Table 1.
Possible unintended consequences of supervised or unsupervised use of oral GLP-1 receptor agonists in children and adolescents
| Adverse effect | Reason for concern |
|---|---|
| Long-term consequences on growth and development | Balance of energy intake and energy expenditure modulate critical growth hormones such as GH and IGF-1. The appetite suppressant, anti-hedonic, and fatigue effects of the GLP-1RA may alter this balance during critical periods of growth and development. |
| Abuse among patients with diagnosed eating disorders | Pediatric-aged patients (male and female) with eating disorders are known to abuse appetite suppressants. |
| Abuse among children and adolescents in certain competitive sports (e.g., wrestling, martial arts, gymnastics, ballet) | Children and adolescents involved in school, club, or community sports like wrestling or gymnastics where body weight is a competitive factor are known to engage in unhealthy behaviors to accelerate weight loss. |
| Unsupervised use for unwarranted self-perception of obesity and overweight, particularly among female adolescents | Inaccurate perception of being overweight in healthy-weight adolescents result in unnecessary weight control behaviors [29]. In children and young adults, supplements sold for weight loss, muscle building, and energy were associated with almost three times the risk for severe medical outcomes compared with vitamins [30]. |
| Excessive or insufficient medical prescription in populations with high prevalence of obesity and poor fitness | Pediatricians have little or no formal training in effective ways to deal with obesity, overweight, or poor physical fitness in their patients. Short-term effectiveness and convenience of drug prescriptions may be well intended but lead to untested effects when used for longer duration during critical periods of growth and development. |
| Distorted cost-benefit relationship of long-term use in youth |
|