A 12-year-old’s journey into the world of weight-loss drugs
A mother in the US found success with a weight-loss drug after a lifelong battle. Noticing her daughter start down the same path, she decided to have her try semaglutide.
Kait Handler spent much of her life in a battle with food noise.
It started in childhood when she would “shame eat” packets of Devil’s Food cookies after school and hide the wrappers. As an adult, she stewed over whether to order a salad or a cheeseburger for lunch.
When her daughter, Birdie, started exhibiting similar behaviours around age eight, she recognised them right away. She noticed Birdie would fixate on the promise of particular foods, like ice cream, and get upset when she couldn’t eat them. She watched her regularly eat adult-size portions at meals and ask for seconds. She heard her make negative comments about how she looked in her clothes. It felt familiar.
Handler started keeping a closer eye on what Birdie was eating, enrolled her in therapy, encouraged her to walk more in their New York neighbourhood and eventually sent her to weight-loss camp. Even while she was encouraging her daughter to be healthier, she felt bad about the way she was doing it.
“The real difficult part about being a woman is then having a child that’s also going to be a woman and realising all of the messed-up internalising that you’ve done,” says Handler, 40. “I started getting a lot of anxiety about her ending up like me.”
Handler was still dealing with her own weight struggles. After having ramped up her exercise routine and trying multiple diets, including ketogenic, WeightWatchers and Whole30, she felt she had exhausted her options.
She went to her primary care doctor and asked about taking a GLP-1, the class of diabetes and weight-loss drugs known for brand names like Ozempic and Wegovy.
Handler, who has worked in e-commerce but now is looking for a job, couldn’t afford to pay $1000 or more a month for the drug, which she says her insurance didn’t cover. She looked into less-expensive compounded versions, which are custom, non-FDA-approved versions of drugs made by special pharmacies. Properly compounded drugs are legal and the pharmacies are largely regulated by state licensing boards. The FDA has warned about risks with compounded versions of the drugs, as well as counterfeit versions, which are illegal.
She began taking a compounded version of tirzepatide, the active ingredient in Mounjaro and Zepbound drugs, in March, and by November had lost roughly 75 pounds (34kg).
As her shame and fixation around food melted away, she began wondering if a similar drug could help Birdie, who was 12 and in the 98th percentile for weight.
‘Almond mums’
In December 2022, the Food and Drug Administration approved Wegovy for weight-management in adolescents ages 12 and older with obesity, defined as having a BMI at or above the 95th percentile for their age and sex.
In January 2023, the American Academy of Pediatrics recommended doctors take a more aggressive approach on childhood obesity, advocating for early and intensive treatment, including weight-loss drugs. Roughly one in five US children and adolescents have obesity, and such children are generally unlikely to grow into healthy-weight adults, research shows.
Pediatric use of GLP-1 drugs — which the manufacturers and most doctors say are intended for long-term use — has led to an intense, high-stakes battle in children’s health.
More than 30,000 adolescents between the ages of 12 and 17 were dispensed brand name and compounded GLP-1 medications last year, according to an analysis by University of Michigan researchers. Of that group, 60 per cent were female.
Data from healthcare research firm Iqvia show that prescriptions of compounded and brand-name semaglutide for those age 19 and younger have nearly doubled in the first three quarters from the same period last year. That age group still accounts for less than 1 per cent of total market use in the most recent quarter.
Roughly 65 per cent of parents of children with weight-related issues say they are interested in having their kids use GLP-1s, if available, according to a Morning Consult poll of more than 4000 parents conducted a year ago. Some parents are trying to spare their kids the bullying and shame they themselves felt as overweight children. Others are trying to help their kids lose a few pounds before prom.
Karla Lester, a pediatrician and board-certified obesity medicine physician in Nebraska who runs a telehealth service in 15 US states for paediatric obesity medicine and coaching, says she regularly hears from “almond mums” and “diet culture dads” who want to get their healthy-weight kids and teens on these medications. Parents of children as young as nine have messaged her, she says.
Lester recalls one mum telling her: “My daughter is size six. She’s body confident. She has friends, she’s very active, but I can’t help but think she would be better at a size 0.”
In many cases though, doctors say these drugs offer kids with obesity a chance at a healthy future they wouldn’t otherwise have by helping them stave off health conditions such as diabetes and heart disease that are striking Americans at younger ages. Still, many paediatricians are hesitant to prescribe the drugs to kids, citing a lack of knowledge of their side effects, a dearth of long-term safety data and concerns over adolescents getting adequate nutrition while taking the drugs. Some doctors, including Lester, are especially wary of compounded versions, because their safety and efficacy aren’t verified by the FDA, and they may contain different amounts of active ingredients than brand name versions.
When doctors won’t prescribe the drugs for children, some parents turn to telehealth providers, which are staffed with doctors, nurse practitioners and others who can prescribe the drugs, including compounded versions.
That has created more concern about medical risks because some doctors say the drugs need to be carefully dosed and their effects monitored. Most telehealth firms don’t require physical assessments and laboratory testing at follow-up visits.
Mochi Health, the telehealth obesity clinic Handler initially joined, says many medications don’t require close monitoring of patients and that parents are largely honest about providing assessments of their children.
‘Felt bad about myself’
Birdie remembers watching the Nickelodeon comedy “iCarly” when she was eight years old and fixating on Sam, Carly’s loyal sidekick, whose food obsession is a long-running joke on the show. Birdie started comparing her own body to what she saw on the screen.
“That was when I first learned that I had a bigger body type,” says Birdie. “And then I felt bad about myself.”
Feelings of shame, compounded by compulsive eating habits, followed. She started hyperanalysing lunch purchases at the school cafeteria: would her friends judge her for ordering something unhealthy because of her weight? If she didn’t order it, would they think it was because she was worried about being perceived as fat?
A classmate made fun of her size. One morning at school drop-off, Birdie regretted selecting shorts to wear and refused to get out of the car, Handler recalls.
Still, Birdie says, she bought a dessert every day. Sometimes, she bought a second lunch in addition to the one she packed. She’d eat an entire bag of popcorn at the movie theatre and feel sick after, Handler recalls.
As a parent, it was hard for Handler to watch her daughter develop shame about her body while also fixating on food — the obsessive thoughts about what and when to eat called “food noise”. Handler, too, had ruminated over food choices and had felt ashamed. As a child, Handler’s parents sent her to a weight-loss camp for at least five summers. She says the camp experiences were fun and helped her, though her fraught relationship with food continued.
When Handler floated the idea of sending Birdie to a similar camp, her husband protested: What if Birdie thought they were telling her something was wrong with her body? What if there were psychological repercussions? But on one tearful day for her daughter, Handler decided the pros outweighed the potential cons. She showed Birdie a video taken from her own time at camp. “I was like, ‘Let me show you this video of me at your age, having the same experience you’re having now. I promise I know how you feel’,” Handler says.
The summer of 2023, Birdie went. She lifted weights, learned about nutrition and took hours of Zumba classes. She lost weight but gained it back months later.
Early this year, Handler took Birdie to see her pediatrician about prescribing a GLP-1 drug. The doctor said she felt uncomfortable prescribing the medication, Handler says. The pediatrician referred the family to a pediatric endocrinologist, whose office said there were no indications that she needed to come in for treatment. Birdie wasn’t diagnosed with diabetes or prediabetes, but her “bad” cholesterol levels were high, according to the results of blood work taken in June.
This summer, she returned to camp. At 5-foot-1-inch (156cm) tall, Birdie weighed 161.5 (73kg) pounds before the session, putting her in the 98th percentile for girls her age. At camp, where she says she was publicly weighed each week, she lost 17 pounds.
But that only put her into the 96th weight percentile. To help Birdie maintain the loss and ease the food noise in her head, Handler made an appointment with Mochi, the telehealth clinic that she had initially joined herself, to get a GLP-1. (Handler’s own prescription is now filled directly by a compounding pharmacy.)
A week or so later, a shipment of compounded semaglutide, the active ingredient in Wegovy and Ozempic, arrived at their door.
Birdie was sceptical. What if her parents spent time and money on something that didn’t help her? Handler assured her daughter that she could stop taking the drug whenever she wanted. After experiencing considerable weight loss herself, Handler wishes she’d had a drug to help her as a child. “She’s struggling with her own self-worth and this could alleviate those issues,” says Handler. “Why wouldn’t I give her the tool that she would need to do that?”
Patient protections
Some doctors and mental-health experts worry that beginning these drugs at such a young age could contribute to disordered eating, metabolic disorders and a host of other potential health problems that they don’t even know about yet.
A team of researchers at the University of California, Irvine raised alarms in a journal article about the use of such drugs among adolescents.
Dan Cooper, the paper’s co-author and a pediatrics professor at the University of California, Irvine, worries that teens won’t get the nutrition necessary for bone growth because the drugs make people feel full and eat less. He also worries that teens won’t feel the need to exercise if they see their weight drop.
“We know that if you don’t have sufficient bone mineralisation between age 11 and your mid-20s, it’s extremely hard to add new bone mineral,” Cooper says. “During that critical period the things that will determine your bone mineralisation are nutrition and exercise.”
Often, doctors say, it’s parents who are pushing for the drugs for their kids.
Minisha Sood, an endocrinologist and obesity medicine doctor in New York City, says she has had a mother call her office every week for a month asking her to put her daughter back on a GLP-1. The girl had been taken off the medication because she started showing signs of restrictive eating.
“Parents are not always on board with what would be medically best for the patient, because of their own disordered eating pattern,” Sood says.
Tom Hildebrandt, chief of the eating- and weight-disorders program at the Icahn School of Medicine at Mount Sinai Hospital in New York, says that since January, he has been seeing about one new teen patient a month who wasn’t overweight but who took the drugs — either from their own prescription or from a parent’s prescription — for the purpose of losing a few pounds before prom or another special event.
The teens were brought to him after losing so much weight that they experienced starvation syndrome, a cluster of physical and psychological symptoms that occur when malnutrition forces the body to adapt, slowing digestion to a point where it becomes painful to eat. The teens now are in treatment for anorexia nervosa, Hildebrandt says. Some mental health providers and pediatricians say the medications, when prescribed with continuous oversight from a doctor who knows them well, have the potential to be lifesavers.
“I’m all for kids having the most tools in their tool kit that can help them be their healthiest,” says Melissa Santos, who heads the pediatric psychology division at Connecticut Children’s and specialises in pediatric obesity treatment. “Obesity as a disease impacts kids in multiple ways and we have to, as a result, treat kids in multiple ways.”
In Birdie’s case, her father says the drug has eased the friction that tends to develop between parents and children over weight battles, removing the need for emotional discussions about eating.
Virtual visit
Shortly after returning from camp this summer, Birdie had her virtual visit with Mochi.
A doctor prescribed Birdie compounded semaglutide based on records Handler provided about Birdie’s health and weight, Handler says. Birdie’s family paid $79 a month for her Mochi membership and an additional $99 a month for the medication.
Patients are required to have check-ins with Mochi’s medical providers at least every 90 days, says Myra Ahmad, a physician who founded Mochi in 2022. Mochi doesn’t independently verify patients’ reported weight or require laboratory results, she adds.
“It’s a live video visit,” says Ahmad, who isn’t board-certified in obesity medicine. “You can tell.”
Birdie began taking the drug in August. She says she has maintained her weight loss from camp and has lost roughly 10 more pounds, which has dropped her to the 94th percentile.
She feels more confident in her clothes and says the only side effect has been mild nausea the day after taking the weekly shot. She says she doesn’t have as much compulsion to buy and eat extra food, for example at school lunch, and feels more in control of her decision-making around food.
In late October, Handler received a message on the Mochi platform informing her that the age threshold was changing to 13 instead of 12. “Unfortunately you are not/no longer eligible at this time,” the message read. Birdie will turn 13 in March.
Ahmad says the change was due to the difficulty of complying with the Children’s Online Privacy Protection Act, which is meant to restrict companies from collecting and disseminating children’s personal data. She says the company plans to roll out a new pediatric practice for kids as young as six up to 12 if and when the FDA approves GLP-1s for that age group.
In the meantime, Handler is scrambling to keep Birdie on the medication through another telehealth platform.
“When I look at myself, I don’t have as much shame as I did before,” Birdie says. “The happier I get, the sadder I’ll be when I’m not happy anymore.”
The Wall Street Journal
