Anyone who shares a table and kitchen with pubescent teenagers who devour mountains of pasta and raid refrigerators at an incredible pace, but still remain skinny “asparagus”, can hardly imagine the opposite: children who are already very overweight when they start school and who remain so throughout puberty and adulthood. The suffering for these children is great, and attempts to change their lifestyle are often not very successful. Drug treatment at a young age could help, although drug therapy in this age group also meets with reservations.
With the participation and financing of the manufacturer Novo Nordisk, pediatricians from the USA have studied the weight-loss drug liraglutide in severely overweight children between the ages of six and twelve. The New England Journal of Medicine and the results presented at a conference show that the weight loss injection is also effective in children with obesitywhich is why experts expect it to be approved for this age group soon.
For one year, 56 children received a daily injection of liraglutide, while the 26 children in the comparison group received a placebo injection every day. On average, the children weighed 70 kilograms and were 1.49 meters tall. The families were also given advice on how the children could eat healthily and be physically active on a regular basis. In the group that received the medication, the average body mass index (BMI) of the children fell by 5.8 percent after one year, while it rose by 1.6 percent in the group that received the placebo. Since children of this age steadily gain height and weight, all participants gained weight during the study phase; the children on liraglutide gained 1.6 percent, those in the placebo group gained ten percent.
Effects of treatment greater than expected
“There is currently no medication available for treating obesity in this age group,” says Daniel Weghuber, head of the Salzburg University Children’s Hospital. For the majority of adolescents who are obese, it already existed when they started school and usually remains so into adulthood. The only treatment available so far was to encourage lifestyle changes as part of family education. “That’s easy to say, but very difficult to implement,” says Weghuber. “In this respect, this study is an important additional step towards a possible therapy for children with an extreme form of obesity.” In other words, the difference in weight change between the two groups is ten times what one would expect from a lifestyle change, according to Weghuber’s estimate.
For Martin Wabitsch, an expert on childhood hormone diseases and diabetes at the University Hospital of Ulm, the effect of the treatment was even “greater than expected”. In 2020, a similar study among adolescents led to less significant weight changes, although these would also have been clinically relevant. “It seems that earlier intervention with liraglutide also leads to a better effect,” says Wabitsch.
While drugs such as semaglutide (trade name Ozempic or Wegovy) and tirzepatide (Mounjaro), which belong to the same group of substances, have long since become lifestyle drugs that are also taken by healthy people to melt away a few fat deposits, the indication for liraglutide in children is to remain limited. “In future, the drug will be considered primarily for children with extreme obesity, certainly not for all children with obesity,” says Wabitsch. “This is a small group of patients who, among other things, have a defect in the central regulation of hunger and satiety.” In Ulm, a study is underway to examine how semaglutide, which only needs to be injected once a week, works in six- to twelve-year-old childrenwith results expected in 2025.
Drugs such as liraglutide belong to the group of glucagon-like peptide-1 (GLP-1) receptor agonists and suppress the feeling of hunger by acting on the corresponding brain centers. This can help patients to better implement dietary changes in their everyday lives. Liraglutide and the other drugs in the group are already approved for the treatment of diabetes and obesity in adults and adolescents.
SZ PlusExclusiveWeight loss drug fraud:Fake Ozempic syringes: New lead leads to Bavaria
Three Austrian women suffered dangerous side effects from fake weight loss injections. The public prosecutor’s office has brought charges against suspected dealers. This has led to new evidence.
By Markus Grill, Berit Uhlmann
Undesirable side effects, particularly nausea, vomiting and diarrhea, occurred in 80 percent of participants in the study, but were mostly mild. In the liraglutide group, more serious side effects such as severe vomiting and intestinal inflammation occurred in 12.5 percent of cases, but this also occurred in 7.7 percent of children in the placebo group.
Since the appetite-suppressing effect of the drug disappears as soon as it is stopped, weight gain almost always follows. However, the health consequences of long-term medication use cannot yet be estimated. The question of how long children should be treated with liraglutide and whether and when the injection can be stopped “cannot be answered today,” says Wabitsch.
On the other hand, extreme obesity in children is associated with significant health risks. It has long been known that obese children often become obese adults and that their risk of diabetes, cardiovascular disease, liver disease and joint problems is greatly increased early in life. According to According to data from the Kiggs study, 15.4 percent of children between the ages of three and 17 in Germany are considered overweight, of which 5.9 percent are obese. Compared to previous surveys, no further increase has been observed, although the frequency is strongly dependent on education and income. Among children with the highest socioeconomic status, only 6.5 percent (girls) and 8.9 percent (boys) were overweight, while in the group with the lowest status, the figures were 27 percent (girls) and 24.2 percent (boys).
There is currently no consensus among scientists on which changes in BMI would be healthy and sensible during growth. “The effects of significant weight loss during this developmental phase are not known,” says nutrition expert Nerys Astbury from the University of Oxford, who points out that all medications have side effects. “Although there was no evidence that liraglutide had a damaging effect on bones, height or the onset of puberty, we need longer-term data on the patients and their further development.”
With material from the Science Media Center
