Weight-Loss Drugs for 8-Year-Olds... Have We Gone Too Far?

[00:00:07] Welcome to the Ask Nurse Alice podcast, the place where we talk about all things health and wellness and make the complicated stuff easier to understand. I'm Alice Benjamin, family nurse practitioner, and join me for a real conversation about the things that affect our health and our lives. Now, unless you've been living under a rock, you've probably been hearing a lot of buzz about weight loss drugs. All different kinds. They're injectables. Now there are oral pills. We hear about them everywhere.

[00:00:36] And the conversation isn't just about weight loss anymore. There's research around cardiovascular health, metabolic health, hormones, even what these medications might mean for your brain health and dementia risk. It seems like every few weeks there's another headline about what GLP-1s is able to do. But let me tell you something you've probably not heard much about. Imagine this. Eight years old. What's that? Second or third grade. Still losing baby teeth. Still growing. Still developing.

[00:01:06] And now, some children that age are being prescribed medications for weight loss. And listen, as a parent, my first reaction is probably the same as a lot of yours. Have we lost our minds? I mean, come on. We're talking about an eight-year-old. They still need reminders to brush their teeth. We're checking backpacks for homework and making sure they get to bed on time. And now, we're talking about putting them on a weight loss medication. That's a lot to wrap your head around as a parent.

[00:01:32] Because this is still a child who's growing and developing. So, of course, I'm thinking, well, what happens when we give a medication that suppresses appetite to a body that still needs nutrition to grow? What does that mean for their hormones, puberty, their development? And what do we know about what happens years down the road? Those are the questions that the parent in me immediately starts asking. But I'm also a family nurse practitioner. And that's where I have to move beyond the initial reaction and look at what the science actually tells us.

[00:02:00] Because as uncomfortable as it may feel to talk about giving an eight-year-old a weight loss medication, there's another side of this conversation that can be just as uncomfortable. There are eight-year-olds already developing health problems related to obesity. And once you understand that, suddenly, have we gone too far? Isn't such a simple question to answer anymore. And that's exactly why this caught my attention.

[00:02:22] Researchers at NYU Langone Health recently published a study in pediatrics looking at GLP-1 prescribing in children 8 to 11 with obesity. And there's one number that jumped off the page. Prescribing increased to 310-fold between 2019 and 2026. 310-fold. Now, I know how that sounds. You hear that and immediately you think like, wait a minute. Are doctors really putting all these kids on GLP-1s now? And no, that's not what the study found.

[00:02:51] Researchers looked at more than 3.5 million children across the entire study population. Only about 0.6% received a GLP-1 prescription. So using children this young is still uncommon. But we can't dismiss childhood obesity as some small or rare problem. About one in five children and adolescents in the U.S. experience obesity. And some of these kids are already developing health problems we usually associate with adults. Like high blood pressure, abnormal cholesterol, prediabetes, and sleep apnea.

[00:03:20] And here's another important part of the study. Children with obesity-related health conditions were more likely to receive GLP-1 prescriptions. The researchers said clinicians appear to be reserving these medications for children at greater metabolic risk. And that made me stop and say, okay, well, who exactly are we talking about here? Because not every 8-year-old with obesity is the same. Let me give you two examples of 8-year-olds. Now, these are hypothetical children, but they're going to help me to show you why this isn't a yes or no question.

[00:03:51] And yes, their BMI meets the criteria for obesity. And before we move forward, quick sidebar. Because BMI works a little differently in kids, we still calculate it using height and weight. But because kids are still growing, we interpret it based on their age and sex using a BMI for age growth chart. At or above the 95th percentile meets the criteria for obesity. Now, back to our 8-year-old. Blood pressure looks good. We're not seeing any obvious obesity-related health complications. They're active. And when we talk to the family, maybe they say something like,

[00:04:20] at our last visit, we were told she needs to lose weight. Okay, weight loss, that's a goal. But what's the treatment plan? Because telling a family where to go doesn't tell them how we're going to get there. What have we actually tried? What support has the family received? And when are we following up to see whether it's working or not? So when I'm looking at this child with a BMI over the 95th percentile, am I asking where to send the prescription? Absolutely not. Now, child number two, same age and also has obesity. But this time, the obesity is more severe because the blood pressure is elevated.

[00:04:49] Maybe cholesterol or blood sugar is starting to change. And this family has been working at it. I mean, they've been making meaningful changes. They've had support and they've followed up. But despite those efforts, this child's health is moving in the wrong direction. Now, we're having a different conversation. Medication doesn't automatically become the answer, but it does deserve a seat at the table. And this brings us right back to that new study. Researchers found higher prescribing among children with obesity-related health conditions. The prescribing pattern they saw look a lot more like child number two than they do for child number one.

[00:05:19] Now, that doesn't tell us whether every prescription was appropriate. The study wasn't designed to answer that. But it does give us a very different picture than hearing 310-fold increase and imagine doctors handing out weight loss drugs to otherwise healthy 8-year-olds. So if you ask me, would I give an 8-year-old a weight loss medication? I'd first ask, well, which 8-year-old are we talking about? Are we talking about the first one? Are we talking about the second one? Now, before medication becomes a part of the conversation, there's a lot that should be assessed.

[00:05:46] We got to look at nutrition, physical activity, sleep, screen time, and sedentary behavior. Also, stress and mental health, medications, family history, and what's happening at home. Because pediatric obesity isn't simply eat less and move more. And remember, we're talking about an 8-year-old. They're probably not the ones that are buying the groceries, setting the bedtime, or deciding what's for dinner. So treatment has to involve the family. There's a lot more parents should know about what a good childhood obesity evaluation and treatment plan should look like.

[00:06:16] And I go into that in much more detail on YouTube. So make sure to visit me on youtube.com forward slash asknerstallis and look for that video. For this conversation, I do want to stay with this new research and these GLP-1 prescriptions. Because here's where things get a little interesting. These children were 8 to 11 years old. Are these medications even FDA approved for obesity at that age? Well, the answer is no. And this is where I suspect some parents are going to say, hold on, Nurse Alice, back it up a bit. GLP-1 medications used for obesity are FDA approved for certain adolescents beginning at age 12.

[00:06:46] But for obesity treatment in children under 12, these medications are not currently FDA approved. Which means when we're talking about 8, 9, 10, and 11-year-olds in this new study, we're talking about off-label prescribing. And I know the phrase off-label can sound a little sketchy. Like someone's back there saying, well, let's just try it and see what happens. That's not what off-label means. It means medication is being used in a way that differs from its FDA approved labeling. And off-label prescribing happens in medicine, including in pediatrics. Let's take Zofran, for example.

[00:07:15] It's FDA approved to prevent nausea and vomiting from things like chemotherapy and surgery. But it's also commonly prescribed to children who are vomiting from a stomach bug. That's an example of off-label use. So off-label use doesn't mean a medication is unsafe, experimental, or that a clinician is doing something wrong. It simply means we're using that medication outside of its specific FDA approved labeling, whether that's for a different indication, a different age group, or sometimes a different dose or route. But off-label doesn't mean anything goes.

[00:07:42] When we're talking about younger children, I want a clear reason for using it. I want to know what evidence we're relying on. I want a real discussion with the family about potential benefits, risk, and what we still don't know. And I want appropriate monitoring and follow-up. And here's something else that's important. The American Academy of Pediatrics actually opened the door to this before the study even came out. In its clinical practice guideline on childhood obesity, the American Academy of Pediatrics says clinicians may offer weight loss pharmacotherapy to children 8 to 11 with obesity,

[00:08:10] according to medication indications, risks and benefits, and as an addition to health behavior and lifestyle treatment. Now listen carefully to those words. May offer. That isn't the same as should prescribe. And it's definitely not your 8-year-old cross the 95th percentile. Here's your prescription. The American Academy of Pediatrics also acknowledged that the evidence in children under 12 wasn't as strong enough to make that same formal pharmacotherapy recommendation it makes for adolescents 12 and older. So now we've got an interesting conversation.

[00:08:38] Prescribing in younger children is rising. The American Academy of Pediatrics says there are circumstances where medication may be considered. But these drugs aren't FDA-approved for obesity under age 12. So what evidence do we actually have that they work in younger kids? Because if we're going to give an 8-year-old a medication like this, well, it works in adults, isn't a good enough reason to give it to your 8-year-old. So here is what we do know. One important study looked at liraglutide, a GLP-1 medication in 82 children ages 6 to under 12 with obesity.

[00:09:07] Both groups received lifestyle intervention, but some children also received liraglutide while others received a placebo. After 56 weeks, BMI decreased by an average of about 5.8% in the children who received liraglutide while it increased in the placebo group. So yes, there is evidence that a GLP-1 can reduce BMI in younger children. But, and you knew there was a but coming, there were 82 kids in that trial. 82.

[00:09:33] Now, that's useful evidence, but when we're talking about potentially treating children for years, 82 kids is not where I close the book and say, okay, we've got it all figured out. Gastrointestinal side effects were also common, which isn't surprising with this class of medication. And the newer research is now looking at semiglutide, the medication in Wigovi in children ages 6 to under 12. Early results have been encouraging, but those results are newer and I want to see the full peer-reviewed data before I give them the same weight. This is where I think we need to understand something about the science. Evidence isn't a light switch.

[00:10:03] It isn't we know nothing or we know everything. There's some gray there. Right now, we have evidence that tells us that medications can work in younger children. What we don't have is decades of experience telling us everything that happens when treatment starts this young. Which brings me back to the question I asked at the beginning. What happens when you suppress the appetite of a body that's still trying to grow? This is the part that gave the parent in me the most pause. First, GLP-1 doesn't work by preventing your child from absorbing nutrients. That's an important distinction.

[00:10:31] Among other effects, these medications increase feelings of fullness and reduce hunger. So a child simply eats less. And when a child has obesity, eating less may actually be the part of how the medication works. And here's the question I have to ask as a clinician. What is the food that they're still eating? Because an 8-year-old isn't just a smaller adult trying to lose weight. The body is building bone, building muscle, growing, preparing for and moving through puberty. So if appetite drops significantly, I want to know the food that the child is eating.

[00:11:01] Is it providing adequate energy, protein, vitamins, minerals and overall nutrition for growth? That's why monitoring matters. We should be watching the child's growth trajectory, nutritional intake, side effects and development. Not just celebrating that the number on the scale went down. And what about the hormones in puberty? The data we have thus far in adults hasn't shown any concern for impaired growth or puberty development during the periods that have been studied. Now that's reassuring.

[00:11:26] But reassuring isn't the same as knowing what happens at year 10, 15 or even 20 years later. Particularly when you start the treatment at 8 instead of 15. I think it's perfectly reasonable for a parent to say, I need more information. That's not being anti-medication. That's making a risk-benefit decision for a developing child. And here's the other side of that. Waiting has risks too. Not because every child with obesity needs medication. They don't. But if a child's obesity is already contributing to high blood pressure, abnormal cholesterol,

[00:11:55] insulin resistance, sleep apnea or other health problems, inadequately treating that disease while we wait for our perfect long-term data isn't necessarily risk-free either. And now we're right back to where we started. Two risks, one child, and a decision that isn't nearly as simple as the headline makes it sound. And there's one more part of the conversation I don't want us to lose while we're talking about BMI and medications and risk. There's still a child in the middle of all this. An eight-year-old is developing physically, and they're also developing emotionally and psychologically.

[00:12:23] They're figuring out who they are and what they think about themselves and their bodies. And parents, language matters too. They're standing in the mirror saying, I'm so fat. I look terrible. I hate my body. They don't necessarily hear that as mom or dad having a bad body image day, especially if the child looks like you. They may start wondering, well, if you think that about your body, what do you think about mine? So whether treatment involves nutrition changes, physical activity,

[00:12:52] medications or some combination, we have to be careful about how we talk about it. Don't make food a punishment. Don't make the scale a report card. And please don't make the child feel like they're a family project. The goal isn't simply to produce a smaller child. The goal is a healthier child. So have we gone too far? Let's go all the way back to where we started, eight years old. When I first said that, my parent brain immediately went, have we lost our minds? And then after looking at the research,

[00:13:19] I'm still not casual about the idea of prescribing weight loss medication to an eight-year-old. I don't think we should be casual about it. But I also don't think that the answer is simply eight is too young. Absolutely not. Remember our two eight-year-olds? Child number one had obesity, but wasn't showing any obvious related health complications and hasn't yet had a meaningful access or comprehensive treatment plan. So medication wouldn't be a place where I start there. Now, child number two, a little bit different. Child number two has more severe obesity health-related problems that are beginning to appear.

[00:13:49] The family has been engaged in treatment. And despite those efforts, we're watching that child's health move in the wrong direction. Here, I'm willing to have the medication conversation. Not because I'm pro-GLP1 and not because I'm anti-GLP1, but because I'm looking at the child in front of me. What's the risk of treating? What's the risk of undertreating? What evidence do we have? What don't we know yet? And what is happening to this child's health right now? That's a conversation I want families to have with a provider who understands pediatric obesity

[00:14:18] and knows how to appropriately use and monitor these medications. Now, let's go back to the number that started this whole conversation. A 310-fold increase in prescribing. Do you hear it a little bit differently now? Because I do. That number still gets my attention, but now we have more context. Across more than 3.5 million children, GLP-1 prescribing was still uncommon. And the children with obesity-related health conditions were the ones most likely to receive the prescriptions.

[00:14:43] Because 310-fold increase can sound like we've suddenly decided to put all of America's elementary school kids on Ozempic, but that's not what the research showed. What that research showed is something that is changing in pediatric obesity treatment. And we need to pay attention to that change without sensationalizing it or pretending that there aren't legitimate questions to ask. So what I want parents to hear from this, what I want parents to take away from this conversation is, don't wait until something looks wrong to take your child for their regular well visits.

[00:15:11] Kids can look perfectly healthy while their blood pressure, growth trajectory, and other health indicators are telling us something we need to pay attention to. And if your child's health care provider tells you they're concerned about your child's weight, ask the question we talked about earlier. Weight loss is the goal. Now, what's the treatment plan? What are we concerned about? What should we be working on? And when are we following up? And if medication comes up, ask why. Why are you recommending this for my child? What evidence supports using it at their age? Is it FDA approved for their age and condition?

[00:15:40] Or is it being used off label? And what side effects should we watch for? How are we going to monitor nutrition growth and development? And what's our follow-up plan? You don't have to walk into the conversation already knowing the answer, but you should understand why treatment is being recommended for your child. So, have we gone too far? I don't think the answer is yes, but I don't think the answer is a comfortable no either. We're entering a new chapter in how childhood obesity is treated. The evidence is evolving, prescribing practices are changing, and there are still so many questions about what treatment beginning this young

[00:16:10] may mean years down the road. For me, age alone isn't enough to make the decision, and neither is BMI alone. I want to know the severity of the child's obesity. I want to know if it's already affecting their health, what treatments have we tried, what evidence supports the medications we're considering, what are the risks and potential benefits, and how are we going to monitor that child as they continue to grow and develop? That's what informed, individualized care looks like. Now, speaking of questions, I want yours. Ask Nurse Alice was built around the questions you have about your health

[00:16:40] and the health of people you love. So, if there's something you've been wondering about, something you've seen in the news, or something your healthcare provider told you that you still don't quite understand, send it to me. Visit askresouts.com and submit your questions. Your question just might become our next conversation. And if you want to go a little deeper into childhood obesity beyond medications, make sure to visit me on YouTube. I talk about some of the other things parents should consider, including nutrition, activity, sleep, stress, mental health,

[00:17:08] daily routines, and even medical issues that could be contributing to your child's weight. Plus, how to better support your child and prepare for a conversation with your healthcare provider. So, this is the end of the episode, but it doesn't mean it's the end of the conversation. Until next time, make good choices, be kind to one another, and live well, my friends. We'll talk soon.