For some children who are extremely overweight, standard therapeutic approaches are unsuccessful. GLP-1 drugs can help curb hunger, but the long-term effects are unclear.
The weight loss injection with the active ingredient semaglutide is also approved for minors. (Archive image) Photo: Roberto Pfeil/dpa
Berlin. Around two million children and young people in Germany are overweight, and around 800,000 of them have the chronic disease obesity. Could the popular weight loss injections also help minors?
For which children are weight loss injections suitable?
Two GLP-1 drugs are approved for children and adolescents with obesity. Semaglutide is injected once a week and can be used from the age of twelve. Liraglutide is administered daily and is approved for ages six and up under certain conditions. The new weight loss tablet has not yet been approved for children.
“Drug therapy can be considered from the approved minimum age, but only as a supplement to a guideline-based lifestyle intervention,” emphasizes child and adolescent medicine specialist Susann Weihrauch-Blüher. Drug therapy should be considered for minors with extreme obesity, in specialized centers under clearly defined criteria. For this purpose, the corresponding medical guidelines were reissued.
How many children does the problem affect?
According to data from the KiGGS study, around 15 percent of children and young people in Germany are overweight and 6 percent are obese. Extrapolated, this corresponds to almost two million children who are overweight, of which around 800,000 are obese and around 200,000 are extremely obese. However, this data was collected between 2015 and 2017. Studies during the corona pandemic indicated an increase. Stabilization at a high level can currently be observed, says Weihrauch-Blüher.
What effect do the weight loss injections have?
The weight loss syringes contain active ingredients from the group of GLP-1 receptor agonists (GLP-1-RA). These signal the brain that you have eaten, which creates a feeling of satiety. In addition, food stays in the stomach longer, which prolongs the feeling of fullness. The patients eat less overall and therefore lose weight.
What side effects are there?
According to current knowledge, the side effects in minors are similar to those in adults. Possible symptoms include gastrointestinal complaints, nausea, a feeling of fullness, loss of appetite and diarrhea. But it is still too early to make conclusive statements about long-term risks, says obesity expert Weihrauch-Blüher. The class of active ingredients has only been around for around two decades; initially, such agents were only used to treat type 2 diabetes. Long-term side effects have therefore not yet been researched. This is particularly relevant for children and adolescents because their bodies are still developing, longitudinal growth is often not complete and puberty can continue, explains Weihrauch-Blüher.
Will the costs be covered?
Families usually have to bear the costs. Because: In Germany, weight loss products are considered lifestyle medicines and are therefore not a health insurance benefit. Families currently have to expect costs of around 200 euros per month, says Weihrauch-Blüher, a professor at the Halle University Medical Center.
The situation is different for people with type 2 diabetes: For them, treatment with semaglutide under the product name Ozempic is covered by health insurance companies. The German Obesity Society recommends that costs be covered for young people with extreme obesity if previous therapies have not helped and further weight gain is to be expected.
How long do young people have to take the weight loss injection?
This is still open. It is known that adults often regain weight after stopping the medication. “Ideally, these children should be included in studies and also given long-term care in order to be able to identify possible risks that we may not yet know in detail today,” says Frank Jochum, chief physician at the Clinic for Pediatric and Adolescent Medicine at the Evangelical Forest Hospital in Spandau.
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What are the causes of extreme obesity?
Obesity is recognized as a chronic illness, but is often trivialized by laypeople as a weakness of the will. It arises multifactorially from genetic, psychosocial, familial and environmental factors. The exact connections between childhood illnesses are not clear. According to Weihrauch-Blüher, a role is played, for example, by which taste preferences are formed in the first year of life, for example whether a baby is given sweet drinks and porridge. Hormonal circuits that control hunger and satiety can also function differently in people who are overweight or obese. According to feedback to the doctor, one family only discovered through the weight-loss injection that “you can have a life without constant hunger.”
How can the problem be managed in the long term?
During regular examinations by the pediatrician, overweight and obesity are detected and possible therapeutic measures are discussed. Doctors also see politics as having a role. The planned sugar tax failed because of the food industry lobby, criticizes Jakob Maske from the board of the professional association of pediatricians and adolescent doctors (BVKJ). Even if parents try, the environment often makes it difficult for children to eat healthily. High-calorie snacks and sugary drinks are available around the clock in many places, including in or in the immediate vicinity of schools.
“There is no comprehensive program to bring children who have been diagnosed with overweight or obesity into a reasonable treatment structure,” criticizes Jochum. With more money for the prevention and treatment of childhood obesity, enormous follow-up costs could be avoided.
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