by Adam Klapperich, DO
12 year old Ricky comes to the clinic with his mother, who requests for him “that medication the celebrities take to get thin.” Ricky is normal height but weighs 260 pounds. He is bullied at school, can’t keep up on his basketball team, and is having knee pain. His mom is concerned about his mental health. He is avoiding school and has made passive suicidal statements.
Should semaglutide be an option for Ricky?
The childhood obesity rate in the United States is a significant concern for the medical community. According to the CDC, it is around 20% for children ages 6-19. 80% of obese children carry this into adulthood. In addition to the health issues associated with childhood obesity, these children may be at higher risk for mental health problems due to the psychological factors of obesity, low self-esteem, bullying/discrimination, lower quality of life. Obesity and mental health problems such as depression, anxiety, and eating disorder often co-occur, with previous research showing that those with mental health problems being more susceptible to weight gain. There is the obvious iatrogenic link between common psychotropic medications and weight gain, with second generation antipsychotics being most notorious. According to Kokka et al (1), apart from the psychological aspects of obesity and mental illness, anxiety and affective disorders may share a common biologic profile with weight gain. “The most prominent biomarker associated with depression is cortisol, due to the deregulation of the hypothalamic–pituitary–adrenal (HPA) axis. The end product of this deregulation is similar to the outcomes of Cushing syndrome, an endocrinological disorder which is characterized by excessive visceral fat accumulation.” There has been correlation between social anxiety and weight gain, “According to this theory, anxiety and fear may cause an increase in food intake, as eating functions as a soothing mechanism towards intense stress.”
In 2023 the FDA approved semaglutide, a glucagon-like peptide-1 receptor agonists (GLP-1) for children ages 12 and up for an adjunct treatment with lifestyle modifications for weight management. The efficacy and safety of this class of medication has not been extensively examined. “Common side effects of semaglutide are vomiting, nausea, diarrhea, constipation, abdominal distension, abdominal pain, headache, dizziness, fatigue, dyspepsia, eructation, hypoglycemia in patients with type 2 DM, gastroenteritis, flatulence, and gastroesophageal reflux disease.” Studies have shown GLP-1 agonists to be efficacious for children with obesity. This class of medication should certainly be second line after intensive health and behavioral lifestyle modifications. However, in children with severe obesity or significant medical complications from obesity, GLP-1 agonists should be considered.
1. Psychiatric Disorders and Obesity in Childhood and Adolescence—A Systematic Review of Cross-Sectional Studies.
2. Usage of Glucagon-Like Peptide-1 for Obesity in Children; Updated Review of Clinicaltrials.gov