Nutrition: weight loss drug for teens?
Last week I saw a news piece about a study testing out a weight loss drug on teens with high BMIs/”obesity”.* The piece touted the drug, semaglutide, at being a successful weight loss tool compared to “diet and lifestyle intervention alone,” and interviewed a female adolescent who had lost a significant amount of weight as part of the study (before and after photos of course included). This brought up a lot of emotions and thoughts in me, and made me wonder the details of the study that the news story likely either got wrong, misinterpreted or sensationalized.
Let’s talk details
So this study, published in a prestigious medical journal, took a little over 200 adolescents with an average age of 15, most of whom had a BMI of >35 (considered “obese”). Most of these kids were female (62%) and the majority were white (79%). The study gave half the participants the weight loss drug combined with diet and lifestyle intervention for weight loss (important distinction, and I believe this included calorie restriction), and half just got the diet and lifestyle intervention, for a total of 68 weeks. The weight loss drug, initially targeted towards diabetes, also reduces appetite and therefore has been used as a weight loss drug in adults. The teens taking the weight loss drug lost more weight and reduced their BMI, there was little change in the group not on the drug. In a short follow up period after 68 weeks, when the drug was stopped, there was a small regain of BMI at 75 weeks. What happens after that is unknown.
Red flags
We are looking at mostly white females here, and it’s impossible to know if the same results would occur in Black and Hispanic populations. At the age of 15, so many female bodies are in absolute hormonal chaos as they go through puberty. It’s completely unknown what kind of impact a weight loss drug might have on this natural process years down the line. Ditto for metabolism, which we know dieting and caloric restriction can seriously mess up for life. On the mental health side, there was no body image work or counseling done with these teens, and they are being taught at a very young age that certain bodies are acceptable and some aren’t. I once worked with a physician (a surgeon) who thought a dietitian’s job was to “focus on the numbers and get weight and BMI down, and not to talk about feelings.” Sorry, but that’s doing a disservice to most people in which food, body and nutrition are closely related to feelings and emotions. It’s called nutrition counseling for a reason, and that’s what so many scientific studies are getting wrong - we are not lab rats, we’re human beings.
The biggest red flag
Aside from all of the points above, the biggest red flag of the study is that we don’t know what happens to these teens after they stop taking the drug, aside from the short 75 week follow up in which there was some weight regain. This is my concern with all weight loss drugs - they’re not meant to be taken forever, so what happens when an individual stops taking them? My inclination is to think that, unless positive behavior change has been adapted, results from taking weight loss drugs are temporary. This is just like… a diet.
Lab values
So as not to cherry pick, I have to mention that lab values like LDL cholesterol, A1C, and triglycerides were reduced in the semaglutide group. This is meaningful data, but in studies like this it’s not clear whether improved cardiometabolic risk factors are due to the weight loss or positive diet/lifestyle changes.
Practice-based evidence of my own
I’m not exaggerating when I say the majority of disordered eating and poor body image I see in my adult female clients stems from experiences during adolescence. Whether this is being body or weight shamed, influence from family members (most often moms and grandmothers) with disordered eating, constantly on diets or imparting strict food rules at home, publicly criticizing their bodies, etc., it is unbelievably common. The damage done during such a vulnerable time in life, when bodies are supposed to be changing, can last for decades and have an immense impact on quality of life. An example I always think about here is a past patient I had in her 70s, who was put on Weight Watchers in her teens by her mother. She lived the rest of her entire life obsessing about food, feeling hungry, hating her body, and never had friends or a romantic relationship as a result. It was and is absolutely heart-breaking. Situations like this are what I truly hope can be avoided in future generations, and the way this study is being talked about is discouraging.
Let us not forget
Fifteen year-old bodies are supposed to change, and it’s possible to support growth and development, healthy behaviors, nutrition, and relationship to food as the body goes through these changes.
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*because I think BMI is an absolute bullsh*t measure and the word “obesity” is stigmatizing. More on these in a future post!