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Concerns Rise as Drug Companies Advocate Weight-Loss Medications for Young Children
Pharmaceutical companies are reportedly adopting a strategy similar to the Jesuit saying, “Give me a child until he is seven and I will show you the adult,â by suggesting that very young children could gain from medications they might require for extended periods, potentially for life.
It has emerged that the manufacturers of the weight-loss injection Wegovy are lobbying for this type of medication to be administered to children as young as six who are overweight. This development follows recent revelations in a Channel 4 Dispatches documentary that highlighted how a 16-year-old girl was able to obtain Wegovy from a Boots pharmacy, despite it being officially restricted to individuals aged 18 and over.
Further investigation reveals that NHS trusts are already providing weight-loss injections, including Wegovy, to children as young as ten as a treatment for obesity. This is occurring even though these medications have not received approval for this age group from the National Institute for Health and Care Excellence (NICE), a health watchdog organization.
Potential Market and Mechanism of GLP-1 Agonists
The market potential for these drugs, known as GLP-1 agonists, is substantial. These medications mimic the effects of the hormone GLP-1, which slows down digestion and diminishes appetite.
Recent research published in The Lancet indicates that British and German children share the highest rates of obesity in Europe. House of Commons statistics from February indicate that over a quarter (26.8 per cent) of children in England aged two to 15 are currently overweight or obese.
Personal Accounts of Wegovy Use
The appeal of treatments like Wegovy is evident. A teenager in the US, under the care of an obesity specialist and prescribed Wegovy, reported losing over 3 stone (50lbs) after prior unsuccessful attempts at weight loss through diet and exercise. Identified as Ann A, she recounted trying a summer weight-loss camp, only to regain the weight and exceed her initial weight afterwards. Concurrently, her health deteriorated, leading to a pre-diabetic condition and elevated blood fat levels.
More than a quarter of British children are considered overweight or obese, placing the country in a tie with Germany for the highest rate of childhood obesity in Europe.
Ann now states, âI feel better not just physically but mentally.â
Although Ann is 18, Wegovyâs manufacturer, Novo Nordisk, based in Denmark, is seeking approval from European and American regulatory bodies to extend the use of GLP-1 injections to children as young as six.
Experts are expressing profound apprehensions about the significant consequences this could have for children’s long-term health.
Novo Nordisk’s Study and Findings
Novo Nordisk initiated groundwork for administering GLP-1 drugs to children in September with a company-funded study published in the New England Journal of Medicine, a highly regarded publication.
The study compared two groups of children aged six to 11. One group of 56 children received the GLP-1 drug liraglutide (marketed as Saxenda by Novo Nordisk), while a control group of 26 received a placebo. Both groups were also given lifestyle advice concerning diet and physical activity.
The 18-month study concluded that liraglutide injections were considerably more effective for weight loss than the placebo. Children receiving liraglutide experienced a 5.8 reduction in their BMI score, compared to a 1.6 per cent reduction in the placebo group.
Participants on the medication had the option to continue its use after the trial. However, more than ten per cent of children on liraglutide discontinued the treatment prematurely due to intolerable side effects, primarily gastrointestinal issues such as stomach upset, vomiting, and nausea, consistent with adult experiences using GLP-1 drugs.
Experts are concerned that children who discontinue GLP-1 drugs may experience weight regain, as indicated by the study’s observation that BMI began to increase following cessation of treatment.
A Channel 4 Dispatches documentary last month revealed that a 16-year-old girl was able to obtain Wegovy from Boots, despite it being intended for individuals aged 18 and over.
In an editorial accompanying the Novo Nordisk-funded study in the New England Journal of Medicine, researchers from the Universities of Birmingham and Bristol described the weight increases observed in trial participants after liraglutide treatment ceased as âworrisomeâ.
This observation is not surprising, as similar patterns are frequently observed in adults.
A University of Liverpool study involving 1,900 overweight adults who took the GLP-1 drug semaglutide for 17 months and then stopped, found that 13 months later, participants had regained, on average, two-thirds of the weight lost, as reported in the journal Diabetes, Obesity & Metabolism in 2022.
This potentially suggests that children might remain on these medications for extended periods.
However, the long-term consequences remain unknown, as children were not included in the initial trials that led to the drugs’ approval.
Professor Claudia Fox, a paediatric gastroenterologist at the University of Minnesota and lead author of the New England Journal of Medicine study, stated upon publication, âWith such a limited sample [of 56 children], itâs challenging to ascertain if rarer side effects exist or might emerge. We require considerably more long-term data with larger sample sizes.â
Regulatory Status and NHS Prescribing Practices
Despite these uncertainties, a Novo Nordisk spokesperson informed Good Health that the company has applied to both the European Medicines Agency and the US Food and Drug Administration to broaden the approval of liraglutide for weight loss in children aged six to 11.
The spokesperson stated that the application is based on data from the New England Journal of Medicine trial.
In the UK, there is no official regulatory clearance to use liraglutide for treating obesity in individuals under 18. NICE indicated in 2021 that Novo Nordisk had not provided sufficient evidence to demonstrate the drug’s effectiveness in children or adolescents.
However, across the NHS, hospital trusts are already using liraglutide to treat children as young as ten.
Following a freedom of information request by Good Health, the University Hospitals of Leicester NHS Trust disclosed that it has administered these injections to 20 children aged 12 to 18 within its paediatric obesity service since 2021. (The trust also mentioned treating âtwo or three patients in the Paediatric Diabetes Serviceâ with liraglutide, although NICE officially permits the drug for children âaged 10 or over with type 2 diabetesâ).
Meanwhile, prescribing guidelines from the NHS Hampshire and Isle of Wight Integrated Care Board recommend GLP-1 drugs for severely obese, non-diabetic children as young as 10.
A spokeswoman for the authority told Good Health, âPrescribing of Wegovy and Ozempic for children is exclusively supported in exceptional cases via our specialist paediatric weight-management services, delivered at specialist centres in Portsmouth Hospitals University Trust and University Hospital Southampton.â
âOnly children with severe obesity who have not achieved weight control through dietary and exercise interventions are referred to our specialist paediatric weight-management service.â The spokeswoman declined to specify the number of children treated at these hospitals.
Similarly, a spokeswoman for the University Hospital Southampton NHS Foundation Trust confirmed that âthis treatment is provided to a very small number of young patients under the age of 18,â but did not disclose the exact numbers due to the âsensitive nature of this treatment and the vulnerability of those involved.â
Dr Nikki Davis, a consultant in paediatric endocrinology and diabetes at the trust, added, âGLP-1 medications are employed very infrequently in children alongside comprehensive weight-management programmes and only after all other options have been exhausted.â
Other NHS local authorities adopt a contrasting approach. NHS Lancashire and South Cumbria Integrated Care Board, for instance, has implemented a âdo not prescribeâ directive for medical personnel (publicly accessible online) concerning âLiraglutide for managing obesity in people aged 12 to 17 yearsâ, citing NICE guidance as the basis.
Lack of Central NHS Data and Expert Concerns
Even NHS England lacks comprehensive data on the number of children being prescribed GLP-1 drugs and the specific circumstances, even when these drugs are administered under the limited NICE approval for type 2 diabetes.
The latest NHS National Diabetes Audit, published 15 months prior, acknowledges that prescription figures for GLP-1 drugs given to children were not included in the data collection. The report states, âThis implies that individuals may have been omitted when they should have been included.â Despite this informational gap, the NHS appears unconcerned.
An NHS England spokesman told Good Health, âThese treatments are strictly prescribed under specialist paediatric supervision, following careful assessment and in accordance with national guidance â ensuring they are safe, clinically appropriate and combined with a comprehensive care package encompassing expert dietary, physical activity and mental wellbeing support.â
The Royal College of Paediatrics and Child Health declined to comment when contacted by Good Health regarding prescribing GLP-1 drugs to children as young as six. However, across the Atlantic, experts are raising alarms.
Warnings from US Experts on Long-Term Risks
Professor Dan Cooper, a professor of paediatrics at the University of California, Irvine, expressed to Good Health that he is âvery worriedâ about the potential harm these drugs may inflict on childrenâs developing bones and brains, potentially leading to severe frailty and lasting mental health issues. Two years ago, Professor Cooper headed a team of clinicians, exercise scientists, pharmaceutical scholars, ethicists, and behavioural experts in cautioning against the potentially catastrophic consequences of widespread medication of young people with GLP-1 drugs.
This warning was published in the journal Clinical and Translational Science, yet Professor Cooper believes the global community is not paying sufficient attention.
He is particularly concerned that initiating GLP-1 treatment in children might constitute a lifelong dependency. He questions, âAre we suggesting to children on GLP-1 drugs that they possess such a fundamental inadequacy that they cannot learn to adopt healthy habits of physical activity and diet?â
âThese medications are remarkably effective. However, they are not a curative treatment that can be discontinued after a period. Continuous, potentially lifelong, use is required. What impact will this have on a child? The notion of giving GLP-1s to six-year-olds deeply troubles me.â
Professor Cooper is particularly concerned about the drugsâ effects on young individuals’ development.
âAdolescence is a crucial developmental stage,â he cautions. âOur understanding of the long-term effects of GLP-1 drugs on this age group is insufficient to determine their impact on development.â
âWe are uncertain how these drugs will affect pubertal development, a biologically intricate phase.â
âHowever, we know these medications create an energy intake imbalance, which will impact bone mineralisation [bone strength], and bone density cannot be increased beyond adolescence.â
âSimilar issues will emerge concerning childrenâs muscle development.â
Furthermore, he states he is âparticularly concerned about the effect on their mental healthâ.
âBefore endorsing widespread use of these drugs in children and adolescents, we must comprehend the repercussions on their developing brains,â Professor Cooper argues. âThese drugs will disrupt their neural development in profound ways.â
âThe reality is that GLP-1 receptors are present in both the brain and the body, and I believe these drugs are influencing childrenâs cognitive processes.â
âWe are already observing that children on these medications exhibit reduced motivation to engage in daily activities. Their youthful vitality is diminished.â
Parallels with Psychiatric Drug Prescribing Trends
It would be a tragic irony if a treatment intended for children’s escalating obesity issues inadvertently exacerbated mental health problems in this age group, particularly when young individuals are increasingly being prescribed psychiatric drugs that they might also require indefinitely.
This issue is not exclusive to obesity medications.
Last year, a panel of British experts led by David Branford, an associate professor of pharmacy at Plymouth University, warned in the British Medical Journalâs Drug and Therapeutics Bulletin about the increasing trend of antipsychotic prescriptions for children, which had risen by over 3 per cent annually between 2000 and 2019.
Concurrently, antidepressant prescribing rates more than doubled among 12 to 17-year-olds between 2005 and 2017, according to the report.
The panel cautioned that doctors were prescribing psychiatric medications to young patients for increasingly longer durations despite âserious concerns about the safety and efficacy of these psychiatric drugs in children and young peopleâ.
As Professor Cooper at the University of California, Irvine, summarizes, âI am deeply concerned about the growing global trend of medicating everything.â
âAre we truly prepared to have children grow up with the belief that medication is the only path to survival for the remainder of their lives?â