The Harsh Impacts of New Dietary Drugs Promoted To “Conquer Obesity” Are Raising Concerns Among Adolescents
The recent flood of controversial weigh-loss pharmaceuticals will help adolescents shed the weight they so desperately want to lose, but psychologists worry that the emotional damage such quick-fix and artificial remedies might have is troubling at best and dangerous at worst.
In December of 2022 the Federal Drug Administration approved four different weight-loss-drugs for use on children as young as 12. Two of these pharmaceuticals, Wegovy and Saxenda, belong to an increasingly popular new class of injectable appetite suppressants designed to combat obesity and treat diabetes. And although decades of research show that weight-loss-drugs can help tackle the severity of physical conditions associated with obesity, nutritionists and dieticians worry that the psychological conditions are being ignored, particularly in children.
“We have a really big problem [of] engaging with young people and suggesting that their bodies are inherently problematic,” says Anna Sweeney, a certified dietitian who specializes in treating eating disorders. “We should be talking about the social determinants of health.”
Sweeney, known as “@dieticiananna” on social media, has acquired an online following of more than 132,000 people who interact with what she terms body-positive content. Some are clients that have personally worked with Sweeney at her center, Whole Life Nutrition, located in Concord, others simply find truth in her belief that larger bodies can be just as healthy as smaller ones. This notion, however, is at the heart of the dispute between researchers and advocates.
“Obesity is a biological and genetic condition that is simply impacted by external factors,” says Eric Bomberg, an assistant professor of pediatrics and core faculty member of the Center for Pediatric Obesity at the University of Minnesota. “Anti-obesity medications are the biological treatment for the biological condition of obesity.”
Bomberg is referencing a 2018 statement released by The Obesity Society that classified obesity as a chronic disease. Weight-loss pharmaceuticals, from this standpoint, are simply necessary to target the comorbidities associated with obesity. And according to many scholars in the field, pills and injections are more productive to weight loss than the routines we associate with healthy living.
“Evidence has shown that lifestyle modifications alone are generally ineffective at being durable solutions for weight loss,” says Bomberg, whose research has been driven by his own struggles with obesity and extreme childhood weight loss. “The medication is meant to help modulate biologically driven signals to make the entire process more efficient.”
Regardless of treatment options, most dieticians and nutritionists agree with Bomberg’s deduction of genetic causation. Jill Castle, a renowned pediatric dietician and author who founded “The Nourished Child,” an educational website that assists parents in the pursuit of raising a healthy child, agrees that weight is largely predetermined. But unlike Bomberg, she doesn’t deem heavier bodies inherently unhealthy.
“There will be children that are just going to be larger in size because genetically they’re determined to be that way,” says Castle, who is well known in the nutrition community for a TEDtalk she gave in October of 2017 where she discusses the struggles she faced when learning how to feed her own daughter. “Rather than focusing so much on the size of the child, really focus on daily habits that are enjoyable and beneficial to a growing child’s health and well-being.”
Castle points out that children, as opposed to adults, are still growing. Adolescence is a time in which a body develops faster than it will ever again. But researchers like Bomberg don’t see the value in waiting around for a child’s weight to return to a neutral number. He acknowledges that a significant amount of research must be conducted in order to study the long-term ramifications of weight-loss pharmaceuticals, but the immediate risk of conditions like hypertension, specific hyperlipidemia and high cholesterol must be attended to before they become life-long battles.
“We definitely know that pediatric obesity carries a lot of risks for future health related complications,” says Bomberg, when questioned about the lack of research on the long-term repercussions of weight-loss medication. “On the flip side, we certainly do know what the long-term complications of not treating obesity are.”
Anna Sweeney, who has spent over a decade working in residential eating disorder treatment facilities, has seen the consequences of a society obsessed with waist size. Sweeney, who has spent her career combating the notion that a person’s weight is their main determinant of health, feels concerned that the draw of a “miracle cure” or “quick-fix” for weight-loss might be too hard for adolescents to resist.
“Frankly, my clients are seeing these advertisements and feeling frightened because they are so appealing,” says Sweeney. “When well-meaning adults suggest that changing body shape and size is going to provide the cornucopia of pleasant body experiences, [they] are ascribing to the idea that diverse bodies are a problem, and that in itself is a problem.”
Becca Fritz, a 33-year-old social media professional from Cambridge, has been working with Sweeney for 10 years. Fritz suffers from Avoidant Restrictive Food Intake Disorder. ARFID, as related by Fritz, is not so much focused on the fear of gaining weight as it is a sensory aversion to food and drink. Fritz says that her issues began in early childhood, and despite multiple pediatric interventions, resulted in years of nutritional deficiency and dehydration.
“I would go for weeks at a time only eating a single food,” says Fritz, who remembers a month where she refused to eat anything but stove-top stuffing. “It would become really dangerous.”
At age 19, Fritz began obsessively searching for a medical answer to her problems. If there was something that would curb her appetite or make her feel full, Fritz might not spend all day agonizing about her next meal and the circumstances surrounding it. She eventually settled on an extremely inaccessible, equine-specific medication that the dark web promised would offer relief. The medication almost killed her. Fritz can remember the fervor in which she searched for and attained this medication, and if adolescents in 2024 can get their hands on similar drugs with only a fraction of her ambition, Fritz worries that the temptation might be too strong.
“If you told me as a kid that I could have a medication that would make me not aware of my appetite and lose weight, it would have been a no brainer for me,” says Fritz. “The list of crazier things I’ve done in search of weight loss is quite long.”
Estimated to be worth over $100 billion by the year 2030, the global market for weight-loss drugs is growing exponentially each day. A report released by Trilliant Health found that prescriptions for weight-loss drugs quadrupled between 2020 and 2022, and with only half of these prescriptions written to treat diabetes, it’s clear that individuals who don’t need prescribed treatments continue to seek them out. Sweeney blames, in part, the commercial advertisements that make it nearly impossible to remain unaware of drugs like Ozempic and Wegovy.
“I have clients who are entertaining medications like this because they are elevated as a holier than thou solution,” says Sweeney. “I would love to be put out of a job, but these organizations and companies are going to guarantee that I remain a necessary human.”
Rampant advertisement, while certainly detrimental, is only half of the issue. Nutritionists and dietitians say that the way in which these pharmaceuticals are represented is causing confusion and leading to uninformed decisions. Caitlin Danz, a registered dietitian, nutritionist, and certified LEAP Therapist, spent years working with families in Boston who struggled with implementing healthy habits. Danz knows what it’s like to spend extended periods of time with the same client, and she knows from experience that weight loss isn’t instant.
“It seems like we just keep putting Band-Aids on things,” says Danz, who now offers a multitude of personalized nutrition services out of her studio in Roslindale. “It [takes years] of the whole family participating to see changes, but those [changes are] sustainable.”
Regardless of how commercials aim to portray weight-loss drugs, there is important information that advertisers neglect to publicize. Becca Fritz was prescribed Ozempic this past spring after three courses of steroids, prescribed for an unrelated matter, caused her blood sugar to elevate into the diabetic range. She tried her best to make the medication work, but the physical side effects became too prominent to ignore.
“I tolerated vomiting multiple times a day for eight weeks until I put my foot down and told my endocrinologist that we have to figure out another way,” says Fritz. “As a kid prescribed that medication, I absolutely wouldn’t have stopped after the eight weeks. I would have done anything I could to make the people around me happy because that’s what they were saying was best for me.”
During and after these eight weeks, Fritz was struck by how little information on Ozempic’s potential side effects was available online. She found social media to be overwhelmingly positive, promoting hundreds of success stories touting the benefits of the drug but none that represented her adverse experience.
“When you’re looking at a medication where people are wrongfully not informing you of the short and long-term risks of the drug because their motivation is to ‘conquer obesity,’ it’s so dangerous,” says Fritz. “I was inundated with all these positives … [and] it completely drowned out any talk about the side effects.”
No matter what research these next few years bring, it is hard to imagine any overlap between the medical and nutritional approach to weight loss. Doctors and dieticians finally agree that weight is genetically predetermined, but one group believes that larger bodies are inherently unhealthy while the other does not. Psychological issues surrounding eating will exist until society destigmatizes fatness, but the increasing accessibility of weight-loss-drugs is significantly lowering the threshold of who is looking for them.
“I don’t know what it is like to live in a fat body,” says Sweeney, “but I do know that it is dangerous and oppressive as f**k.”