Guidelines Backlash, the Biggies — Drugs, Part 1

Now that the American Academy of Pediatrics has recommended weight-loss meds for teens and maybe even children, what kind of pharmaceuticals are we talking about here? For starters, only six medications have been approved by the Food and Drug Administration specifically for weight loss, and for long-term use in that capacity. Their generic names are semaglutide, liraglutide, orlistat, phentermine-topiramate, bupropion-naltrexone, and setmelanotide. The first two are the ones we hear the most about.

They are GLP-1 agonists, which means they all work by imitating a natural hormone called glucagon-like peptide-1. In other words, GLP-1 works on areas of the brain that regulate appetite and food intake. Semaglutide and liraglutide can control diabetes, but also incidentally are able to reduce obesity, and they can legitimately be prescribed for either case. So far, they are the only two of the GLP-1 agonists that are officially approved to treat obesity in people who do not have diabetes, and even then the green light is brand-specific.

Liraglutide is administered by daily subcutaneous injection. Its ability to bring about weight loss of around 7% over a year has been called “significant.” Semaglutide can be taken by mouth daily, or injected weekly, and is also useful against other endocrine disorders like insulin resistance, metabolic syndrome, and pre-diabetes.

Several other anti-diabetes drugs in this class can also facilitate weight loss, but their use for that purpose is described as “off-label” because it is not really what they are primarily authorized for. They are administered by injection weekly or daily, and one is even a twice-a-day shot.

Dr. M. Regina Castro explains how these drugs “mimic the action of a hormone called glucagon-like peptide 1.” When blood sugar goes up, they stimulate the body into producing insulin to lower the blood sugar level. They curb hunger by slowing down the movement of food from the stomach to the small intestine. Subjectively, many patients feel “full” more quickly, and hold out for longer without becoming hungry again. This type of drug also acts on the brain, and is often very effective in reducing appetite.

The drugs that are FDA-approved were actually tested on humans as young as 12, and are said to be “just as effective and no more dangerous in children than in adults.” Of course, there are caveats. Along with medication, the AAP also recommends eating sensibly and getting a reasonable amount of exercise, because no anti-obesity medication is going to work by itself when the person continues to take direct action against it. It requires a certain amount of cooperation. This aspect raises some serious questions.

The meds work by convincing the body that it no longer feels hunger; that the stomach is full and that there is no rational need to put any more food into it. But what if the person is just engaging in “recreational eating,” or “eatertainment”? What if the pleasure they feel is derived not from a full stomach, but from the sensations of chewing and swallowing, which can theoretically be engaged in for 16 hours per day, regardless of how full the stomach purports to be? To put it bluntly, what if the emptiness is not physical but emotional?

Your responses and feedback are welcome!

Source: “GLP-1 agonists: Diabetes drugs and weight loss,”, undated
Source: “An Aggressive New Approach to Childhood Obesity,”, 01/26/23
Image by ZaldyImg/CC BY 2.0

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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