Weight Loss Drugs for Kids: Breakthrough or Ethical Minefield?

In 2023, the American Academy of Pediatrics (AAP) made headlines when it issued updated guidelines recommending that children as young as 12 years old could be considered for anti-obesity medications—marking a historic shift in how childhood obesity is treated in the United States.

Since then, the pediatric use of weight loss drugs has expanded rapidly. But as prescriptions rise, so do concerns—from pediatricians, ethicists, and parents—about safety, side effects, stigma, and the very definition of “healthy” in young bodies still developing physically and emotionally.

Which Weight Loss Medications Are Being Used in Children?

Here are the primary FDA-approved medications and those used off-label in children and adolescents for weight management:

? FDA-Approved for Pediatric Obesity (as of 2025):

1. Orlistat (Alli, Xenical)

   • Approved for ages 12+.

   • Works by blocking fat absorption in the gut.

   • Common side effects: gastrointestinal discomfort, oily stools.

2. Liraglutide (Saxenda)

   • Approved for ages 12–17 since 2020.

   • GLP-1 agonist, reduces appetite.

   • Side effects: nausea, vomiting, possible thyroid C-cell tumors.

3. Setmelanotide (Imcivree)

   • Approved for rare genetic obesity disorders in children ≥6 with POMC, LEPR, or PCSK1 deficiency.

   • Not for general pediatric obesity.

4. Semaglutide (Wegovy)

   • Approved for adolescents ≥12 years in 2022.

   • Weekly injection, widely known due to Ozempic for adults.

   • Side effects include GI symptoms, potential pancreatitis, and unknown long-term effects in teens.

? Not Approved but Commonly Used Off-Label:

5. Phentermine (Adipex-P, Lomaira)

   • Sometimes prescribed to adolescents 16+, but not officially approved for pediatric use.

   • Stimulant; suppresses appetite.

   • Side effects: insomnia, heart palpitations, dependency risk.

6. Topiramate + Phentermine (Qsymia)

   • Used off-label in teens despite lack of FDA approval for under-18s.

   • Associated with cognitive side effects (brain fog, depression) and birth defect risks.

7. Metformin

   • Approved for type 2 diabetes in children; used off-label for weight control, especially in PCOS.

   • Less effective for weight loss but often safer.

The Medical Debate: When Is It Too Soon?

Obesity affects roughly 20% of U.S. children, according to the CDC. With rising rates of type 2 diabetes and fatty liver disease in adolescents, many pediatricians say inaction is no longer ethical.

“We’re not just treating weight. We’re treating metabolic disease, depression, bullying, and early death,”
says Dr. Sandra Miller, pediatric endocrinologist at Boston Children’s Hospital.

But critics argue that prescribing lifelong medications to children raises red flags.

“These drugs affect the gut-brain axis. What happens when we alter that at age 12?”
asks Dr. Jonathan Reyes, pediatric neurologist. “We have no long-term data on semaglutide use beyond 2 years in adolescents.”

Side Effects in Children: Early Findings

Initial data show that children experience similar side effects to adults, though with more emotional sensitivity and growth considerations:

• Semaglutide and Liraglutide:
  GI symptoms (up to 65% of users), headaches, early satiety. Some teens reported food aversion severe enough to affect family meals and social life.

• Stimulants like Phentermine:
  Increased anxiety, irritability, sleep disturbance. Parents report mood swings, appetite suppression, and—at times—depression.

• Social Impact:
  Early anecdotal reports suggest a link between weight loss and disordered eating behaviors emerging post-treatment. The fear of weight regain leads some teens into restrictive or obsessive eating.

Equity and Access

Most insurance plans do not cover anti-obesity medications for children unless there is a documented comorbidity. As a result, wealthier families are more likely to access Wegovy or Saxenda privately—raising serious concerns about healthcare equity.

In many states, Medicaid coverage is inconsistent or nonexistent for these drugs in teens. AAP and advocacy groups are pushing for broader access—but critics argue that systemic change (healthy food, physical activity, mental health support) should come first.

What Do Parents Think?

Some parents see weight loss drugs as a last resort. Others see them as a miracle.

“My daughter couldn’t run 50 yards without gasping. Now she bikes to school,”
says Tamika Johnson, whose 14-year-old has been on Saxenda since 2023.
“But yes, she threw up for the first few weeks. And she’s afraid to eat pizza with friends.”

Others, like Michael R., regret the decision:

“We gave our son Wegovy. He lost weight. But he also became anxious, withdrawn, and lost 15 pounds of muscle. He’s 15 years old.”

Conclusion: A Delicate Balancing Act

The rise of weight loss drugs in children is a frontier of medicine—but also a minefield of developmental ethics, data gaps, and societal pressure.

For now, doctors urge caution, monitoring, and individualized care.

“These drugs are not magic,”
says Dr. Miller.
“They are tools. And in children, tools must be used with surgical precision—not marketing enthusiasm.”

Key Takeaways:

• FDA-approved pediatric obesity drugs include Orlistat, Liraglutide (Saxenda), Semaglutide (Wegovy), and Setmelanotide.

• Semaglutide (Ozempic/Wegovy) is increasingly prescribed to teens, raising concerns about long-term safety.

• Side effects include GI distress, mood changes, possible disordered eating.

• Insurance and access remain uneven.

• Pediatric use must be approached with caution, monitoring, and family education.