Weight-loss drugs for children: Breakthrough or cause for caution?

So, how significant is this result? In India, where childhood obesity is an escalating problem, a 40.4 per cent reduction to below the obesity threshold is clinically meaningful. This is particularly important because many children with severe obesity are already on a trajectory toward early-onset Type 2 diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD), hypertension, polycystic ovarian syndrome (PCOS) and premature cardiovascular disease. Achieving substantial weight reduction within roughly a year, particularly in children with severe obesity, may alter their long-term metabolic trajectory and in fact, change their life completely. However, sustained benefits will depend on maintaining healthy behaviours and appropriate long-term management.

Even in the trial, both the semaglutide and placebo groups received a reduced-calorie diet and increased physical activity. Because both groups received lifestyle intervention, the difference between the groups largely reflects the additional effect of semaglutide. The substantial difference in weight reduction, therefore demonstrates that semaglutide can provide an important incremental benefit when added to lifestyle measures. However, lifestyle modification remains fundamental. Children need to develop sustainable eating, activity, sleep and behavioural habits; medication should complement these changes, not replace them.

The bigger question is whether pharmacological treatment should be begun at such a young age, particularly in children aged 6 to under 12? In carefully selected children with severe or clinically significant obesity, pharmacological treatment may help interrupt the progression toward adolescent type 2 diabetes, hypertension, fatty liver and other obesity-related complications. It may also improve physical functioning and reduce some of the psychological burden associated with severe obesity, including weight-based bullying and social stigma which may result in mental stress and depression.

The key concern about pharmacological treatment in primary school-aged children raises legitimate questions about long-term safety, effects on nutrition and development, duration of treatment, affordability and access. There is also a risk of medicalising obesity without adequately addressing the family and environmental factors that drive it. In India, the high cost and limited availability of these therapies mean that they are currently inaccessible to the vast majority of families. Cost consideration is particularly important given the possibility of long term therapy.

The available clinical trial data are reassuring, with no major adverse signals regarding growth or pubertal development over the relatively short period studied (68 weeks). However, these data cannot answer questions about decades of exposure, and long-term surveillance remains essential. Nutrition deserves particular attention in India because obesity can coexist with micronutrient deficiencies — the so-called double burden of malnutrition. Semaglutide markedly reduces appetite and food intake, so adequate intake of protein, micronutrients and other essential nutrients must be ensured during periods of rapid growth, when linear growth and acquisition of peak bone mass are especially important. Such attention to nutrition must continue during treatment and when treatment is being withdrawn.

For Indian parents, where cultural perceptions have sometimes equated a chubby child with a healthy child (hata-katta bachcha), a fundamental change in mindset is needed. The focus should be on improving metabolic health, physical fitness, nutritional quality, psychological well-being and sustainable behaviour. Management should therefore be comprehensive: appropriate assessment of glucose metabolism, lipids and liver health; improvement in physical activity and fitness; adequate protein and micronutrient intake; reduction in excessive screen time and ultra-processed foods; and attention to mental health. Most importantly, childhood obesity is a family and environmental problem. Parents need to modify household eating and activity patterns alongside the child.
Medication may have an important role in selected children with severe obesity, but it should be viewed as one component of a broader, long-term treatment strategy, not a substitute for healthy family habits.

(The author is Executive Chairman, Fortis C-DOC for Diabetes, Metabolic Diseases & Endocrinology, New Delhi)