WINDER, Georgia – Aiden Gatlin-Wright lay down on the living room couch to receive an injection of weight loss medication and pulled up his shirt to reveal his stomach.
“Ow,” Ayden yelled, cartoons playing in the background. He is 9 years old.
Ayden and twin brother Kayden are part of the growing epidemic of childhood obesity. Traditional weight loss methods do not work well for many children, especially those with severe obesity.
Now, even primary school children are being given popular weight loss drugs like Wegovi.
Doctors say that by prescribing GLP-1 drugs early, they aim to prevent lifelong obesity and complications such as type 2 diabetes and high blood pressure, which are appearing in teens and even younger children.
These medications have not yet been approved for obesity in patients this young. And without further study, it’s not certain that young children can safely use medications for weight loss without compromising critical periods of their bones and brain development.
But doctors who prescribe off-label drugs say the risk of obesity complications is too severe for some patients to try a treatment that could be so effective. These drugs are approved in the US for obesity in children under 12 years of age and are being tested in children under 6 years of age.
“I see kids who have developed type 2 diabetes at 10, 11 years old,” said Dr. Jessica Reilly, medical director of the Strong4Life Pediatric Obesity Clinic at Children’s Healthcare of Atlanta, where she treats Ayden and Kayden. “They desperately need help.”
Intensive behavioral treatment programs that focus on diet and physical activity for obese children can be difficult to find, are often not covered by insurance and typically result in only very modest weight losses — doctors say a 1% to 3% reduction in body-mass index is normal. Other medications frequently used in young children, such as stimulants, may also not be effective enough. Meanwhile, doctors who are prescribing GLP-1 to young children say they are seeing BMI reductions of up to 20%, and sometimes even more, in some patients.
The negative health effects of obesity, including heart disease and type 2 diabetes, may emerge much earlier than previously thought. Pediatric obesity experts say they’re seeing more high blood pressure, poor blood sugar control and liver dysfunction in children as young as 4. And new research shows that children who are obese usually never recover.
Still, doctors are hesitant about putting growing children on GLP-1s. Some people worry that inadequate calorie and nutrient intake may adversely affect bone growth, puberty, and brain development. When people stop taking the medications, most of the lost weight comes back. No one knows the possible consequences of consuming these drugs since childhood for decades.
Dr. Sarah Hample, who lives in Kansas City, Mo. “We just don’t have enough evidence at this point to safely prescribe it to children under 12 for obesity,” said Dr. Joe, who is part of the Pediatric Obesity Program at Children’s Mercy Hospital in the U.S., and was the lead author of the American Academy of Pediatrics’ clinical practice guideline for the treatment of obesity in children and adolescents. “I think the potential for a positive effect exists, but there haven’t been enough studies yet.”
AAP guidelines recommend that pediatricians provide intensive behavioral treatment for children ages 6 and older who are overweight or obese, or refer children to other health care professionals who can provide it. The guidelines state that the medicine should also be given to children aged 12 and above who are obese.
About 21% of American children and adolescents ages 2 to 19 are obese, according to data collected between 2021 and 2023 by the Centers for Disease Control and Prevention. Obesity rates in America began to rise in the 1980s. In the 1970s, only 5% of children and adolescents suffered from obesity.
Doctors who are prescribing GLP-1 to children under 12 say the all-but-few health problems that occur with severe obesity may outweigh their concerns about the drugs’ potentially unknown long-term effects.
“We don’t know what the long-term effects might be and it can be scary and troubling,” said Dr. Claudia Fox, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota, who is working on clinical trials of GLP-1 for children. “I know that being obese when you’re 7 years old, especially severe obesity, definitely reduces quality of life, has the potential for premature death, really is not a good life.”
Fox is prescribing GLP-1 for some young children with obesity and the results have been “transformational,” he said. Fox, the 10-year-old who is being treated, has seen his BMI drop by about 30% since taking the drug, Fox said.
Novo Nordisk said it does not encourage off-label use of its obesity drugs. The company’s Wegovi injection and Saxenda drugs are approved in the U.S. for obesity in adolescents younger than 12 and are being tested in children younger than 6 with obesity. Eli Lilly’s Zepbound is approved for adults, and the drugmaker is studying the obesity drug in children ages 6 and older—including teens. An Eli Lilly spokesperson said, “Lilly does not promote or encourage the use of any Lilly drug outside its FDA-approved indication.”
GLP-1 is approved in the US for children ages 10 and older with type 2 diabetes.
Latrell Gatlin and Alexander Wright adopted the twins at birth. The boys were about 4 years old when their weight started increasing rapidly. Sometimes he would eat so much at one go that he would vomit. He felt so hungry while sleeping that he started crying.
Working with their children’s pediatrician and a nutritionist, the couple tried to feed their sons more frequent, smaller meals. He limited portion sizes and allowed ice cream only once a week. They started switching to sugar substitutes like Splenda. He enrolled the boys in karate classes.
But the twins’ BMI continued to increase dramatically. When the boys were 6, their pediatrician referred them to the Strong4Life program, about an hour and 20 minutes from their home. The demand was so high that it took almost a year for the family to get an initial appointment.
At Strong4Life, they discovered that boys have a genetic mutation that affects the perception of fullness and increases the risk of obesity.
The information was a relief to Wright, who is 48 and has taken medical retirement in 2023 from his job with the federal government. He said, “As a parent I always feel defeated – it’s my fault. Maybe I’m doing something wrong.”
At age 7, the boys’ weight was already affecting their health. His A1C, which is a measure of blood sugar, was elevated. Symptoms of liver dysfunction and worrying cholesterol levels appeared.
Reilly gave the boys a drug commonly used to treat seizures, which can make people feel full more quickly and reduce cravings. It is often used off-label in young children who are obese. Kayden and Ayden, who has ADHD, were also on stimulant medication. Doctors use stimulant medications in young children who are obese, even if they do not have ADHD, because the medication can suppress appetite.
Gatlin and Wright redoubled their efforts to get their children healthy eating and exercise. She began cooking most meals at home, using olive oil instead of butter, and taking family workouts. But Ayden and Kayden’s weight continued to increase. “They were still moving up the charts to the point that was worrying,” Wright said. The boys’ weight was affecting their ability to run and play.
At an appointment in January, Wright and Gatlin asked about the GLP-1s. The couple knew the medications were not approved for children so young, but nothing they had tried so far was working for the boys. “They were discouraged. Why are we putting in so much effort and we’re not seeing any results?” said Gatlin, who is 41 and works in health care.
Gatlin and Wright were also concerned about the twins’ mental health. His father says the boys are bullied because of their size and children call them names. The name-calling had a particularly deep impact on Ayden, Gatlin said. “He would come home and just cry, like literally cry for hours.”
The boys started with .25 mg of Vegovy, then moved up to .5 mg and in May to 1 mg weekly shots.
The drug “helps us make healthier choices,” Wright said he explained to his boys.
The twins have experienced few side effects, their father says. When he started the drug and while taking new doses, he sometimes complained of vomiting or diarrhea about 48 hours after the shot.
Gatlin and Wright say they have seen big changes since starting the drug. Boys have less appetite and do not eat breakfast frequently. They are more confident and their grades have improved. “They see themselves changing. They’re more motivated to change, more motivated to eat healthy and read labels,” Wright said. Kayden played basketball for the first time at recess. “They’re more energetic. They’re more friendly.”
And they’ve lost weight: Ayden’s BMI dropped 5% and Kayden’s 7% in the first two months on Wegovi.
The couple paid about $700 out of their own pocket for four weeks of Wegovi for their two sons. They have had to cut costs elsewhere and withdraw some money from their retirement savings.
Temptation is everywhere. On a recent Thursday afternoon, Ayden pushed a cart at the Ingalls grocery store in Winder. The family was having some ground beef and taco shells for dinner that night. Wandering into the store, the boys wanted a soda. They wanted candy bars and they grabbed them off the shelf and imitated bites. “Guys, it’s not,” Gatlin said.
Gatlin and Wright hope their sons won’t stay on Wegovi forever. Maybe three years, Wright says. “They can learn to manage themselves, exercise, healthy habits, read their bodies properly,” she said. “The goal is for them to learn that, you know, this is going to be their life as they grow up.”
The family has a big goal for the summer: getting the boys cycling.
Write to Andrea Peterson andrea.petersen@wsj.com
