We know that GLP-1 prescriptions are trending across all patient groups, but will we soon be recommending these weight-loss drugs for children? 

Let’s take a closer look at the study and investigate the risks vs benefits on this vulnerable population.

What the study revealed

Currently, the use of liraglutide for the long-term treatment of obesity is FDA-approved in adults. However, in a September 2024 issue of the New England Journal of Medicine, researchers reported the results of a randomized controlled trial of liraglutide for the treatment of nonmonogenic, nonsyndromic obesity in children who were younger than that.

Fox CK, Barrientos-Pérez M, Bomberg EM, et al. Liraglutide for children 6 to <12 years of age with obesity—a randomized trial. N Engl J Med. September 10, 2024.

The 82 pediatric patients who participated in the 56-week trial ranged in age from 6 to <12 years.

Serious adverse events were reported in 12% of the participants in the liraglutide group, as compared with 8% of those in the placebo group. Additionally, gastrointestinal adverse events were significantly more common in the liraglutide treatment arm (80% vs 54%).

Discussing the controversies

While this trial has shown efficacy to reduce BMI (reminder—this is not necessarily the same as fat mass) in young children, the long-term safety of using GLP-1s or any other weight-loss medication in children as young as 6 to 11 years of age is unknown, because the long-term effects on growth and development are still unknown.

In a discussion in Nature of the issues surrounding use of GLP-1s in children, the author points out that “GLP-1 mimics are currently considered lifelong drugs.”

Nowogrodzki J. Should young kids take the new anti-obesity drugs? What the research says. Nature. September 17, 2024.

But this raises some important questions for children, as Sarah Ro, MD, a weight management specialist who was interviewed for the article, considers. In practice, she says, “some children will need to stop taking the drugs—when their families lose insurance coverage, for example, or if the negative side effects, such as nausea, become intolerable."

What the exit strategy would look like for kids is a key question for further research.

Many pediatricians and public health experts would much prefer to see childhood obesity prevented through education and systematic societal changes, and treated via lifestyle interventions, which are safe, effective, and long-lasting.

Sarah Nutter, PhD, a weight stigma researcher at the University of Victoria in Canada who was also interviewed for the article, expressed her concerns that “families might make decisions on the basis of weight stigma.” All agree that further research is needed on the safety and efficacy of obesity medications in children, particularly as compared with lifestyle interventions, over the long term.

Trial limitations

It should be noted that body composition was not measured in this RCT, so the possibility of a loss of muscle mass cannot be ruled out, especially because BMI is known to be a poor surrogate for fat mass. In addition, the number of children included from traditionally underserved populations was small (for instance, only 6 of the 82 participants were Black), so extrapolating the results to these populations is problematic.

Another issue of concern raised by this trial is the issue of therapeutic duration. As noted by the authors of an accompanying editorial, “During the off-treatment follow-up period, the BMI standard-deviation score increased in the liraglutide group, which is worrisome because it implies the ongoing need for pharmacotherapy to prevent BMI rebound.”

Barrett T, Hamilton-Shield J. Childhood obesity and GLP-1 receptor agonists—a coming of age? [editorial] N Engl J Med. September 10, 2024.