GLP-1s Use in Kids
The use of glucagon-like peptide-1 receptor agonists (GLP-1RAs or GLP-1s) in pediatric patients for obesity, type 2 diabetes, and hyperinsulinemia is on the rise, just like in adults.
Patient injecting a GLP-1 medication into the abdomen.
Since the current obesity rate in US adolescents aged 12-19 is 1 in 5, the use of GLP-1s in adolescents is not surprising.
These meds have now been around for 20 years, with the first medication in this category approved in 2005. The US approved them for children with type 2 diabetes ages 10 and up in 2022 and for obesity treatment in children ages 12 and older in 2024. Europe approved them for childhood treatment of type 2 diabetes in 2019 and for obesity treatment in children in 2021.
There are now numerous drugs that fall under this category:
Semaglutide
Liraglutide
Dulaglutide
Tirzepatide
It is estimated that 17% of children/adolescents on these medications develop nutritional deficiencies within the first year of treatment. This is concerning; these deficiencies can impact a critical time of growth, development, and brain function.
What are GLP-1RAs and how do they work?
These medications were developed to treat type 2 diabetes. Over the last 10-12 years, many more were developed to treat obesity, since they work as an appetite suppressant.
GLP-1s promote blood sugar control and cause weight loss by suppressing appetite, delaying stomach emptying, and increasing satiety, which decreases food intake.
GLP-1s resemble the glucagon-like peptide-1 hormone that we make that naturally stimulates insulin release, prevents glucagon release, and slows gastric emptying. These meds work the same way by binding to the same receptors and enhancing the effects.
When appetite is suppressed, getting adequate nutrition is difficult. Intake may not keep up with energy needs, especially in a growing child undergoing pubertal development, with increasing bone and muscle mass. Those who limit their diet may quickly develop micronutrient (vitamin and mineral) deficiencies, which can affect brain function, cognition, and mental health.
Calcium, vitamin D, iron, zinc, and B vitamins are of particular concern.
Studies on pediatric populations ages 10-17 on GLP-1 RAs with no prior nutritional deficiencies, found the most common deficiencies were vitamin D, followed by iron and iron-deficiency anemia. These occurred within the initial 6-12 months of treatment.
Despite the therapeutic benefits of these medications, they may also increase the risk of inadequate intake of calories, protein, fluids, vitamins, and minerals at a critical time in a child’s development.
Issues to discuss with your doctor before starting your child/teen on these meds:
Are there other treatment options besides medication?
What other interventions beside medication should we do - exercise, dietary changes, etc.?
How will they be monitored? How often should they have lab work?
Will we also work with a dietitian for healthy eating advice?
How do we prevent muscle loss?
What are the goals, and how long should we expect to stay on the medicine?
Are there any concerns for disordered eating?
What are the risks/side effects? When should we call/be concerned?
Currently, most experience and safety data are from adults rather than from children. There have not been long-term safety studies in children. The bottom line is that there is short-term benefit, but we don't have the long-term data to know whether there are effects on the pubertal growth spurt, bone health, and lean body mass. These meds are a treatment tool, not the ultimate solution.
The takeaway is that nutrition monitoring and counseling should be part of GLP-1 usage, especially in children. Screening for nutrient deficiencies and ensuring a wide variety of foods, especially whole, natural, minimally processed foods, while watching for eating habits that aren’t too restrictive or limited. A multivitamin with iron and calcium supplement may be indicated. Steps to prevent muscle loss and guard against inadequate intake should be taken and may involve other professionals. The goal is to improve their health status, not create more problems.
Comments