September 25, 2024 – As a psychiatrist specializing in eating disorders, Kim Dennis, MD, has seen firsthand the complex connection between obesity treatment and mental health in adolescents.
Now, as weight-loss drugs like Ozempic change into more popular, she worries she'll see more of those young patients.
“We haven't seen any patients yet, but I'm sure they're on the way,” said Dennis, a professor on the University of Illinois College of Medicine in Chicago. She can be co-founder, CEO and chief medical officer of SunCloud Health, an outpatient eating disorder treatment center in Illinois.
Dennis' concerns reflect a growing unease amongst eating disorder specialists as newer obesity drugs, so-called GLP-1 drugs, gain traction amongst adolescents.
The FDA has approved semaglutide (Wegovy) for weight reduction in adolescents ages 12 and older December 2022 and liraglutide (Saxenda) for ages 12 and up December 2020. One study found that the variety of adolescents prescribed GLP-1 for type 2 diabetes and weight control increased from 8,722 to 60,567 between 2020 and 2023 – an almost seven-fold increase.
“The number of young people taking these medications is increasing because they work,” said Dr. Suzanne Cuda, medical director of Alamo City Healthy Kids and Families, a weight management medical clinic in San Antonio. The drugs have been shown to treat type 2 diabetes, lower blood pressure and reduce the chance of heart problems.
“The younger you are, the better the outcome,” Cuda said.
But experts like Dennis have expressed concern about teens with eating disorders who're taking these medications or have developed a disorder while taking these medications.
In a recent one study,Nearly 80% of teens treated for obesity reported eating disorder symptoms. These included signs of binge eating and lack of control.
The randomized clinical trial, conducted from 2018 to 2023, examined 141 adolescents with obesity who performed interventions similar to low-calorie diets or intermittent fasting. Almost half said they were in danger for an undiagnosed eating disorder. At the top of the intervention, many continued to have eating disorder symptoms.
The results highlight a big challenge: balancing effective weight management with the chance of worsening or triggering eating disorders, said Hiba Jebeile, PhD, a nutritionist on the Children's Hospital at Westmead in Westmead, Australia, and lead writer of the study.
Adding weight reduction medications could make treatment even harder.
Treating Adolescent Obesity: Why Weight Loss Medications Are Different
How GLP-1 drugs affect adolescents in the long run just isn't yet clear.
Studies of GLP-1 medications in patients with eating disorders have shown mixed results. Some suggest that the medication is decreasing Binge episodes for those with Binge eating disorder or bulimia nervosa. But these studies checked out one thing small number of people and only short-term impacts were measured, while long-term outcomes and risks remained unknown.
Traditional treatments for eating disorders deal with regular eating habits, body acceptance, combating weight stigma, and improving perception of hunger and satiety signals.
GLP-1s, however, suppress appetite, alter metabolic signals and may inadvertently increase weight reduction as a primary goal, potentially making a mismatch between the goals of eating disorder recovery and the drug's biological effects, experts say.
“One of the concerns is the extreme calorie reduction this could cause [GLP-1s] in children and adolescents,” said Cuda, who cares for adolescents with eating disorders looking for GLP-1.
Unlike adults, adolescents expend calories not just for physical activity but additionally for growth and development. “You can’t catch up with this growth and development,” she said.
The National Eating Disorders Association expressed concerns concerning the possible misuse of those medications and their potential to worsen eating disorder behaviors in people at higher risk. This includes individuals with mental disorders or stress, dieters and folks who've experienced weight-related bullying.
Also in danger are patients with less obvious eating disorder symptoms, similar to picky eating, insomnia or sleep disorders or, in girls, irregular menstrual periods, Dennis said. These patients usually tend to go undiagnosed or be misdiagnosed. Research also suggests that folks of color are less more likely to be diagnosed with an eating disorder or receive specialized treatment.
Treating obesity is a critical option to screen and monitor eating disorders. But Dennis said that wasn't the case in every single place. Validated screening tools like this EDE-Q and the Revised Center for Epidemiologic Studies Depression Scale, 10-item version will help.
But regular check-ups together with your doctor during treatment are also vital, said Cuda.
Building your weight reduction management team
The Obesity Medicine Association (OMA) has emphasized the importance of a collaborative approach that features connections with psychologists and nutritionists who focus on eating disorders.
Consulting with an obesity medicine specialist may also be helpful, said Cuda, co-author of the OMA statement. “It is impractical to expect a GP to do everything: screen for nutritional disorders, provide comprehensive nutritional advice and follow up on activities.”
Bottom line: Focusing on healthier lifestyle habits (versus restrictive diets) is the most effective approach, the experts said.
“I think a weight-independent approach, where the focus of care is not on weight loss but on improving health-protective behaviors and dietary intake, is safest for all children,” Dennis said, “particularly those with eating disorders or risk factors for.” Eating disorders.”