Ads for glucagon-like peptide-1 receptor agonists (GLP-1s) are everywhere, and if your teen has type 2 diabetes or obesity, you may wonder if these drugs could help. “Are they safe for teens?” is likely the next question you ask yourself.
GLP-1 medications work by mimicking a natural hormone in the body that helps regulate blood sugar, appetite and digestion. They were first approved for adults with diabetes in 2005 and weight loss in 2014. Since then, they were approved for teens in 2019 for type 2 diabetes and 2020 for obesity. GLP-1s show real promise, but they’re not the right fit for everyone and should be considered within the context of other lifestyle factors.
As a pediatric endocrinologist who works with teens who have diabetes and/or obesity, I’d like to share a list of further questions parents should ask when considering GLP-1s for their teen:
Is my teen a good candidate for GLP-1s?
Specific breakdown of FDA approval is for kids 10 and older with type 2 diabetes or for kids 12 and older with a BMI in the 95th or greater percentile. However, there are other things you should discuss with your teen’s doctor, such as:
- Severity of disease. Is there weight related disease that warrants starting a GLP-1 medication along with lifestyle modifications, or is there time to work on lifestyle changes alone?
- Lifestyle factors. GLP-1s were never meant to be used alone, nor as a first step in a weight management program. They work best when used alongside or as a booster to diet, exercise and better sleep.
- Support from other providers. Teens will need a doctor or nurse practitioner who is monitoring for specific labs, a dietitian who can help boost nutrition and an exercise program to help maintain muscle mass.
- Goals to consider. While these drugs are prescribed for weight loss, this should not be the only goal or marker. Sometimes our patients won’t see a drastic change in the number on the scale, but their metabolic health, liver markers, mobility and quality of life will greatly improve.
- Mental health evaluation: Determine if there are any concerns related to body image, anxiety, disordered eating or bullying. These need to be addressed alongside any medical treatment.
What are the short- and long-term risks and side effects?
We have short-term data that shows these drugs are overall safe, but they haven’t been around long enough to determine long-term safety. Your doctor should walk you through these safety concerns as well as the potential side effects, which tend to increase with a greater dose:
- Most common side effects: Nausea, vomiting, constipation or diarrhea and decreased appetite. These usually get better with time.
- Uncommon side effects: Gallbladder problems, inflammation of the pancreas and low blood sugar.
- Biggest risk: Muscle loss. Any time you lose weight, you risk losing muscle mass. Muscle protects against diabetes, liver and cholesterol issues. This risk can be mitigated by eating a diet rich in protein and having an exercise plan that includes resistance training.
Is it safe for my teen’s developing body?
Bring up development concerns like puberty and growth with your teen’s doctor. Typically, GLP-1s do not affect growth and puberty unless their bodies don’t have enough energy for these processes. Both need to be monitored closely.
How long will my teen need to be on GLP-1s?
This is an important point to discuss with your doctor. GLP-1s work by helping to regulate appetite, blood sugar and metabolism. They are a long-term medication, not a short-term fix. Obesity and type 2 diabetes are chronic diseases, and these medications support ongoing treatment. Once ideal markers have been reached, the disease is not cured. Instead, it is maintained by continuing the medication and other lifestyle modifications. Stopping medication can lead to a return of previous symptoms, including weight regain.
How is the medication started, adjusted and monitored?
If you and your doctor decide that GLP-1s are the right fit for your teen, you will want to discuss things like:
- Dosing schedule
- How and when to increase dose
- Managing side effects
- Monitoring: labs, follow-up visits
What are the financial considerations?
When discussing the cost with your doctor, you should consider:
- How long they will be on the medication.
- Qualifying for insurance coverage.
- The expense of paying out of pocket (if necessary).
- Avoiding compounded forms. They are less expensive but not recommended for kids as they are not regulated and monitored like pharmacy prescriptions.
If you are interested in learning how our endocrinology team can help your child, please call 513-636-3005 or fill out an online form for more information.
