The disturbing news about our young children’s health is coming at us fast and furious. First we find out that there is an obesity epidemic among our youth, that more than 20% (perhaps more) are now obese, and I can tell you as a practicing internist that today’s obese child could be tomorrow’s obese adult with type 2 diabetes, heart disease, high blood pressure or stroke. And now we find out that, according to the latest CDC data, a third of all children ages 12 to 17 have pre-diabetes. 

Please note: this is not connected to the kind of diabetes (type 1) that is autoimmune or tied to genetics and the most common form diagnosed it childhood, but the kind (type 2) where you don’t make enough insulin to drive the glucose you have into the cells and where insulin resistance builds up. And it doesn’t take actual type 2 diabetes to do that. Pre-diabetes is well on the road to actual diabetes, though it can often still be reversed by lifestyle changes. The inflammation and excess glucose associated with pre-diabetes can also damage kidneys, coronary arteries, retinas, and nerves, whether a child goes on to develop full type 2 diabetes or not.

Considering that between 21 and 40% of obese patients have pre-diabetes, and considering that the GLP1 agonist drugs including Ozempic and Wegovy are highly effective at not just glucose control but also weight loss, and adding to that they appear to have cardioprotective effects and are also seemingly good for the brain, it is no surprise that there is a huge clamor for them all across America. So shouldn’t all of our children with a weight or sugar problem be on them?

The answer is a resounding no. 

Not only are there concerns about gastrointestinal side effects and intolerance, but optical side effects (headaches, macular degeneration, and even loss of vision have been reported) need to be further studied along with thyroid cancer concerns. Currently, there is no data on long-term side effects and a child who, once committed to them, could be on these drugs for life. 

CHILDREN’S HEALTH DECLINES IN LAST 17 YEARS, STUDY FINDS

It is easy to see that the benefits outweigh the risks much more for adults than for most children.

Also, at a time when there is an epidemic of social media and excess screen-time addiction, where our children’s diets are filled with ultra-processed high-sugar foods, when too many children are not exercising, I feel it would be a big mistake to rush to these semaglutide drugs as a quick fix to the problem.

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Don’t get me wrong, I much prefer the drugs to the long-term side effects of obesity, which include all the diseases and more mentioned above. If I knew for sure that a child was in a group where they were destined for diabetes or heart disease because of their weight and I could do something about it, of course I would, but most of the time there are lifestyle changes to promote first. Clearly, we have a long way to go to improve our kids’ diets, but now is the time to start.

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For those children with persistent obesity and/or prediabetes, a nutritionist along with an endocrinologist should be involved, but for most, it should be a very runway before the Ozempic or Wegovy plane is launched, at least for now.

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