Doctors are prescribing Ozempic and other GLP-1 RAs to children

And what does this mean regarding our perception of free will and agency?

A few days ago NBC News released a short report highlighting two children who are taking GLP-1 RAs for obesity.

This story isn’t all too surprising given that the American Association for Pediatrics updated their guidelines for the first time in over 15 years to include recommendations for weight-loss medications such as Ozempic for those as young as 12, which was released in early 2023.

Nonetheless, it’s rather concerning that there was any sort of uptake in children being provided these medications to begin with. As noted in NBC’s article associated with the above video, around 4,000 prescriptions for Semaglutide (Ozempic and Wegovy) were provided to children between the ages of 12 and 17 in 2023 according to data collected from health analytics company PurpleLab.

As more people and as more children begin to look to these drugs as the new approach to obesity there comes serious concerns with how our relationship with food and our own health are being co-opted by pharmaceutical manufacturers.

There’s no denying that most foods available are intentionally addictive, and anyone who has put in an earnest attempt to lose weight can empathize with the difficulties of it all when it seems like you are doing your best but can’t seem to make a dent on the scale.

That being said, what has been happening in recent years is that any discussion around weight seems to obfuscate deep introspection with overarching narratives of “muh genetics” or other reasons as to why one is not losing weight. That is, even though we believe we are eating healthy it doesn’t mean we necessarily are.

This is due to the fact that many foods that may be listed as being healthful alternatives may be just as calorie-riddles as the processed stuff, or we may not be aware of the actual portions that we are eating. One thing that I have heard quite often is how people believe eating salads are a healthy choice only for these people to realize that just a few servings of a salad dressing can already tip someone over their daily calorie allotment. Just because you believe you are eating healthy doesn’t mean that you objectively are- talk about a relationship built on denial.

This may be even more true with children where perceptions of actual portions or the caloric nature of foods is not taken into consideration, with general assumptions made towards what is healthy.

With that, consider Demi’s story highlighted in the NBC video. When discussing all of the things that she did to lose weight she explains trying different sports while also commenting that she would do the same workouts and eat the same portions as her friends but they would be losing weight while she didn’t.

Now, what’s important with Demi’s story is that such a description doesn’t provide us much details. That isn’t to say that Demi and her family didn’t give an earnest attempt, but that we can’t really gauge what attempts were made. How extensive and strenuous were those sports activities, and what workouts were done, or how active of a lifestyle did Demi live prior to taking Wegovy?

One important thing to consider is that Demi draws parallels to friends who seem to have done well even though they had the same workouts and foods, but keep in mind that most of us don’t know what goes on in other people’s lives when we are not within their view. Or put another way, someone who may be perceived to be eating well in front of us may not be eating well in private.

This reminds me of a Reddit post from several years back in which a formerly obese person described how he and his best friend would constantly hang out and eat tons of junk food (think ordering tons of pizza and other takeout). Even though it seemed that they ate the same the poster was obese while his friend was skinny (or at least normal weight). Of course, this didn’t make sense to the poster, and when he asked his friend he realized that his friend would not eat that day knowing that they would pig out, or would do other things to offset the huge caloric intake. In contrast, the poster realized that he was still eating meals even after he had stopped hanging out with his friend. So what may have appeared as “eating the same” was in reality two completely different dietary habits, with one of excess and another of moderation.

To put it simply, our behaviors can’t be gauged or externalized to others because there are so many variables to take into account. Comparisons aren’t really effective if it leads us to pretend that we are doing things right when we may not be. We generally realize this when we see muscled-out social media influencers or actors in movies and are aware that they are likely on steroids no matter how much they pretend that they got their bodies through hard work and exercise. In the same way, we can intuit that people on My 600 Pound Life who swear that they are sticking to their diet but not losing weight are possibly snacking or lying about their actual dietary intake.

Most children are in a very precarious situation where they are malleable to any belief that they see around them. They are still finding themselves and look to others in order to gauge how they should perceive the world. If children are being told that they can’t do anything about their weight, or that it is out of their control then they may no longer consider that their weight is within their control, that they have the power within themselves to make the necessary changes, and to instead give up their autonomy to pharmaceutical manufacturers.

It doesn’t help that even Oprah Winfrey herself has been quoted as saying that it’s no longer about willpower, as noted in this article from USA Today:

"I was actually recommending it to people long before I was on it myself," Winfrey told People. "I had an awareness of medications, but felt I had to prove I had the willpower to do it. I now no longer feel that way."

With how influential Oprah Winfrey is what exact message does this send to all of her followers? That you don’t actually have the willpower?

And what do we make about articles such as the following from Business Insider, which also emphasizes the lack of willpower, and that we have no control over our desires or cravings (emphasis mine):

I was skeptical about last year's glowing articles about Ozempic and other GLP-1 medications. Like so many chronically overweight people, I'd seen it all and then some: stimulants, supplements, low-carb, low-fat, intermittent fasting, even laxatives. But these medications are nothing like what I expected. They're not really "weight-loss drugs" at all. They're something far more powerful and surreal: injectable willpower.

GLP-1s' increasing popularity won't just mean that millions of us who've beat ourselves up for being overweight will be able to win that lifelong battle. It will mean fundamentally reevaluating our conception of free will and human agency — and reckoning with our tortured relationship with shame.

So much of diet culture, of our culture writ large, belittles the choices we make about food. What happens, then, when a drug reveals that eating, gambling, and so many other behaviors aren't choices at all? Just like when Prozac dismantled the myth that depression is a choice, or when earlier scientific advancements disproved the idea that illnesses like cancer were moral indictments, GLP-1s and similar medications are changing our shared sense of what is blameworthy and what is biology.

So what does all of this teach our children? For those who are so concerned about shaming children is the answer to remove all sense of agency and autonomy from impressionable youth? For children such as Demi and Brenden what are they learning when they are given these medications and are being told they likely will have to be on them forever? Will they take steps to wean off of these medications and learn to garner a better relationship with food and their bodies, or will children be told that they have no control and must turn to drugs as a means to manage their vices?

And given that GLP-1 RAs are mimicking hormones, what exactly would be the long-term effects from using these medications, especially in developing children? Of course, incretin hormones don’t operate the same as sex hormones, but given that incretin hormones such as GLP-1 appear to have influences in many organ systems throughout the body shouldn’t some degree of precaution be taken in those still developing?

As we continue to question the ethics of the widespread use of these medications, there also lies a large incentive to prescribe these drugs to as many people as possible, and announcements made just today from Goldman Sachs seem to suggest that the more people who take GLP-1 RAs the quicker the economy will grow.

From Business Insider

The estimates don’t seem to be tied to revenue from prescribing these medications, but appear to be based on estimates made in reducing the obesity epidemic and the downstream reductions on healthcare burdens as well as the increase in productivity by employees.

Regardless, there’s a greater point to be made about how these drugs influence our perception of the world. Not through just our diet and lifestyle choices, but to what degree we are able to freely make our own choices, or if we may be compelled into believing that drugs and medications are the only way to better health. And more importantly, what does all of this tell us about what we are teaching children.

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