Young people with obesity may soon have a powerful new tool to help them lose weight.
Results of a clinical trial released in the New England Journal of Medicine on Wednesday found that adolescents who got a weekly injection of a drug that reduces appetite lost an average of 14.7% of their starting bodyweight, while those who got a placebo and counseling on diet and exercise gained 2.7% of their initial weight. The trial included 201 young people ages 12 to 17 at three medical centers around the country and in Europe and Mexico.
By the end of the study, over 40% of the participants who got the drug, along with lifestyle counseling, were able to reduce their BMI by 20% or more, said study co-author Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota.
The drug semaglutide, sold under the brand name Wegovy, has been used to treat Type 2 diabetes. Diabetes doctors noticed a side effect of the drug, which works by telling the pancreas to secrete more insulin to control blood sugar. Some patients lost weight. When doctors pointed out the weight loss to drugmaker Novo Nordisk, the company designed trials to study semaglutide’s impact as a tool to address obesity. An earlier study in adults showed that the drug did indeed help with weight loss. The Food and Drug Administration approved it in 2021 for adults with obesity.
“I’m absolutely excited,” Kelly said. “We’ve entered the phase where we are seeing the kind of weight loss where teens come to us in tears. It’s the first time they’ve had control of their weight in their lifetimes.”
More than 1 in 5 young people ages 12 to 19 in the U.S. are considered obese based on BMI, according to the Centers for Disease Control and Prevention. Kids with obesity face higher rates of weight-related disease later in life, experts say.
“We have a huge problem with overweight and obesity in this country,” said Dr. Monica Bianco, an assistant professor of pediatrics at the Northwestern University Feinberg School of Medicine and an attending physician at the Lurie Children’s Hospital of Chicago. “As obese kids become young adults, they start to develop conditions, like hypertension, diabetes and high cholesterol,” she said. “We’re seeing people as young as 30 having heart attacks.”
By the time Emmalea Zummo entered the study, her weight had shot up to 250 pounds. The 17-year-old from Jeannette in western Pennsylvania had been struggling with weight gain related to a hormonal condition called polycystic ovary syndrome, or PCOS, for years.
“I tried diets,” Zummo said. “I tried exercise. I’m in more sports than any other kid I know, and nothing would work. My body would just get used to the extra exercise, get used to the new diet and the weight would come back.”
Zummo felt hopeless. “I was diagnosed with depression due to my weight,” she said.
When the opportunity came to participate in the study, Zummo jumped at it. “Even at the first appointment when they were explaining what the medication was, it was already like I felt lighter mentally,” she said.
She lost more than 70 pounds. Now, her weight has dropped to 170-180, “which I’m really happy about,” Zummo said. “I felt better within my own skin, which is something I never felt before.”
The average weight of the participants was 237 pounds, and 193 made it to week 68; 131 got the medication plus lifestyle intervention, and 62 received the lifestyle intervention only.
Overall, 73% of those who received the medication had a weight loss of 5% or more as compared to 18% of those who received only the lifestyle intervention.
In addition to the weight loss, the drug reduced some cardiovascular risk factors, including waist circumference and bad cholesterol. The teens also reported notable improvement in their quality of life.
“That’s the first time to my knowledge that an anti-obesity medication in teens has been shown to improve their quality of life,” Kelly said.
There were some side effects, including nausea, which appeared to diminish as the teens got used to the medication.
There is another drug approved for use in adolescents with obesity. Based on the findings of the new study, semaglutide is the “most highly effective anti-obesity medication for teens,” Kelly said.
Many people still think of obesity “as a lifestyle problem that is under our control,” said Dr. Eduardo Grunvald, medical director of the Weight Management Program at the University of California, San Diego. “But we know that the impact of just lifestyle interventions is modest at best.”
Will the weight come back?
While weight loss surgery in teens tends to be accepted by the public, “medications for treating weight in children is a novel concept for most people,” Grunvald said. “As we get more data on safety and efficacy, these medications are going to become more commonplace.”
The effectiveness found in the new study “is exciting for the general public and for those of us who practice bariatric medicine,” said Dr. Zhaoping Li, a professor of medicine, Lynda and Stewart Resnick Endowed Chair in Human Nutrition, and director of the Center for Human Nutrition at the David Geffen School of Medicine at the University of California, Los Angeles.
One thing the study doesn’t shed light on is whether the medication will continue to be effective long term, Li said.
Long-term follow-up data on people who have been taking the medication for diabetes shows that people have gained weight, Li said. “Of course the bigger issue is, if people stop taking this drug after one or two years, would the weight come back? The answer is probably yes,” she said.
As it turns out, even when people get weight loss surgery, “three years out, there is significant weight gain,” Li said.
When a weight loss drug like this is prescribed to patients, that shouldn’t be the end of things, Li said. “We should use this as an opportunity to identify the fundamental issues that led to weight gain in the patients’ individual lives and help them to make fundamental changes not only to lose weight and maintain the weight loss, but also to help them lead a healthier lifestyle,” she said.