Anti-obesity medications for teens: Considerations for families
Childhood obesity rates are rising in the U.S., affecting nearly 1 in 5 kids and teens ages 2 to 19 years.
For parents of teens struggling with obesity, it can be difficult to know how to help your child lose weight, while also protecting their mental health and self-image.
Recently, the American Academy of Pediatrics (AAP) — the largest professional association of pediatricians in the U.S.— included anti-obesity medications in their recommended guidelines for treating childhood obesity for the first time.
Dr. Alexandra Roche, pediatrician and division chief of adolescent medicine at CHOC and an AAP member, is excited to have four anti-obesity medications in her toolbox to help tackle teen obesity.
In this Q&A, Dr. Roche discusses the benefits and risks of anti-obesity medications for teens, and how parents help their teens develop healthy habits and a positive self-image.
Please note: This information about anti-obesity medications should not replace the expertise of your child’s physician.
When are weight loss (anti-obesity) medications recommended for teens to treat obesity?
I’m excited to have access to four anti-obesity medications to help tackle obesity in teens, says Dr. Roche. However, it is important to recognize that there are specific indications for when to use them — and they should be used responsibly.
The newest anti-obesity medications are called Glucagon-Like Peptide-1 (GLP-1) receptor agonist medications. These medications are recommended for teens 12 years and older struggling with obesity.
GLP-1 agonists may also be used for teens who are overweight and have other conditions related to obesity such as hypertension, elevated cholesterol levels, nonalcoholic fatty liver disease, polycystic ovary syndrome (PCOS), pre-diabetes or obstructive sleep apnea (OSA).
What kind of weight loss (anti-obesity) medications can be used to treat obesity in teens? Are there side effects?
Liraglutide and Semaglutide (commonly known as brand names include Saxenda and Wegovy)
Liraglutide and semaglutide are both injection medications that work like natural hormones by slowing down the process of digestion in the stomach. They also increase the release of insulin which impacts the nutrition center of the brain. These medications cause teens to have fewer food cravings and feeling fuller sooner, resulting in more significant weight loss than with lifestyle changes alone.
Although they show very promising results, these medications do have common side effects like nausea, vomiting, diarrhea, headache, abdominal pain and low blood sugar.
Significant but less common side effects include: the development of gallstones and pancreatitis (signs and symptoms can include severe abdominal pain, nausea and abdominal pain).
Other important medications that can be used to treat obesity in teens include Orlistat and Phenteremine/Topiramate. These medications are not GLP1 agonists.
Orlistat (also known as brand names Alli and Xenical)
Orlistat, which is approved for use in teens 12 and older, has been available for many years. It is essentially a fat blocker—instead of absorbing the fat, it exits the body through waste. Orlistat may not lead to significant weight loss and can have uncomfortable side effects.
Orlistat side effects include stomach pain, bloating, indigestion, excessive gas, diarrhea and oily stools. It can also interfere with the absorption of some vitamins.
Phentermine / Topiramate (also known as brand name Qysmia)
A medication combining phentermine and topiramate has also been approved for teens 16 years and older. This medication works as an appetite suppressant, meaning that the patient won’t be as hungry while taking it.
Dr. Roche says that while this medication is effective, it can lead to congenital malformations if taken while pregnant, may decrease the effectiveness of contraceptives, and should be avoided in those with thyroid disease, kidney stones and glaucoma.
Are there any special considerations parents should have about weight loss (anti-obesity) medications for teens?
Yes. Always provide a complete personal and family medical history to your healthcare provider before starting medications. Some teens with certain medical conditions family history should avoid some medications for obesity. This includes teens who may, for example, have Type 1 diabetes or family history of pancreatitis or thyroid cancer.
While anti-obesity medications are effective, availability and supply may be limited. Some health plans may offer limited coverage and some may require intensive weight loss program participation before starting the medication. These medications can be expensive when paid for out of pocket.
How long should teens take weight loss (anti-obesity) medications to treat obesity?
This is one area where we still do not have clear answers, says Dr. Roche. If your teen doesn’t see a weight loss response after 12 weeks on the medication, then they should stop taking it.
In adults, there is often weight regain after discontinuing GLP1-agonists. We do not yet have data on the long-term effects these medications have on adolescents, and they may need to be lifelong medications.
However, we do know that obesity can cause significant long-term health consequences for teens like: high blood pressure, heart disease, non-alcoholic fatty liver disease, Type 2 diabetes, breathing problems (obstructive sleep apnea), trouble sleeping, joint pain, hormonal changes, low self-esteem or even depression.
It’s important to discuss the benefits and risks with your family and your doctor.
Should teens still practice healthy diet and exercise while taking weight loss (anti-obesity) medications?
Absolutely! Exercising and eating a balanced diet is still the foundation for supporting a healthy weight, says Dr. Roche. Various studies have shown that a combination of exercise and medications has improved results over medications alone.
Exercise supports heart health and muscle development, which maximizes metabolism. It also supports the development of strong bones and has a positive impact on sleep and brain health. It’s recommended for teens to have one hour (60 min) of moderate-to-vigorous activity daily. Teens can start slowly and work up to this recommendation over time, if needed, advises Dr. Roche.
A balanced diet provides the essential nutrients a teen’s body needs and teaches them how to maintain a long-term healthy lifestyle, even when not on medications. Focusing on vegetables, fruits, whole grains, and lean proteins with occasional treats allows teens to continue to enjoy food with friends and family.
Are there alternative treatments to medications to help treat obesity in teens?
The most effective way to treat obesity in teens – without the use of medication – is balanced, consistent nutrition, exercise, hydration and sleep.
Some teens with severe obesity may find success with bariatric surgery. Although these surgeries are not offered at CHOC, they can be effective for weight loss, as well as the improvement or reversal of obesity-related health conditions like high blood pressure and Type 2 diabetes.
These surgeries can be a big decision, and require serious thought and discussion between the teen, their family and their doctor.
Can obesity in teens be prevented?
Yes. A healthy, balanced lifestyle with healthy meals and exercise can help prevent obesity in teens.
Get Dr. Roche’s 10 quick tips to help kids and teens maintain a healthy weight.
Can anti-obesity medications cause eating disorders and negative self-image in teens?
Any child or teen struggling with excess weight and medical complications due to excess weight is at risk for poor self-image, depression and eating disorders.
When addressing obesity with your teen, it’s vital to emphasize supporting healthy, balanced eating and exercise. Parents should avoid using any negative language around body image and should focus on their teen’s health rather than appearance.
The following tips may also help parents support their teens dealing with a negative self-image and concerns about obesity:
- Keep open communication: Allow your teens to express their feelings and concerns without fear of criticism.
- Utilize positive reinforcement: Acknowledge and celebrate your teen’s strengths and achievements, emphasizing qualities beyond physical appearance.
- Seek professional support: If negative self-image is significantly impacting a teen’s mental health, consider seeking professional help. Mental health professionals can provide guidance and support tailored to the individual’s needs.
- Promote media literacy: Discuss media literacy and help teens critically evaluate the images and messages they encounter on social media. Encourage your teens to have a realistic understanding of diverse body types.
Is there anything else you would like parents to know about weight loss (anti-obesity) medications?
Medications are a great tool to be used in addition to a healthy lifestyle in the right circumstances. Make sure to talk with your child’s doctor about options.
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