Experts at University of California, Irvine Caution Against Use of Certain Weight Loss Drugs in Young People

Concerns have been raised by a group of University of California, Irvine professionals about the off-label application of GLP-1RA drugs, such as Ozempic and Wegovy, in the pediatric population for the management of obesity and diabetes. The effectiveness of these medications in adults has led to worries about their potential overuse in young people, which may be exacerbated by societal pressures amplified by social media to attain certain body images. The issue is compounded by the risk of counterfeit products and unauthorized online procurement, posing significant risks to children’s health. A proactive plan has been proposed to confront these issues and ensure the safety of children.

The use of glucagon-like peptide-1 receptor agonists in popular weight loss treatments like Ozempic and Wegovy has been identified as a possible health hazard for children.

A collaborative group of experts from the University of California, Irvine, including clinicians, exercise physiologists, pharmaceutical experts, ethicists, and behavioral scientists, have expressed their concerns about the employment of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in treating pediatric obesity and type 2 diabetes.

The group, led by Dr. Dan M. Cooper, a noted professor in the Department of Pediatrics at the UCI School of Medicine, shared their insights in a perspective piece in the Journal of Clinical and Translational Science, highlighting the dangerous possibility of these drugs being misused by children and adolescents.

Potential for Harmful Outcomes in Children

The perspective underscores that while the GLP-1RA class of drugs has significantly changed the management of obesity and type 2 diabetes in adults, evidence suggests they could have potent effects in children and adolescents as well. Considering the severe pediatric obesity crisis and the associated increase in type 2 diabetes among young people—a situation worsened by the COVID-19 pandemic and the decrease in physical activity opportunities—these drugs could indeed benefit those with severe obesity and type 2 diabetes.

However, there is a noticeable gap in research concerning the effects of GLP-1RAs on children and adolescents. As the use of these drugs in this age group is likely to be for a prolonged period, the long-term effects during vital growth stages are not well understood. Dr. Dan Cooper points out this concern from UCI.

The exceptional success of these drugs has led to apprehension among the team regarding their potential overutilization and exploitation in the youth demographic.

“Our main worry centers around the disordered and inappropriate decrease in caloric or energy consumption that may accompany the use of these weight loss drugs,” Cooper remarked, who serves as associate director of the UCI Institute for Clinical and Translational Science and as the interim director of the UCI Institute for Precision Health. “Children and adolescents, in contrast to adults, require adequate energy and calories not just for physical activities but also for their growth and development.”

A Balanced Approach to Diet and Physical Activity for Lifelong Wellness

The equilibrium between dietary energy intake and expenditure, which includes physical activities like playing and exercising, is crucial for a child’s development and long-term health. Any disturbance in this balance could negatively affect their health in later years. For instance, maintaining optimal levels of diet and exercise promotes bone strength during the critical growth phase in children, reducing the risk of osteoporosis and bone fractures in the future.

The team also highlighted the risk of these drugs being misused by young people with eating disorders and those participating in competitive sports such as wrestling, martial arts, gymnastics, and ballet.

The Influence of Social Media on Body Perception

“The evaluation of the long-term benefits versus the costs, both economically and in terms of life quality, of these drugs in the pediatric population needs careful consideration,” commented Jan D. Hirsch, a co-author and dean of the UCI School of Pharmacy and Pharmaceutical Sciences. “The rise of social media has already exposed young individuals to an overwhelming diet culture and unrealistic body ideals which could be detrimental to health. Unsupervised administration of these drugs could pave the way for numerous health and emotional issues as children grow older.”

Cooper also highlighted the contribution of environments lacking safe exercise and play spaces for children and the prevalence of affordable high-calorie fast foods to the pediatric obesity epidemic, which disproportionately affects minority groups.

With these medications becoming more effective and popular, pharmaceutical companies are hastening the development of oral versions, which may limit oversight and lead to misuse. Anecdotal evidence suggests awareness of GLP-1RA’s effectiveness as satiety drugs that aid in weight loss among the youth, further fueled by media representation.

“Information about GLP-1RA agonists is now widespread across social media platforms and is frequently discussed by celebrities, models, and influencers,” stated Emma Cooper, MD, a resident physician at the UCI School of Medicine’s Department of Psychiatry & Human Behavior. “It stands to reason that as these drugs become more accessible, there will be a rise in their unsupervised use among children, striving to meet societal beauty norms.” Dr. Emma Cooper also noted the increasing prevalence of mental health disorders, including eating disorders, urging healthcare providers to be vigilant about and intervene in the improper use of these medications.

There are also concerns about the risks posed by the spread of counterfeit drugs, as well as unauthorized internet access.

Following their extensive research and clinical experience in exercise, diet, and obesity prevention, the UCI team proposed an action plan. It targets the network of academic centers like UCI, recipients of the Clinical and Translational Science Award (CTSA) from the National Center for Advancing Translational Sciences, with the following initiatives:

• Establishing and maintaining multidisciplinary teams, including frontline clinicians, community stakeholders, physiologists, and behavioral and pharmaceutical researchers, to fill the knowledge void on the impact of GLP-1RAs in children and adolescents.
• Tackling the translational bioethics research issues arising from the pediatric formulations of GLP-1RA medications and the broader implications of the medicalization of health conditions like pediatric obesity.
• Enhancing the availability and quality of pertinent data from real-world settings such as school-based physical fitness tests (SB-PFT), mandated in 16 states, which affect approximately 60% of American school children.
• Collaborating with the FDA and other agencies to refine lifestyle intervention guidelines in pediatric clinical trials that adopt advanced methods for quantifying and assessing physical activity, dietary adherence, and accurate measurement of body composition, moving beyond the limited BMI metric for overweight and obesity in adolescents.
• Improving the education of the clinical trial workforce on cutting-edge lifestyle intervention strategies, including training for primary care pediatricians whose current knowledge in exercise and nutrition science is quite basic.
• Creating and disseminating educational modules for school staff, parents, children, pediatricians, and child mental health professionals regarding GL1-RA medications, their proper application, and risks of abuse.

This effort represents a collaboration across multiple disciplines at the University of California, Irvine, encompassing the UCI School of Medicine, the UCI School of Pharmacy and Pharmaceutical Science, and the UCI Institute for Clinical and Translational Science.

Reference: “Unintended consequences of glucagon-like peptide-1 receptor agonists medications in children and adolescents: A call to action” by Dan M. Cooper, Mark A. Rothstein, Alpesh Amin, Jan D. Hirsch, and Emma Cooper, 18 August 2023, Journal of Clinical and Translational Science.
DOI: 10.1017/cts.2023.612

Frequently Asked Questions (FAQs) about GLP-1RA misuse in youth

More about GLP-1RA misuse in youth

• Understanding GLP-1RA Medications
• Childhood Obesity and Medication Risks
• Social Media’s Role in Weight Loss Drug Misuse
• UC Irvine’s Call to Action on Pediatric Drug Safety
• FDA Guidelines for Pediatric Medications
• Research on Counterfeit Drugs and Child Health