or your child is interested in semaglutide for weight loss
It seems like the informed consent process for semaglutide medications may be individual for each physician. (Informed consent is a process of discussing risks and benefits along with what research does and doesn’t know so far). If doctors aren’t initiating detailed risk and benefit conversations about semaglutide, it will probably benefit you to ask some questions.
I’ll stay with Leslie as my example. These risk/benefit questions popped up for their mother and me.
- Once started for weight loss, the medication can be needed for the rest of an adult’s lifetime. Is that the same for a child?
- Taking the shot should make Leslie eat less. Could that then lower their energy and ability to exercise? Leslie loves their movement and dance, and not doing those as much would negatively affect their mental health for certain.
- Wegovy and Ozempic warn of a risk of thyroid cancer. Pancreatitis, kidney issues, and gall bladder problems are rare but serious side effects these medications list. Leslie already has the genes for a genetic disease that will cause a transplant of a different major organ at some point in their life. How might the semaglutide medication interact with or affect that existing jeopardized organ?
- Genetics strongly influence eating disorders (Bulik, Blake, & Austin, 2019). Weight loss and dieting can push the metaphorical “on button” for susceptible people. There are eating disorders in Leslie’s family, which could put Leslie at higher risk for a clinical eating disorder, too. Eating disorders are known for increased risk of death due to physical complications or suicide.
- In Europe, the medications are being investigated to ensure they don't compel suicidal ideation in some people (Constantino, 2023). How safe is the medicine to add to young, developing brains?
- When we under-eat, our thinking can get fuzzy (Franklin et al., 1948). Is there a chance this will affect Leslie's academic performance?
- Moods are affected by nutrition intake (Franklin et al., 1948). Will the moods, anger, and angst of teen years be the usual teen stuff, or is there a chance the medication and reduced nutrition will amplify it?
- Malnutrition can happen if we eat too little or in unbalanced ways. Though the shots would make Leslie eat less, will they eat enough and have enough balance for optimal health?
- What other effects have been shown to happen for teens? For instance, How does dating and eating with friends get affected as, for example, this young person socially develops?
- What are the benefits of weight loss—not “correlative” but causal or proven positives—sans lifestyle changes? For example, Leslie is already quite active. Shouldn’t that already protect them from some of the disorders commonly correlated with “obesity"? How does less adipose tissue provide more protection?
- Considering these risks/benefits, do the potential benefits outweigh (no pun intended) the risks?
Wrapping This Up
Of course, your risk and benefit questions would be specific to your child, family, and culture. But it seems that these medications are here to stay. In 2023, the Academy of American Pediatrics recommended prescribing weight-loss pharmaceuticals for children 12 years old or older who have “obesity” (Hampl et al., 2023). And studies are emerging. Recently, one concluded that "semaglutide represents an efficacious treatment option for adolescents with obesity.” But long-term outcomes and more information will take time.
A power differential exists between medical doctors and their patients. Sometimes, it's hard to question what a doctor recommends. However, often, it's up to us—you and me—to bring up questions and concerns about recommendations. To do that well before the pharmacist consult at the drug store while receiving the medication? That can be a challenge.
After my friend and her teen met with the prescribing doctor, a cloud of shame landed on the precious kid. Shame is rarely a vehicle for inspiring lasting change. Further, if Leslie has any issues with binge eating, Leslie may find their head in the cupboard and mouth full. Research backs that experiencing weight stigma can amplify eating pathology (Puhl & Suh, 2015; Westby, Jones, & Loth, 2021).
This blog is for informational purposes and does not offer therapy or professional advice.
Bulik, C., Blake, L., & Austin, J. (2019). Genetics of eating disorders; What the clinician needs to know. Psychiatric Clinics. 42(1). https://doi.org/10.1016/j.psc.2018.10.007
Constantino, A. K. (2023, July 26). UK investigates weight loss, diabetes drugs like Wegovy and Ozempic for suicide risks. https://www.cnbc.com/2023/07/26/wegovy-ozempic-uk-investigating-suicide-risks.html
Franklin, J. C., & Schiele, B. C. (1948). Observations on human behavior in experimental semi-starvation and rehabilitation. Journal of Clinical Psychology, 4(1), 28–45. https://onlinelibrary.wiley.com/doi/10.1002/1097-4679%28194801%294%3A1%3C28%3A%3AAID-JCLP2270040103%3E3.0.CO%3B2-F
Hampl, S. E., Hassink, S. G., Skinner, A. C., Armstrong, S. C., Barlow, S. E., Bolling, C. F., Avila Edwards, K. C., Eneli, I., Hamre, R., Joseph, M. M., Lunsford, D., Mendonca, E., Michalsky, M. P., Mirza, N., Ochoa, E. R., Sharifi, M., Staiano, A. E., Weedn, A. E., Flinn, S. K., Lindros, J., … Okechukwu, K. (2023). Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics, 151(2), e2022060640. https://doi.org/10.1542/peds.2022-060640
Kelly, A. S., Arslanian, S., Hesse, D., Iversen, A. T., Körner , A., Schmidt, S., Sørrig, R., Weghuber, D., & Jastreboff, A. M. (2023). Reducing BMI below the obesity threshold in adolescents treated with once-weekly subcutaneous semaglutide 2.4 mg. Obesity (Silver Spring), 31(8), 2139-2149. doi:10.1002/oby.23808
National Institute of Mental Health. “Suicide.” https://www.nimh.nih.gov/health/statistics/suicide
Puhl, R., & Suh, Y. (2015). Stigma and eating and weight disorders. Current psychiatry reports, 17(3), 552. https://doi.org/10.1007/s11920-015-0552-6
Westby, A., Jones, C. M., & Loth, K. A. (2021). The Role of Weight Stigma in the Development of Eating Disorders. American Family Physician, 104(1), 7–9.