Nov. 10, 2022 — The prospect of being concerned in a analysis program that may assist her shed weight intrigued Emmalea Zummo. At 15, the confident, energetic teenager from Jeanette, PA, weighed 250 kilos – sufficient to be thought-about overweight. The trial she realized about by way of her endocrinologist was for a drug known as semaglutide.
Earlier than becoming a member of the examine, Emmalea had exhausted a reservoir of methods.
“She had been doing a wide range of train packages, was concerned in numerous sports activities and actions to remain energetic, as a few of her early docs stated that will work,” Davina Zummo, Emmalea’s mom, says. “She counted energy, did a gluten-free weight loss plan, restricted what she ate, when she ate, and the way a lot.”
Emmalea minimize out all snacks, junk meals, and sweets, however nothing made a distinction, Zummo says: “She felt defeated.”
The FDA final yr accredited semaglutide, which was developed initially as a therapy for sort 2 diabetes, for weight reduction in adults. However researchers wished to know if the drug, which targets areas of the mind that regulate urge for food, additionally might assist adolescents shed weight. Emmalea was curious, too.
Though usually youngsters might be judgmental of one another, Emmalea’s buddies “had been comfortable for me, continuously motivating and supportive,” she says.
At this time, Emmalea, now almost 18, says the medicine helped her lose 75 kilos, giving a lift to the approach to life and weight loss plan teaching she obtained all through the 68-week examine.
Mother and father of teenagers like Emmalea who battle with weight problems hear the identical chorus: If their youngsters slash the sugar, eat wholesome snacks as an alternative of junk meals, and train usually, the outcomes will comply with.
However for a lot of obese youths — as with adults — shedding kilos usually proves irritating. Positive factors come and go, regardless of good intentions.
May medicine assist?
A new examine within the New England Journal of Drugs exhibits that semaglutide can certainly result in small however significant losses of extra body weight. Whether or not that’s sufficient to tip the scales, because it had been, towards total higher well being is unclear, however the findings have specialists in youngster well being optimistic.
“There’s a actual want for protected and efficient medicines to deal with weight problems,” says Silva Arslanian, MD, a pediatric endocrinologist on the College of Pittsburgh Faculty of Drugs and a co-author of the brand new examine.
“Usually, we make way of life suggestions: Eat extra greens; don’t eat fried meals; don’t drink soda,” Arslanian says. Sadly, she says, we reside in a world the place “it may be very exhausting to make these adjustments.”
Many specialists agree that medicine must be a part of the dialog.
“It’s thrilling to see this therapy changing into out there. And the examine outcomes counsel few unwanted side effects, so the drug was protected and tolerable,” says Amanda Staiano, PhD, a researcher on the Pennington Biomedical Analysis Middle at Louisiana State College in Baton Rouge. “Though not accredited but by the FDA, semaglitude and different new medicines are remodeling weight problems therapy for adolescents. It’ll be an thrilling time for treating weight problems.”
Staiano stresses, nevertheless, that way of life and behavioral counseling are key for the success of any weight problems therapy, together with medication like semaglutide.
Daniel Weghuber, MD, a pediatrician at Paracelsus Medical College in Salzburg, Austria, says that though weight problems is “not a problem of lack of willpower, this drug appears to allow people who find themselves residing with weight problems to stick to the suggestions that they’ve been following for years and years however weren’t in a position to obtain the objective. I believe that that is vital. It permits folks to attain their targets.”
Within the new examine, 201 overweight or obese girls and boys between the ages of 12 and 18 obtained both once-weekly injections of semaglutide or sham pictures. In addition they all obtained way of life interventions — counseling on wholesome diet and bodily exercise — all through the almost 16-month examine.
By the top of the examine, 75% of the adolescents who obtained semaglutide had misplaced and saved off a minimum of 5% of their extra physique weight, in comparison with 17% of those that obtained the sham injections. On common, these handled with the drug misplaced 33.7 kilos, in comparison with a median of simply 5.3 kilos within the different group.
Weghuber stated the analysis suggests the mixture of way of life adjustments and weight problems medicines “will open up a brand new chapter” for treating adolescents with weight problems.
Greater than 340 million youngsters and adolescents worldwide aged 5-19 had been obese or overweight in 2016. Within the United States, weight problems affected 22.2% of 12- to 19-year-olds from 2017 to 2020, in keeping with the CDC.
Weight problems is linked with decreased life expectancy and better danger of creating severe well being issues equivalent to sort 2 diabetes, coronary heart illness, nonalcoholic fatty liver illness, sleep apnea, and sure cancers. Youngsters with weight problems are additionally extra prone to have melancholy, nervousness, poor vanity, and different psychological points.
Whereas weight problems in youngsters has lengthy been a public well being concern, the issue has worsened throughout the COVID-19 pandemic, Melissa Ruiz, MD, with the Pediatric Diagnostic Middle in Ventura, CA, says. A few of her sufferers who had been “chubby” pre-pandemic had weight good points of 20-30 kilos at post-pandemic clinic visits, she estimates.
Ruiz and different specialists say dad and mom ought to discard the notion that weight problems is one thing youngsters – or adults — are doing to themselves, or that they’re failing their youngsters by not maintaining their weight in examine.
“There are genetic parts that determine into weight problems, and we’ve got to acknowledge that,” Ruiz says.
Mother and father ought to search assist from their youngster’s pediatrician. “If the pediatrician can not enable you, ask, ‘The place can I am going?’ Say, ‘I perceive that you just won’t be educated on this but’ and ask for a reference for somebody who might help,” Ruiz says.
However medicine shouldn’t be thought-about an all-in treatment, in keeping with one skilled.
“Medicine is a final resort, solely after behavioral interventions fail and after exploring the vary of behavioral methods to weight reduction, together with altering dietary patterns equivalent to timing and meal plan,” says Lydia Bazzano, MD, PhD, a diet researcher at the Tulane College Faculty of Public Well being and Tropical Drugs in New Orleans.
Medicine and even surgical procedure have a spot, however provided that sufferers have exhausted all of the dietary and way of life choices, Bazzano says. “You don’t need the adolescent to have a lifetime of medicine. Medicine ought to solely be used to kickstart the kid to the purpose he must be — after which keep that weight,” she says.
Adolescent weight problems is a really troublesome topic to navigate, Bazzano provides. “You need to have interaction the whole household, and never simply the kid. It needs to be on the degree of the entire household, and that may be very difficult. If the whole household engages collectively, there could be a modest weight reduction.”
And Bazzano says she’s not impressed with the load loss seen within the newest examine. A 5% drop in physique weight is useful, she says, however “that’s not sufficient of a lower to say the kid is out of the dangerous vary.”
Staiano thinks specialists want extra details about semaglutide earlier than they need to begin prescribing it to youngsters.
“We have to see long-term outcomes from power medicine use and whether or not weight rebounds when adolescents cease utilizing the medicine,” she says.
“How lengthy ought to the medicine be prescribed? For the remainder of their lives? How will we assist sufferers who’re in a position to lose such a big quantity of weight? How will we guarantee these remedies — behavioral counseling, medicines, and weight reduction surgical procedure — are accessible and financially inside attain of households?”
Emmalea, who stopped taking semaglutide a couple of yr in the past, has maintained her weight because of concentrating on a well-balanced weight loss plan and train. Whereas she says she’s happy along with her progress and “feels snug in my very own pores and skin,” she doesn’t take into account her present weight of 171 kilos to be the top zone. “I’d wish to be someplace between 145-150,” says the 5’4” highschool senior.
Nonetheless, she says, “I don’t strictly monitor myself as a result of pondering of meals in a adverse approach will not be wholesome and may truly result in worsening a meals dysfunction.”
When she launched into the examine, she wasn’t positive it will be efficient for her. However due to her curiosity in drugs and analysis, she says, she wished to be concerned: “I believed that if it didn’t assist me, a minimum of it’d others.”