Last spring, Chloe, a 15-year-old who lives in the US state of Georgia, was stuck. She had tried dieting with a nutritionist and exercising with a personal trainer, but her weight was not budging. She felt self-conscious and depressed, and struggled to carry her heavy school bag. When her mother suggested she try a weight-loss drug, Chloe saw it as a “miracle”, she recalls. “I was like, ‘Oh my goodness, thank God there’s a solution.’”
The teenager suffers from polycystic ovary syndrome, which predisposes women to obesity. Doctors had offered the contraceptive pill to try to ease some symptoms, but nothing to address the obesity, and her mother was worried about the long-term effects on her health.
After taking semaglutide, the active ingredient in Wegovy, for nine months, Chloe has lost 25 pounds (11kg). She wakes up nauseous in the morning — a common side effect — but sees this as a price worth paying; she often felt unwell already. She accepts she is likely to need to take the injection for life, but she hopes it will protect her from diseases like diabetes.
“I’d rather be skinny and happy with myself, than be fat, overweight, not feeling great about myself,” she says. “It’s awesome sauce.”
Chloe is one of many teenagers who have used Mochi Health, a telemedicine platform based in San Francisco, which launched a paediatric clinic in 2023. Myra Ahmad, its founder, saw an opportunity when adult patients who were taking weight-loss drugs asked if they could get their kids prescriptions too.
Often, she explains, parents had “tried and tried and tried” other solutions; some had even sent kids for inpatient treatment. “They are at their wits’ end and they want to try something that’s going to work,” Ahmad says.
Obesity rates have more than tripled globally since 1975, according to the World Health Organization, and increased by almost five times among children and adolescents. As access to unhealthy food has soared and physical activity has fallen, some 250mn children are forecast to have obesity by 2030, suggests the World Obesity Federation, which represents experts, practitioners and patients.
The federation also predicts that the vast majority of countries are likely to fail to meet the WHO goal of keeping childhood obesity at 2010 rates this year. And the problem is increasingly expensive. In the US, the lifetime medical costs of treating a 10-year-old who has obesity — classified as having a BMI over the 95th percentile for their age — are up to $20,000 more for than a child at a normal weight, even if the latter child puts on pounds as an adult. In the UK, which ranks as one of the worst countries for obesity in Europe, hospital admissions of obese people under 17 have nearly tripled in a decade.
But a battle over how to treat childhood obesity is brewing between two groups who each believe their approach has young people’s best interests at heart. On one side are scientists and clinicians, including the American Academy of Pediatrics, who want to use the drugs, combined with lifestyle changes, to stop obesity in its tracks. On the other are doctors and researchers who worry that we have no idea how the weight-loss jabs will shape children’s growing bodies, still less their long-term health.
That debate is just one of many that the new generation of weight-loss treatments has ignited. They have been held up as a solution for stubborn and life-threatening conditions such as heart disease and diabetes — even Alzheimer’s and addiction. But they have also stoked fears about an increasingly medicalised society that relies too heavily on pharmaceutical interventions.
There is an economic and ethical question too: is it right to rely on the pharmaceutical industry to help tackle a problem rooted in another industry, an abundance of cheap junk food? Both markets are expanding: analysts forecast that the global market for obesity drugs could be worth about $105bn by 2030, while researchers expect the global market for fast food to soar to over $1.5tn by 2028.
In the case of people under the age of 18, the arguments are starker still. While treating adult obesity can be seen as a remedy for past mistakes — and sparing overburdened healthcare systems — medicating children could keep them dependent on drugs for the rest of their lives, implications they might not fully comprehend until later.
$1.5tnExpected size of fast food market worldwide by 2028
While no weight-loss drugs are currently approved for children below the age of 12, the medicines could soon be made available to young children. Danish drugmaker Novo Nordisk is currently seeking approval in the US and Europe for its obesity treatment Saxenda in children aged six and over, while US rival Eli Lilly is testing Mounjaro on children as young as 10 who also have type 2 diabetes.
Some critics draw comparisons with antidepressants, which they say are too often used as a sticking plaster for complex mental health problems, diverting both attention and resources from deeper root-cause solutions.
Naveed Sattar, a professor of cardiometabolic medicine at the University of Glasgow, argues that helping kids reduce dangerous excess weight should improve their quality of life so much that it outweighs the risks.
But he sees the dilemma too. “On the other side, is it the right way to go to medicalise very young children with drugs because of what is, in part, a societal issue?” he asks. “I don’t have an answer.”
Tens of thousands of teenagers already have a weekly injection to help them shed weight. More than 60,000 people in the US aged 12 to 25 were taking weight-loss drugs in 2023, according to research by the University of Michigan, and as the supply of the medicines has increased, that number is likely to have grown.
While drugmakers still cannot keep up with demand from adults — Novo Nordisk reported a 50 per cent-plus rise in year-on-year sales of its obesity drugs last week, beating expectations — they have also been testing the medicines in children, partly because regulators often require paediatric trials.
Sattar says obesity is a “disaster” for a child’s physical and mental health, and that the benefits of these drugs likely outweigh the risks.
A trial of Wegovy published in 2022 and sponsored by the company showed that, compared with participants who were given a placebo, teenagers taking the drug not only lost weight but also saw improvements in risk factors for cardiometabolic diseases, such as high blood sugar and levels of an enzyme that indicates liver damage.
Karla Lester, a US-based paediatrician and life coach who prescribes the drugs alongside lifestyle interventions and coaching, says that one of her teenage patients, who was showing elevated blood sugar levels and classified as pre-diabetic, managed to reverse the condition after being on a low dose of Ozempic for eight months.
“These are potentially very powerful and effective metabolic health tools,” she says.
Like adults with obesity, overweight children are at greater risk of developing diabetes, heart and liver problems. But the earlier these diseases develop, the greater the impact: according to a recent large-scale study, being diagnosed with type 2 diabetes at the age of 30 can reduce a person’s life expectancy by up to 14 years, a far larger amount than if the disease appears later.
Many overweight teens are bullied and end up feeling isolated, says Sattar. A study of almost 7,000 adolescents with obesity showed that those who were on this type of drug, known as a GLP-1, were a third less likely to experience suicidal ideation or have attempted to take their own life.
“A lot of young kids living with obesity are very miserable,” he says.
But others worry that paediatricians will reach for these drugs without properly considering the ways in which they could harm children’s health.
In the short term, teens suffer from the same common side effects as adults, with 62 per cent of trial participants experiencing gastrointestinal symptoms such as vomiting and diarrhoea. In the longer term, a recent very large study in adults showed a correlation between taking the drugs and a higher risk of arthritic, kidney and pancreatic disorders.
Scientists still understand remarkably little about how bodies grow and develop, and it is an open question whether these drugs could also interfere with growth, hormones or bone density as teenagers become adults.
“Adolescence is a critical period of growth and development,” says Dan Cooper, a professor of paediatrics at the University of California. “There’s a sequence of physiological and biological events in which muscle is developing, bone is becoming mineralised, the brain is continuing to be developed.”
Crucial processes that happen during puberty, such as bone strengthening, cannot be replicated later in life, and many are hard to track, he explains. “It is not like we can do a blood test that tells you where you are.”
He adds that records already show an “exponential rise” in prescriptions for the drugs, but that the health of teenagers actually taking them is not being monitored in a consistent, large-scale way.
So far, results suggest that if people using obesity drugs stop taking them, the weight piles back on, Cooper points out. “Are we expecting these 13 and 14-year-old kids to take these medications for the rest of their lives?” he asks.
“The idea of starting these in six-year-olds — that is where I really would put my foot down,” he adds.
Many clinicians also worry about the risk of young people developing eating disorders. While some parents may indeed have their child’s best interests at heart, there is anxiety that others are simply passing on their own problematic eating practices to their offspring.
Lester, the paediatrician and life coach, says she is wary of parents who are “pretty messed up and stuck in diet culture”, which is why she coaches teens alongside their parents, as well as prescribing therapy and blood tests, plus keeping a close eye on how much weight they are losing. It is “definitely a concern” if teens are not working with an expert, she adds.
The risk of abuse is another problem, especially if under-18s can access the drugs without their parents’ knowledge or consent, perhaps from online pharmacies. When pill versions of the medicines come on the market — as many predict they will in the next couple of years — it could be even easier for young people to get access without their parents knowing.
Tom Hildebrandt, who leads the eating and weight disorders programme at Mount Sinai hospital in New York, describes how — as well as seeing evidence that people with known eating disorders were using the drug — he began to encounter people who had started to show symptoms of anorexia after using them as early as 2023. Many had started injections for cosmetic reasons, but then developed an eating disorder.
“The problem is that if you flip someone from healthy into anorexia nervosa, they don’t just flip back because you take the drug away,” he says. “So that’s a different kind of life sentence.”
Today, roughly one in nine or 10 Americans develop an eating disorder, but Hildebrandt predicts that these drugs could increase the prevalence to one in 7.5 or 8.
Hildebrandt suggests there should be a requirement for a “long and drawn-out” psychological review of teenage patients before prescribing weight-loss drugs, as they do at Mount Sinai for under-18 patients who are considering bariatric surgery, a procedure to shrink stomach volume.
For many critics, it is hard to justify prescribing weight-loss drugs to children — with all the risks and unknowns — when there are already proven alternative ways of tackling obesity.
Health services could offer more nutritional help to mothers-to-be, say scientists: researchers have found that taking vitamin supplements during pregnancy can reduce the chance of two-year-olds developing obesity by half.
Another approach is to tax junk food at higher rates: one study found the UK’s tax on sugary drinks, which came into effect in 2018, cut obesity in 10 and 11-year-old girls in the UK by 8 per cent.
For children and teens who have already been diagnosed with obesity, intensive behaviour-change coaching, which aims to improve diet, exercise and mental health, has been shown to help. The American Academy of Paediatrics recommends 26 hours of support over three to 12 months, ideally done face-to-face and involving the whole family. Healthier school food and more physical education teaching also produce positive results.
Most obesity-drug trials do not test the drugs in isolation — although one group of patients takes the drug and another a placebo, both cohorts also receive interventions such as guidance on healthy eating and exercise, so the combined effects can be measured.
But Cooper, of USC, argues that these kinds of interventions are “anaemic” — far less hands-on than the support recommended by the AAP and others. If the group not taking the drug had benefited from the more intensive coaching, he believes the comparison would be fairer.
Yet, according to Cooper, the AAP’s guidelines are “extremely difficult to implement” because of lack of money and time. In the UK, the NHS has launched clinics that offer this kind of care for around 3,000 obese children — but that is nowhere near the one in seven under-18s in England estimated to have obesity.
The doctor is at pains to say he recognises that this is far from a “simple issue”. He also concedes there could be a role for the drugs in treating diabetic children, who are already dependent on insulin, if they are monitored closely.
But overall, he argues that clinicians and society should find ways to make it easier for children to lose weight rather than assuming one drug can be a silver bullet.
He cites the example of cancer treatments, which are prescribed for children despite terrible side effects. “We do that ethically, because we know that if we don’t treat them, they’ll die,” he says. “My point with obesity is there are other ways of treating it now.”
Data visualisation by Clara Murray
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