Off-label GLP-1 prescribing reaches one in eleven US children aged 8 to 11 with obesity

A rise from 0.03 per cent to 9.3 per cent is a factor of about 310 since 2019 ^[21], and the current share works out at roughly one child in eleven ^[22]. Babak Orandi's study counts prescriptions. It reports which children are getting the drugs and what conditions travel with the prescription ^[6].

The effect estimate comes from elsewhere: Novo Nordisk reported that 40 per cent of 6-to-12-year-olds with severe obesity on weekly injections were no longer classified as having obesity after 68 weeks ^[3]. That is about 16 months ^[23], and 60 per cent of them were still classified as having obesity when it ended ^[24]. The endpoint is a classification threshold crossed. What happens to a body taking these drugs while it grows and goes through puberty is not known ^[13].

There is already one near-term signal in the literature. A recent study found the medications increased children's risk of iron and other nutrient deficiencies, because they eat less ^[14]. Danielle Longmore of the Murdoch Children's Research Institute in Melbourne told New Scientist: "We know from other health conditions that if you're not gaining weight or if you're not well-nourished as a child, it can stall growth and delay puberty" ^[15]. On the effect on strength and bones in later life, she said, "We haven't really thought that far ahead" ^[16].

The case for treating rests on the untreated course. Childhood obesity is associated with depression and low self-esteem, and it raises the later risk of heart disease, type 2 diabetes and liver disease ^[10]; New Scientist cites an estimate that severe obesity before the age of 4 cuts life expectancy by up to 42 years ^[11]. Orandi said: "It's still an open question as to what the effects are of GLP-1 drugs on children's development and we don't really know what that looks like yet, but we do know what it looks like for kids with obesity, and the risk of not treating is real" ^[18].

Cost shapes who is in the data. Orandi found that families of children given these off-label prescriptions tended to be richer ^[6], and he said the treatment "can be hundreds of dollars a month" ^[7]. The children accumulating the first years of exposure are not a cross-section of children with severe obesity.

Children, like adults, often regain weight when they stop taking GLP-1 drugs ^[20]. A child started at 8 who stays on the drug to hold the loss will be taking it through puberty. No published study has followed that. New Scientist's account gives no participant counts for the New York University study or the Novo Nordisk trial ^[25].

Longmore thinks the UK and Australia have a case for extending access below 12 in severe cases. "I think that would need to be a very considered decision, but there might be some young children whose health risks are so great at the moment that it's probably worth giving these medications a try," she said ^[17].