Everything You Need to Know About Ozempic for Kids, According to a Pediatrician, Obesity Expert and Psychologist

In 2023, you couldn’t turn a corner without bumping into Ozempic. It was everywhere, from subway ads in New York to online gossip rags tattling on who had taken it to drop 20 pounds, fast. Now, the class of drugs known as GLP-1 agonists could be available to children as young as 6, as reported by USA TODAY in October. And it’s not without controversy, from The Cut’s in-depth profile of a teenage girl in Missouri to The Atlantic’s examination of the drug’s implications.

With Ozempic for kids seemingly on the horizon, we sat down with a pediatrician, obesity expert, pediatric endocrinologist and adolescent psychiatrist to talk about the benefits and risks of pursuing treatment.

• Angela Fitch, MD, is the founder and chief medical officer of knownwell, a weight-inclusive healthcare provider based in Needham, Massachusetts. Dr. Fitch also serves as the president of the Obesity Medicine Association and received her medical degree from the University of Cincinnati College of Medicine.
• David E. Myles, MD, is a pediatrician and assistant professor at Walter Reed National Military Medical Center in Bethesda, Maryland. Dr. Myles graduated from the Yale University School of Medicine and completed his pediatrics internship and residency at Johns Hopkins University.
• Mirela Loftus, PhD, is the medical director at Newport Healthcare. She specializes in diagnosing and treating various mental health concerns such as depression, anxiety, bipolar disorder and eating disorders. Before joining Newport Healthcare, Dr. Loftus spent 15 years as an attending and consulting psychiatrist at Hartford HealthCare’s Institute of Living, and two years as the medical director of the clinical trials unit. Dr. Loftus holds a PhD from the University of California, Davis.
• Sheela Magge, MD, is a board-certified pediatric endocrinologist, professor of pediatrics and director of the division of pediatric endocrinology at Johns Hopkins Medicine. Her expertise is the diagnosis and treatment of endocrine disorders in children and adolescents. Dr. Magge is a member of the National Institutes of Health Human Studies of Diabetes and Obesity Study Section. She holds an MD from the Yale University School of Medicine and completed her fellowship in pediatric endocrinology at the Children’s Hospital of Philadelphia.

First thing’s first: Ozempic is one of three FDA-approved brand names for an injectable semaglutide drug, which is also known as a GLP-1 agonist. GLP-1s have four functions: increase insulin secretion, reduce glucagon secretion, slow the emptying of the stomach and reduce appetite.

Last year, there was a well-documented frenzy of adults trying to get their hands on semaglutide medications—primarily for weight loss. But these medications were only authorized to treat obesity in people 12 years and older. Now, Dr. Myles says, there are 19 clinical trials running to determine efficacy and safety for children and adolescents, with children as young as 6 participating. There is not a special formula created for kids. Rather, Dr. Fitch explains, it’s the same drugs but with different dosing patterns. GLP-1s, she says, “work in your gut by decreasing how fast the food moves out of your stomach. It helps with your metabolism in a way, because it affects how your body sees and stores energy around your fat cells and your insulin production.”

“We are at an unprecedented time in recognizing that many more of our children and adolescents—increasingly younger children—are dealing with obesity,” Dr. Myles says. There are also more children being diagnosed with high blood pressure, fatty liver disease and high cholesterol than ever before, according to Dr. Magge.

Still, all the doctors we spoke with agreed that GLP-1 drugs are a serious treatment (specifically for children) that should be considered the last resort before bariatric surgery. And as a result, there are pretty strict barriers to entry. To be prescribed the drug, adults must have a BMI of 27 with co-existing health issues (comorbidities), or a BMI over 30. When it comes to evaluating adolescents, Dr. Fitch explains, healthcare providers use percentiles, as advised by the American Academy of Pediatrics (AAP): a youth’s BMI would need to be in the 85^th percentile with a comorbidity, or above the 95^th percentile without one to warrant a prescription.

If they meet these requirements, Dr. Fitch says, “that would qualify them for medication intervention in addition to lifestyle intervention.” But again, most doctors would be hesitant to do so without first trying other avenues. (And remember that we don’t yet know the BMI requirements for children under 12, since the studies have yet to be concluded. However, Dr. Magge believes the same thresholds would apply.)

“I think one of the big things that people don’t understand is that when the American Academy of Pediatrics put out their obesity policy, they just mentioned the use of medication as one part of [weight loss], if lifestyle modification hasn’t worked,” Dr. Magge says.

Indeed, the Obesity Medicine Association (OMA) lists “four pillars” of obesity treatment: nutrition, physical activity, behavior and medication, with nutrition and physical activity being the first lines of defense.

Per the AAP, the first steps in obesity treatment should be lifestyle changes: nutrition, behavioral and physical activity, and your child’s pediatrician would absolutely try these measures before having a conversation about GLP-1s. (Dr. Myles notes that as a practicing pediatrician, this would be his last resort if he were trying to avoid recommending bariatric surgery, itself a serious procedure.)  

But should your child be prescribed a medication (likely after a consult with a pediatric endocrinologist), Dr. Fitch explains that managing the meds would be an ongoing process; a healthcare provider would typically check in every four to six weeks to evaluate the response to the treatment and any side effects. Additionally, the family would meet with a dietician and health coach to initiate lifestyle changes that would further set the patient on the road to healthy weight maintenance.

As for how long the treatment lasts, the doctors we spoke with agreed that it could be an indefinite arrangement, with the hope that, with proper lifestyle changes, a child may be able to stop taking the medication eventually.

“[For this class of medications], insurance companies are generally not paying for it if it’s being prescribed for obesity,” Dr. Magge explains. “They’re paying for it [if it treats diabetes], but if I try to get Ozempic for weight loss, they won’t cover it.” This can result in out-of-pocket costs of $1,200 to $1,300 per month, per Dr. Fitch’s estimate.

That said, many, manufacturers of expensive medications do offer coupons to assist with pricing for folks whose insurance won’t cover it. (Unfortunately, people on Medicaid and Medicare are often not allowed to use these coupons.)

Last year’s coverage of GLP-1 drugs was dizzying. On the one hand, it seemed like a “quick fix” to lose extra weight. On the other, reports made it sound like everyone was completely miserable. Nausea, vomiting, diarrhea, stomach pain and constipation were a handful of the more common symptoms.

But the reality was probably somewhere in between, with a 2023 study reporting that only six percent of patients completely stopped medication due to side effects.

A recent clinical trial reviewed by the OMA showed that adolescent response to semaglutide was similar to that of adults. Nearly 75 percent of participants lost at least five percent of their body weight and 62 percent experienced the symptoms noted above. There are currently many ongoing trials (including those of younger children), but the actual hard data is scarce, with Dr. Loftus noting there’s only about a year’s worth to study. Dr. Magge adds that doctors may ask questions to determine whether a child is predisposed for certain complications, such as thyroid cancer and pancreatitis. Otherwise, present data suggests the medications are suitable for youth with similar results experienced by adults.

Still, because of the recency of the AAP’s recommendation and the limited data, it is difficult to determine long-term beneficial and adverse effects.

“Ideally, you would follow these children into at least early adulthood to see to what extent these [medications] have long term impacts,” Dr. Myles says.

Then there is the question of how long your child might need to be on the medication. Dr. Myles likens it to adults taking a long-term prescription for, say, high blood pressure. And while they might not need it indefinitely, Dr. Magge confirms that when patients have stopped, the weight often comes back. This can be due to lack of lifestyle changes, but also the medication itself, which increases production of hormones called incretins. They help the body produce more insulin, slowing and delaying emptying of the stomach. Ceasing the medication will stop these processes, Dr. Magge explains.

Still, despite the risks, the doctors we spoke with agreed that semaglutides could be worth it, in order to help children properly manage their obesity.

“Having excess adiposity [fat], no matter what your state, is not good for you,” Dr. Fitch asserts. “It’s inflammatory. It produces inflammatory cytokines. It leads to an increased risk of Covid and increased risk of death from Covid.”

Short story: any time a kid is being told to lose weight, it’s probably not great for their psyche. “Across the board, I think girls probably have the worst of it in terms of peer pressure,” Dr. Myles says. “To toss into [that], you have a pediatrician saying, ‘there’s a weight issue.’ There’s some well-intentioned trepidation about approaching that topic.”

“My advice to parents is to always start with open communication,” says pediatric psychiatrist Dr. Loftus. “Be curious. Ask questions rather than give advice. Validate [your child’s] feelings, if not necessarily their choices.” In other words, she’s hesitant for parents to suggest medications like Ozempic unless it comes via a doctor’s recommendation. She also warns that there’s potential for the development of eating disorders, because GLP-1s can drastically alter someone’s relationship with food.

Additionally, should a child or teen begin such a medication, Dr. Loftus stresses the importance of pairing it with proper psychological guidance. “You will want to make sure that whoever starts this medication is followed by someone in the mental health field, be it a psychologist, a social worker or a psychiatrist.”

Bottom line: Guiding a child or adolescent towards any sort of weight-loss regimen has the potential to negatively impact their mental health, so parents need to tread with caution, listening to their kid’s needs in tandem with recommendations from their doctor. “[At the end of the day],” Dr. Fitch says, “it’s about trying to make lifestyle changes that are positive from a healthful nutrition standpoint because they’re good for us, not because we want to lose weight.”