Should I Let My Child Take Ozempic?
I remember sitting on the slick, varnished floor of my middle school gymnasium, listening to the PE teacher address us on the first day of class. We were going to be weighed and measured — individually and privately — at the beginning and end of the school year, she explained. All of us would gain weight, the teacher told us confidently. We were growing children. That was our job.
I’m sure I wasn’t the only student who was feeling nervous about stepping on that scale. But what really makes the moment stand out in my mind is the way that teacher presented the prospect of gaining weight so matter-of-factly, without the judgment I was accustomed to hearing in adults’ voices every time they uttered those words.
According to those adults, losing weight, on the other hand, was to be celebrated as a joyous accomplishment. Think: Oprah Winfrey pulling a little red wagon of fat onto the stage to illustrate the 67 pounds she lost on a crash diet. (Winfrey has since apologized for her contribution to “diet culture.” She has also spoken about her own use of weight loss drugs, telling People magazine, “The fact that there’s a medically-approved prescription for managing weight and staying healthier, in my lifetime, feels like relief, like redemption, like a gift.”)
We tend to think of dramatic interventions like restrictive diets, intense exercise, weight loss drugs or surgery, as being the purview of adults, who, fairly or not, are considered culpable for their own weight gain. Children, on the other hand, are more likely to be presumed innocent. If we’re looking to assign blame for a child’s weight, we generally direct it at their parents.
But children are not immune from the discourse that surrounds them. Like my peers and I sitting on the floor of the gymnasium, kids understand from a very early age that there is a stigma associated with being fat, and that when grown-ups gain weight they talk about it with shame.
The entrance of semaglutide medications for weight loss onto the market in recent years (Ozempic was approved for Type 2 diabetes in 2018, and the same drug in a different dose, marketed as Wegovy, was approved for weight loss in 2021) has complicated the conversation about weight loss and health — first for adults, but now for kids, too.
In 2023, the American Academy of Pediatrics updated its guidelines for treating children with obesity, which it calls “a common chronic disease that has been stigmatized for years and is associated with serious short and long-term health concerns when left untreated, including cardiovascular diseases and type 2 diabetes.”
Previously, the guidelines had emphasized lifestyle modifications, such as diet and exercise, and a spirit of watchful waiting. The new guidelines, however, recommend the use of weight-loss medications in children as young as 12, and bariatric surgery for children as young as 13 — in addition to counseling around diet and exercise.
While it’s hard to argue against a treatment that is lowering a child’s high blood pressure or treating their Type 2 diabetes, the question of stigma is a thornier matter. Does it make sense to prescribe these medications to a child just because they are fat? And what are the risks, both physical and emotional, to having kids who aren’t done growing take weight loss drugs?
The effects of obesity can be serious, even in children.
Research shows that about 80% of adolescents who are obese will continue to be obese in adulthood — but many will experience negative impacts from the disease before then.
“Obesity is a chronic, progressive disease that often starts in childhood. In fact, it is the most common chronic disease of childhood,” Dr. Caren Mangarelli, medical director of the pediatric bariatric program at Lurie Children’s Hospital, told HuffPost. Currently, 17% of children ages 6-12 in the U.S. meet the clinical definition of obesity.
“It is a disease that often affects quality of life, mental health and overall
lifespan,” Mangarelli said.
Medical complications of obesity in children can include “high blood pressure, obstructive sleep apnea, Type 2 diabetes, metabolic-dysfunction
associated steatotic liver disease, joint and bone disease, as well as other medical conditions,” Mangarelli said.
She added that research from studies on bariatric surgery suggests that these health conditions may be “more reversible earlier on in life.” In other words, by losing weight in adolescence, someone might not simply lower their current blood pressure but improve their future cardiovascular health for years — potentially extending their life expectancy.
Children taking these medications should be carefully followed by their physicians.
“The adult care world is not the same as pediatrics. We cannot and do not treat teens/kids like little adults. They have growing bodies and growing brains,” Dr. Stephen Cook, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital, told HuffPost.
Cook noted that in weight management centers such as the one he works in, kids aren’t simply weighed and measured to calculate their BMI, like in a pediatrician’s office.
Providers at these centers “measure their body composition closely for muscle and fat changes, which the scale can’t tell you,” he said.
Doctors must also help patients manage side effects, the most common of which is “gastrointestinal upset,” Mangarelli said. “Symptoms like nausea, vomiting, diarrhea, and abdominal pain are the most frequently reported. For this reason, these types of medications necessitate slowly increasing the dose over time.”
Children should be in regular contact with their medical providers while they get used to taking the medication.
This means paying close attention to kids’ mental health — and potentially their parents’, too.
Providers like Cook are also careful to screen for eating disorders, which a person can develop at any body size.
“Teens come with more mental health issues, body image issues, and disordered eating behaviors,” Cook explained, adding that many adult primary care providers don’t discuss such issues with their patients.
In some cases, an adult with disordered eating passes these behaviors along to their child when they become a parent, adding another layer of concerns for medical providers to unravel.
“We need to be careful that we are centering health goals and not appearance,” Mangarelli said. “We don’t want to be perpetuating body image perfectionism nor disordered eating patterns.”
She added, “This can be especially problematic for girls or young women in our society.”
Ruth Micallef, an eating disorders specialist, told HuffPost that she believes weight loss drugs should not be prescribed to children who have eating disorders.
“By simply reducing a patient’s appetite, we do not get to the core of supporting them to process why their eating disorder emerged in the first place,” she said. “Studies continue to show us that three quarters of patients put on these medications for obesity put back on the weight once they have come off of the drugs.” In other words, the medications would not offer a long-term fix to the weight a child might gain from their disordered eating.
“Early intervention and support for eating disorders is key, and this is particularly true for teenagers,” Micallef said.
It also means keeping in mind social determinants of health.
Just as with adults, and with other chronic diseases, obesity does not affect all children in an equitable way. Data from 2023 show that Black (23.5%), Hispanic (22.2%) and Native (19.2%) youth are more likely to be obese than their white (13.2%) and Asian (10.2%) peers.
Poor children are also more likely to be obese. Obesity impacts 24.1% of children living below poverty level, but only 10.4% of children whose families’ incomes were four times as high or higher.
This disparate impact is a result of many factors, including food insecurity and less-walkable communities. Unfortunately, weight loss medications may be further exacerbating these inequalities, as the medications are expensive (costs for Wegovy can exceed $1,000 a month) and often not covered by insurance.
“This is likely not only a purely financial decision by insurance companies, but also influenced by weight bias in our culture, and the predominant, but erroneous belief that obesity is a personal failing and the consequence of purely poor lifestyle choices,” Mangarelli said.
Making the drugs available doesn’t mean every child with obesity has to take them.
Both Mangarelli and Cook emphasized that each patient’s unique case should be carefully considered before a physician prescribes weight loss drugs.
A child’s health, not fat stigma, should be driving motivation.
“Not everyone develops negative health consequences at the same weight,” Mangarelli said, adding that she would consider the drugs for her own child “if my child was having negative health consequences associated with their weight.”
“We are seeing and hearing about primary care doctors that feel pressured to treat adolescents with medications because families are asking for them,” Cook said, even though pediatric endocrinologists and weight specialists are just beginning to familiarize themselves with these drugs.
“This is a really complex issue, and I’ve not ever seen anything like this in my 23+ years of practice,” Cook said. “These are promising drugs, but we need to proceed cautiously with using them.”
