Thread by @nicknorwitz

Weight loss drugs for kids!

1) As you may have heard, the FDA has approved the weight loss drug semaglutide (a GLP-1 agonist) for kids 12 and older with #obesity

Good? Bad? I wanted to do a thread 🧵on the STEP TEENS data with some thoughts...

PLZ READ IN FULL

2) Semaglutide Treatment Effect in People (STEP) with obesity TEENS trial was a double-blind RCT that lasted 68 weeks & included kids 12-18 years. 180 completed the trial

Baseline means:
-Mean age was 15.4 years
-BMI = 37
-Weight = 237lbs
nejm.org/doi/full/10.10…

3) The data show 16.1% weight loss in the semaglutide plus lifestyle intervention group, as compared to no BMI change in the placebo plus lifestyle group over 68 weeks. (nb: after semaglutide discontinuation for 7 weeks, weight began to rebound as expected)

4) Metabolic benefits were also noted, including lipids, HbA1c, and liver enzyme

5) In terms of side effects, GI distress was higher in the semaglutide group (62% vs. 42% in the control), and 4% of semaglutide participants (n=5) developed gallstones. There was also an increase in pancreatic enzymes (amylase and lipase), although no cases of pancreatitis.

6) Scores for wellbeing and mental health also improved

7) Overall, it's clear there was a health benefit from the treatment. If I had a child with obesity and I, as a parent, we're not able to help them achieve better health with lifestyle alone (although I hope I would be able to), I would certainly advocate for my own child...

8) In addition, any clinician advocating for their individual child patient - and without daily interface to help them maintain lifestyle change - will advocate for their patient to receive treatment based on these data. That said, I have unease and here is why...

9) The problem at hand is one we as a society created

Our environment is filled with refined grains and sugar

Our norms encourage indulgence far beyond what is healthy

The epidemic of childhood #obesity is, at it's roots, a lifestyle problem not a drug deficit

10) Having this problem, what can we do?

One option is to have a revolution with respect to lifestyle, medicine, and social norms. This isn't easy, but it would address the roots of the problem.

Alternatively (albeit not mutually exclusive), we can try to engineer our way out

11) This second, pharmacological, solution is tempting as it permits us to have our cake and eat it too

But the question I want to pose are:

(1) what are the limits of this approach

(2) what are it's consequences on motivation to address the root problem

12) With respect to Q1, I'm not sure drugs can solve the childhood obesity epidemic

With engineering in weight loss pharma there is continued Co-Evolution of the food and social environment; in this evolutionary race, I personally think drugs are doomed to fail in the end

HBU?

12) Perhaps most importantly to me, I worry about the implications of becoming continually reliant as a society on weight-loss pharma

As it becomes the safety net, norm, and default, it necessarily removes societal pressure to restructure and re-normalize healthy lifestyle

13) In summary, this is a complex issue

I personally think it's reasonable to have FDA approval in this age-group at this time, BUT I'd hope that we be judicious about over-prescription

& I really hope we can be observant about where our norms are trending and correct course

14) Thanks for reading and, in advance, for sharing our thoughts (and clinical or personal experiences)
🙏🫂🙏