OW2022: A Huge Advance for Obesity in Teens

Mind-blowing. That’s how pediatric obesity medicine expert Claudia Fox described the outcomes with semaglutide for teens with obesity at OW2022 yesterday. As she and a panel of experts in the field discussed this huge advance for teens with obesity, every seat and space to stand in the ballroom was taken. Daniel Weghuber presenting these results at the meeting. Simultaneously, he was the lead author on a publication of all the details in the New England Journal of Medicine.

“Crazy Good” Results

Pediatric obesity researcher Aaron Kelly tells us that these results are “crazy good,” with placebo-subtracted weight loss of almost 17 percent – notably higher than the comparable number seen for this measure in adults. For example, in 2021 NEJM published a 68-week study of semaglutide in adults with obesity. The placebo-subtracted weight loss in that study was 12.4 percent.

In the present adolescent study, the teens who received a placebo instead of semaglutide actually gained weight during the study – even though they were receiving lifestyle coaching designed to prevent that. The trouble is that for these kids with clinically significant obesity, simply working on their lifestyle is not enough to change the pathophysiology of obesity. In other words, the problem here is not really just behavior, it’s the physiology of an honest-to-goodness disease. Side effects were comparable to those seen with other drugs in this class. The incidence of serious events was 11 percent.

One of the teens in this study, Emmalea Zummo, explained:

“I tried diets. I tried exercise. I’m in more sports than any other kid I know, and nothing would work. My body would just get used to the extra exercise, get used to the new diet and the weight would come back.”

She lost 70 pounds while taking semaglutide.

Rethinking Obesity in Kids

Along with more research to come, these results will prompt a re-thinking of how to care for kids with obesity. The old way of thinking was to presume that the kids or their parents were doing something wrong and obesity was the result. Reflecting that old way of thinking, Zhaoping Li of UCLA told NBC News:

“We should use this as an opportunity to identify the fundamental issues that led to weight gain in the patients’ individual lives and help them to make fundamental changes not only to lose weight and maintain the weight loss, but also to help them lead a healthier lifestyle.”

Implicit in those words is the assumption that there’s something wrong with the lifestyle of kids with obesity. That “we” can help them change their ways and erase this disease by living a healthier life. The problem with such thinking is that the kids in this study got that help and simply gained more weight unless they received treatment with semaglutide.

Dr. Li is doing us the favor of illustrating just how hard it will be to let go of the presumption that these kids (or their parents) have done this to themselves. It explains why progress against childhood obesity has been so slow in coming. Old presumptions die hard.

But with this huge advance for obesity in teens, it should be hard to hang onto those false presumptions. Thank goodness. All that finger-pointing does a lot of harm.

Click here for the study in NEJM, here and here for more reporting on the study.

Children and Sunny Trees, painting by August Macke / WikiArt

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November 3, 2022