Ozempik is a teenage mess

Somehow, America’s desire for Ozempic only grows. The drug’s active ingredient, semaglutide, is sold as an anti-obesity drug under the brand name Wegovy, and it has become so popular that its maker, Novo Nordisk, recently limited shipments to the US and halted advertising to prevent shortages. Its promise has lured would-be patients and set off a pharmaceutical arms race to create more powerful drugs.

Part of the interest stems from Ozempic’s potential as a teenager. In December, the FDA approved Wegovy as a treatment for adolescent obesity, which affects 22 percent of 12- to 19-year-olds in the United States. The drug’s ability to promote weight loss in teenagers has been described as “mind-blowing”. In January, in its new guidelines for the treatment of childhood obesity, the American Academy of Pediatrics (AAP) advised doctors to add weight-loss drugs such as semaglutide as treatment for some patients.

But while many doctors and obesity specialists have embraced semaglutide as a treatment for adults, some are concerned that taking it at such a young age and in such a volatile phase of life could pose serious risks, particularly because the drug’s long-term physical and mental health effects are still unknown. is Others, however, believe that no Using this drug in teenagers is even more risky because obesity makes teens vulnerable to serious health conditions and early death. In part because of doctors’ concerns, semaglutide prescriptions for teenagers are not as widespread as they are for adults. At this point, whether these drugs will ever be used as a treatment for adolescents remains deeply uncertain.

Semaglutide is not only effective for teenagers. it’s possible even more effective than in adults. In a large Novo Nordisk-funded study published The New England Journal of Medicine“The degree of weight reduction in adolescents was better than what was seen in the adult trials,” Aaron S. Kelly. In another Novo Nordisk-funded study published last week, a team led by Kelly showed that the drug, along with counseling and exercise, nearly halved the number of obese teenagers after 68 weeks of treatment. For both teens and adults, a weekly injection “doesn’t magically melt away body fat,” Kelly said. instead, it works to induce feelings of satiety and soothe hunger pangs.

Adolescents’ experiences with obesity are different, in some ways more intense, than those of older adults. Puberty is a time of much growth and development, so the body fights weight loss attempts “with every mechanism,” Tamara Hannon, a pediatric endocrinologist at Indiana University School of Medicine, told me. Adolescents may also have less control than adults over what they eat or how active they get, as they are largely limited by their family and school, as well as social pressure to conform to the eating habits of their peers. “Making good choices means doing something different than most other kids,” Hannon said. “There’s something around every corner that directly contradicts weight loss.”

Because obesity is a chronic disease, its early development can be devastating. In many cases, this can lead to diseases such as type 2 diabetes and fatty liver at a young age. Children are 5 times more likely than their peers to be obese in adulthood. As obese teenagers become obese adults, they can “develop very, very aggressive disease,” Fatima Stanford, M.D., an obesity medicine physician at Massachusetts General Hospital and Harvard Medical School, told me. Weight-loss drugs give doctors a chance to intervene before obesity snowballs, he says, which is why the AAP’s new childhood obesity guidelines advocate using them as part of early, aggressive treatment, along with many hours of individual health care. and lifestyle therapy. If used early enough, semaglutide or other drugs can change the trajectory of a teenager’s entire life.

But semaglutide can also skew a teenager’s trajectory. Because the treatment is considered lifelong, stopping usually results in rapid weight regain, teenagers who start the medication will take it for decades. “We have no way of knowing whether these drugs, used so early in life, could have unanticipated adverse effects,” David Ludwig, an endocrinologist at Children’s Hospital Boston, told me. While adults face many of the same unknowns, the dangers for teenagers can be more serious because their bodies and brains are in constant flux. Of particular concern are the drug’s potential effects on physiological changes specific to adolescence. “We need to track girls’ puberty and menstrual history,” Hannon said. In addition, the drugs can cause unpleasant side effects, such as gastrointestinal problems, and can have other effects, including significant muscle wasting and remodeling of the brain’s reward circuitry. Scientists are just beginning to understand these effects. at the moment only two There have been no major studies of semaglutide in adolescents, and none included a long follow-up period.

The effects of semaglutide treatment on mental health, an important aspect of obesity care, are even less understood. Teens are “more likely to have intermittent access to medication than adults,” Kathleen Miller, MD, an adolescent medicine specialist at Children’s Hospital of Minnesota, told me, and missing multiple doses in a row can pose physical and psychological risks. Another concern is that the overall effect of taking semaglutide—a decrease in appetite that leads to eating less—is essentially the same as dieting. When teenagers follow very restrictive diets, whether they include weight-loss drugs or not, “we know it can be detrimental to their mental health and contribute to disorders,” Hannon said. Because their brains are so plastic during puberty, “there’s a risk that these patterns will become entrenched in adolescence,” Miller says.

With so many unknowns, would obese adolescents be better off avoiding semaglutide? At least for now, many pediatricians are reluctant to prescribe it. “The idea of ​​using obesity medication was difficult even in adults a few years ago,” says Angela Fitch, an assistant professor at Harvard Medical School and president of the Association for Obesity Medicine; Acceptance of its role in child care lags even further. But getting teenagers off drugs, he told me, is the biggest danger. teenagers develop unhealthy attitudes about their bodies when they don’t get help to lose weight. Explaining to a teen that obesity is not their fault, and correcting the underlying biological problem with medication or other treatment, helps them “build a better understanding of their bodies,” she said.

None of the experts I spoke to said that semaglutide should never be used in the treatment of teenagers. Even those who were wary of the drug acknowledged that it could be medically appropriate for teenagers who really struggle with their weight and have had little success losing it through other means. That argument can only get stronger as more convenient drugs or drugs with fewer side effects are approved for teen use. Both Novo Nordisk and Pfizer announced this week that pill versions of these drugs have been successful in early trials.

Even without all the answers about how the drug might affect adolescents long-term, Fitch predicted that “adoption of semaglutide and other anti-obesity drugs into pediatric clinical care will be slow and gradual.” After all, they can be seen as one of several weight loss tools to help children create a healthier life. Treating adolescent obesity shouldn’t be an either-or choice, Ludwig said. “That’s all, and.” He suggested that, for example, combining semaglutide with a low-carbohydrate diet could have a synergistic effect on adolescent weight loss.

For the foreseeable future, semaglutide isn’t ready to take off for teenagers the same way it does for adults. Despite the hype surrounding Ozempic, experts and their patients are left with a difficult choice based on varying risk assessments; Either way, teenagers have the most to gain and the most to lose.

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