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November 10, 2022 – Emmalea Zummo was intrigued by the prospect of being involved in a research program that could help her lose weight. At 15, the confident, energetic teen from Jeanette, PA weighed 250 pounds — enough to be considered obese. The study, which she learned about from her endocrinologist, involved a drug called semaglutide.
Before participating in the study, Emmalea had exhausted a reservoir of strategies.
“She had been on a variety of exercise programs, involved in countless sports and activities to stay active as some of her early doctors said it would work,” says Davina Zummo, Emmalea’s mother. “She counted calories, went on a gluten-free diet, limited what she ate, when she ate and how much.”
Emmalea cut out all snacks, junk food and sweets, but nothing changed, says Zummo: “She felt defeated.”
The FDA last year approved semaglutide, originally developed to treat type 2 diabetes, for weight loss in adults. But the researchers wanted to know if the drug, which targets areas of the brain that regulate appetite, could also help adolescents lose weight. Emmalea was curious too.
Although teenagers often judge each other, Emmalea’s friends have been “happy for me, constantly motivating and supporting,” she says.
Today, Emmalea, who is now nearly 18, says the drug helped her lose 75 pounds, giving a boost to the lifestyle and nutritional coaching she received throughout the 68-week study.
Parents of teens like Emmalea struggling with obesity hear the same refrain: If their kids cut down on sugar, eat healthy snacks instead of junk food, and exercise regularly, the results will follow.
But for many overweight teens — as well as adults — shedding pounds often proves frustrating. Profits come and go, despite good intentions.
Can medication help?
A new study in which New England Journal of Medicine shows that semaglutide can actually lead to small but significant losses in excess weight. Whether that’s enough to tip the scales to better overall health, so to speak, is unclear, but the results give children’s health specialists cause for optimism.
“There is a real need for safe and effective drugs to treat obesity,” said Silva Arslanian, MD, a pediatric endocrinologist at the University of Pittsburgh School of Medicine and a co-author of the new study.
“Usually we give lifestyle recommendations: Eat more vegetables; do not eat fried food; don’t drink soda,” says Arslanian. Unfortunately, she says, we live in a world where “making these changes can be very difficult.”
Many experts agree that medication should be part of the conversation.
“It is exciting to see this treatment becoming available. And the study results indicate few side effects, making the drug safe and tolerable,” said Amanda Staiano, PhD, a researcher at Louisiana State University’s Pennington Biomedical Research Center in Baton Rouge. “Although not yet FDA approved, Semaglitude and other new drugs are transforming the treatment of adolescent obesity. It’s going to be an exciting time for obesity treatment.”
However, Staiano emphasizes that lifestyle and behavioral advice are key to the success of any obesity treatment, including drugs like Semaglutide.
Daniel Weghuber, MD, a pediatrician at the Paracelsus Medical Private University in Salzburg, Austria, says that while obesity “no question of lack of willpower, this drug seems to allow people living with obesity to stick to the recommendations they have been following for years but have been unable to achieve the goal. I think this is important. It enables people to achieve their goals.”
In the new study, 201 obese or overweight boys and girls between the ages of 12 and 18 received either once-weekly semaglutide injections or dummy injections. They all also received lifestyle interventions — advice on healthy eating and physical activity — throughout the nearly 16-month study.
At the end of the study, 75% of the adolescents who received semaglutide had lost and maintained at least 5% of their excess body weight, compared with 17% of those who received sham injections. On average, those treated with the drug lost 33.7 pounds, compared to an average of just 5.3 pounds in the other group.
Weghuber said the research suggests that the combination of lifestyle changes and anti-obesity medication “will open a new chapter” for the treatment of adolescents with obesity.
More than 340 million children and young people worldwide aged 5 to 19 were overweight or obese in 2016. In which United States, affected by obesity 22.2% of 12- to 19-year-olds from 2017 to 2020, according to the CDC.
Obesity is associated with a reduced life expectancy and a higher risk of developing serious health problems such as type 2 diabetes, heart disease, non-alcoholic fatty liver disease, sleep apnea and certain types of cancer. Teens with obesity are also more likely to have depression, anxiety, low self-esteem, and others psychological problems.
While childhood obesity has long been a public health concern, the problem has worsened during the COVID-19 pandemic, says Melissa Ruiz, MD, of the Pediatric Diagnostic Center in Ventura, California. Some of her patients who had been “chubby” before the pandemic had gained 20 to 30 pounds in post-pandemic clinic visits, she estimates.
Ruiz and other experts say parents should discard the notion that obesity is something children — or adults — do to themselves, or that they are failing their children by not controlling their weight.
“There are genetic components that play a role in obesity and we have to recognize that,” says Ruiz.
Parents should consult their child’s pediatrician for advice. “If the pediatrician can’t help you, ask, ‘Where can I go?’ Say, ‘I understand you may not be trained in this,’ and ask for a reference for someone who can help,” says Ruiz.
However, drugs shouldn’t be viewed as an all-in-one cure, according to one expert.
“Medications are a last resort only after behavioral interventions have failed and after the range of behavioral strategies for weight loss has been explored, including changing dietary habits such as timing and meal plan,” says Lydia Bazzano, MD, PhD, nutrition researcher at Tulane University School of Public Health and Tropical medicine in New Orleans.
medicines etc even operated have a place, but only if patients have exhausted all diet and lifestyle options, says Bazzano. “They don’t want the adolescent to be on medication for life. Medications should only be used to get the child to where they should be — and then maintain that weight,” she says.
Adolescent obesity is a very difficult subject, adds Bazzano. “You have to involve the whole family, not just the child. It has to be at the whole family level and that can be very challenging. If the whole family sticks together, there can be a modest weight loss.”
And Bazzano says she’s not impressed with the weight loss found in the latest study. A 5% drop in body weight is helpful, she says, but “that’s not enough to say the child is out of risk.”
Staiano believes experts need more information about semaglutide before they start prescribing it to children.
“We need to see the long-term results of chronic drug use and if the weight will come back when teens stop taking the drugs,” she says.
“How long should the drug be prescribed? For the rest of your life? How do we support patients who are able to lose so much weight? How do we ensure that these treatments — behavioral counseling, medication, and surgery for weight loss — are accessible to families and financially achievable?”
Emmalea, who stopped taking semaglutide about a year ago, has maintained her weight thanks to a focus on a balanced diet and exercise. While she says she’s happy with her progress and “feels comfortable in my skin,” she doesn’t consider her current weight of 171 pounds to be the end zone. “I would like to be somewhere between 145 and 150,” says the 1.60 meter tall high school graduate.
Still, she says, “I don’t strictly control myself because it’s not healthy to think negatively about food and it can actually make an eating disorder worse.”
When she started studying, she wasn’t sure if it would be effective for her. But because of her interest in medicine and research, she says, she wanted to be part of it: “I thought if it doesn’t help me, maybe it will help others.”
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