Two Recent Childhood Obesity Studies in the Spotlight

We’ve been focusing recently on advertising to kids and the GLP-1 weight-loss drugs in the news, but what’s going on in the world of childhood obesity research? Most notably, two recent studies reveal the worsening of severe childhood obesity and cast doubt on one of the AAP-recommended guidelines. Let’s take a look.

A WIC study shows an obesity rate rebound to 2020

Last December, Fortune reported that a recent study published in Pediatrics indicates that severe obesity is becoming more common among young children in the United States. While previous research had shown a slight decrease in obesity rates among children enrolled in the Women, Infants and Children (WIC) program, the latest update reveals a rebound in obesity rates by 2020.

The study examined children aged 2 to 4 enrolled in the WIC program, finding that the rate of severe obesity had initially decreased from 2.1% in 2010 to 1.8% in 2016, but then rose to 2% by 2020. This increase was observed across various states and racial/ethnic groups, with notable rises among Hispanic children. While the exact reasons for the increase are unclear, some speculate that changes in policy, such as the elimination of the expanded child tax credit, and economic hardships faced by low-income families may have contributed.

The study’s findings are significant despite some challenges faced by the researchers, such as declining enrollment in WIC over the past decade and incomplete data due to the COVID-19 pandemic. As was the case with similar studies, further research is needed to understand the ongoing trends in childhood obesity, especially in light of the potential impacts of the pandemic.

This AAP guideline doesn’t seem to work, study finds

Another study reveals there’s no proven benefit to the AAP-recommended motivational interviewing method. A recent study, also published in Pediatrics, found that Motivational Interviewing (MI), a weight loss intervention recommended by the American Academy of Pediatrics (AAP), did not effectively reduce childhood obesity. MI is a patient-centered communication style recommended by the AAP to address various health behaviors, including nutrition and physical activity.

The study randomly assigned 18 pediatric primary care practices to either use the MI intervention or provide usual care for childhood obesity. The intervention included counseling sessions by pediatric clinicians and registered dietitians, text message reminders, and a study portal for parents and healthcare providers. However, results showed that children in the intervention group actually gained more weight compared to those receiving usual care.

The researchers suggested that methodological and cultural factors, along with the COVID-19 pandemic, might have contributed to the lack of improvement. Laura Rolke, Ph.D., and Michelle J. White, M.D., MPH, both of the Duke University School of Medicine, commented that the study reflected the “urgent need for child obesity interventions that target the structural factors which contribute to child obesity including socioeconomic, built environment and food policies.”

They also said:

Although pandemics are (we hope) rare, the social, environmental, and economic factors that lead to child obesity are ubiquitous… Interventions focused on individual or family behavior change alone are unlikely to overcome them. Moreover, such interventions may place too much onus on the caregiver to initiate and maintain behavior change against a powerful current of adverse factors.

The study authors recommended reconfiguring the intervention model, possibly by involving healthcare professionals trained in behavioral change counseling and motivation more extensively. They wrote:

The required dose to achieve weight effects may be unattainable in our current health care delivery system… Further, the use of dietitians and pediatricians may need to be reconsidered. It may be beneficial to include other health care professionals who are primarily trained in behavioral change counseling and motivation, perhaps providing them with nutrition counseling skills or perhaps engaging dieticians only once or twice during the intervention.

Your responses and feedback are welcome!

Source: “Study findings cast doubt on childhood obesity intervention,” Healio.com, 1/29/24
Source: “Severe obesity increasing among young American children, new study confirms,” Fortune.com, 12/18/23
Image by Kenny Eliason on Unsplash

GLP-1 Weight Loss Drugs in the News, Again

The latest news about the GLP-1 weight-loss drugs looks at how the latest developments can potentially both positively and negatively affect consumers and businesses. Let’s take a look at several recent headlines to glimpse at what’s happening in the world of weight loss meds.

North Carolina won’t cover GLP-1 weight-loss drugs for its state employees

The North Carolina state employee health plan is discontinuing coverage for expensive GLP-1 weight-loss drugs like Wegovy and Zepbound due to their high cost. The decision, made by the plan’s board of trustees, comes as the drugs have become increasingly popular among members, costing the plan $102 million in 2023 alone.

This decision is expected to be the first major state health plan to cease coverage for these drugs. Despite concerns about the affordability of the drugs for members, especially considering the state’s economic ties to the manufacturer, Novo Nordisk, the board has decided to end coverage entirely, except for current users who will be grandfathered in.

This move is projected to save costs for the plan, but it also means losing a substantial rebate from the drug’s manufacturer. Other states, like Texas and Connecticut, have also grappled with the high costs of these weight-loss medications, with some implementing restrictions or prior authorization procedures to manage their use.

Unsurprisingly, the manufacturers are not amused. As Ars Technica reported a couple of days ago,

A spokesperson for Novo Nordisk called the vote to end coverage entirely “irresponsible,” according to a statement given to media. “We do not support insurers or bureaucrats inserting their judgment in these medically driven decisions,” the statement continued.”

Ars Technica’s Senior Health Reporter Dr. Beth Mole also quotes Sam Watts, director of the North Carolina State Health Plan, who told Bloomberg:

Every state has been wrestling with it, every professional association that my staff is a part of has had some discussion about it… But to our knowledge, we’re the first major state health plan to act on it.

Why is this important?

We’d say for three reasons. First, because people still want them, despite potentially serious side effects and sticker-shock prices. Second, this could be seen as a trend, for lack of a better description, that other states might follow.

The third reason is a downright dangerous one. As Reuters reported just two days ago, The World Health Organization (WHO) has issued a warning about global shortages of popular diabetes medications used for weight loss, such as Ozempic, leading to a rise in suspected counterfeit versions.

These fake drugs, primarily distributed through unregulated outlets including social media platforms, pose serious health risks due to potential lack of efficacy and contamination. Instances of dangerously low blood sugar and hypoglycemia have been reported in those who took suspected fake versions of these medications.

The high demand for these drugs, coupled with manufacturing constraints, has led to shortages in the U.S. market, exacerbating the issue of counterfeit drugs. The WHO emphasizes the importance of obtaining medicines from authorized and regulated suppliers to ensure patient safety. Not only all patients are at risk should they choose to (or unknowingly) buy counterfeit, “but the increased circulation of fake versions was likely to have a disproportionate effect on patients with type 2 diabetes.”

The rise in GLP-1 prescriptions can also influence commercial real estate

Say what? Bear with us. Last week, CoStar, a commercial real estate information outlet, reported that the increasing popularity of weight-loss drugs like Ozempic could have significant implications for commercial property demand, according to Anton Pil, an executive at J.P. Morgan Asset Management.

With potentially millions of users in the United States, the rise in GLP-1 prescriptions could influence consumer behavior and impact real estate decisions. Pil said:

While there’s no guarantee the popularity of the drug will grow or that any behavioral changes will be long-lasting or widespread, spending patterns already are changing for people who are taking GLP-1s, according to anonymous data from 95 million J.P. Morgan Chase Bank customers…

TheRealDeal.com broke down the four ways the drugs’ increased use and popularity could influence commercial real estate, and it makes sense. Here goes:

Decline in fast-food sales: Weight-loss-drug users may reduce spending on fast food by about 85 percent, prompting questions about how fast-food restaurants can adapt their offerings, which could impact real-estate footprints.

Drop in alcohol sales: Individuals on these drugs might make a 60-70 percent reduction in their alcohol consumption, impacting liquor retailers.

Shift in snack and soda preferences: Spending on snacks may decrease by 80 percent, and soda consumption may drop by 70 percent, potentially leading to increased spending at alternative venues like juice bars.

Increased demand for fitness and apparel space: A shift towards a healthier lifestyle post GLP-1 usage could result in higher demand for spaces such as gyms, spa and beauty retailers, and apparel stores as consumers seek to support their new lifestyle.

Your responses and feedback are welcome!

Source: “Blockbuster weight-loss drugs slashed from NC state plan over ballooning costs,” Ars Technica.com, 1/29/24
Source: “Rise in reports of fake weight-loss drugs linked to shortage of real thing, WHO says,” Reuters.com, 1/29/24
Source: “Four Ways the Rise of Ozempic Could Shift Real Estate Investments,” CoStar, 1/22/24
Source: “Weight-loss drugs could reshape commercial real estate,” TheRealDeal.com, 1/27/24
Image by Anna Pelzer on Unsplash

GLP-1: More Competition, Soaring Prices, and What Medicare Won’t Cover

Despite soaring prices, reported side effects (some serious), and the fact that many gain their weight back after stopping taking their weight loss medications, overweight adults are still very much interested in taking them. A recent poll from the University of Michigan found that more than 60% of overweight adults ages 50 to 80 are interested in taking one.

And many doctors are on board. “These are game-changing medications,” Shauna Levy, M.D., an obesity medicine physician at the Tulane University Medical Center and medical director of Tulane’s Bariatric and Weight Loss Center, was quoted as saying in a recent AAPR article detailing possible side effects of the new weight loss medications.

Let’s take a quick peek at last week’s headline to glimpse at what’s happening in the world of weight loss meds.

The competition heats up, and more pharma companies want in

Last week, CNBC Digital Reporter Annika Kim Constantino wrote about how the weight loss drug market is witnessing increased competition as drugmakers aim to tap into its potential worth of tens of billions in the next decade. Dominated by Novo Nordisk and Eli Lilly, the market is attracting both large and lesser-known players.

Some companies entering the race include Boehringer Ingelheim, in collaboration with Zealand Pharma, developing the drug survodutide targeting GLP-1 and glucagon, Constantino reported. The list of interested entities entering the game is growing. Consider this: Terns Pharmaceuticals is conducting early-stage trials for an oral weight-loss drug focusing on GLP-1. Viking Therapeutics and Structure Therapeutics are developing drugs targeting GLP-1 and other hormones. And Altimmune’s pemvidutide has shown promising results with a 15.6% weight loss.

Additionally, Sanofi and Bayer are considering entering the market with potential next-generation weight loss drugs. The demand is expected to rise, with Goldman Sachs projecting 15 million U.S. adults on obesity medications by 2030.

At the same time, the prices are soaring in 2024

Pharmaceutical companies have raised prices for over 700 medications, including popular drugs like Ozempic and Mounjaro, with an average increase of about 4.5% at the start of the year, slightly slower than in previous years. Notable increases include Ozempic (3.5% to $984.29) and Mounjaro (4.5% to $1,000), both GLP-1 agonists used for weight loss. CBS News reported that the analysis from 46 Brooklyn Research, a nonprofit that processes drug pricing data, found that the average price increase at year start was about 4.5%.

Why Ozempic and Mounjaro? These GLP-1 agonists, while designed to help diabetics regulate their blood sugar, also had been found to be effective weight loss drugs, prompting non-diabetics to seek out the drugs in order to slim down. Greater demand led to shortages.

Why this is bad news for employers

Increased prices mean potentially higher healthcare costs for employers. A recent article on Inc.com notes that the impact on employers may be more significant this year due to the already high costs and widespread use of Ozempic and Mounjaro. Associate Editor Brit Morse writes that market demand, coupled with inflationary pressures, is cited as the reason for the price hikes.

Morse quotes Nelly Rose, a pharmacist at NFP, a benefits consulting company, who said that covering said drugs through a workplace benefits program could be beneficial not only to employees but also to the companies who decide to offer them long-term. Employees who struggle with their weight are more likely to be on more expensive medication, or need more frequent hospital visits, Rose told Inc.com.

What Medicare won’t cover and why

If you have Medicare and want to lose weight, Ozempic won’t be covered. But if you need to take it for your type 2 diabetes, you are in luck. In an article for VeryWellHealth.com, Tanya Feke, M.D., a board-certified family physician, patient advocate and best-selling author, discussed the conditions for which Medicare covers Ozempic and when it does not.

In a nutshell, it’s super simple. Dr. Feke writes:

Medicare covers medications that it considers to be medically necessary. This includes most drugs approved by the Food and Drug Administration (FDA) for certain indications, which include a diagnosis, illness, injury, syndrome, or condition.

Ozempic is an injectable medication in the class of drugs known as glucagon-like peptide agonists (GLP-1 medications). It has an FDA-approved indication for type 2 diabetes and for cardiovascular-event reduction in people who have both type 2 diabetes (the body cannot properly regulate and use blood sugar as fuel) and known cardiovascular disease (conditions affecting the heart and blood vessels). Many Medicare Part D plans will cover Ozempic for beneficiaries who have these conditions.

Off-label use for weight loss may not be covered by Medicare due to regulations from the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, restricting coverage for cosmetic or weight loss purposes. Ozempic can be expensive, and if not covered by insurance, patients may need to go through prior authorization or step therapy processes.

Still, Dr. Feke notes, “That could change as professional organizations lobby for coverage of weight-loss medications by Medicare in the future.

Your responses and feedback are welcome!

Source: “What Are the Side Effects of New Weight Loss Medications?,” AARP.com, 1/17/24
Source: “Views on Medications for Weight Management,” HealthyAgingPoll.com, 12/13/23
Source: “The weight loss drug market may soon get more crowded. Here are the companies trying to enter the booming space,” CNBC.com
Source: “Drugmakers hiking prices for more than 700 medications, including Ozempic and Mounjaro,” CBSNews.com, undated
Source: “Prices for Weight-Loss Drugs Like Ozempic Are Skyrocketing. That’s Bad News for Employers,” Inc.com, undated
Source: “Medicare Coverage for Off-Label Ozempic to Lose Weight,” VeryWellHealth.com, 1/16/24
Image Copyright mahmud7.

A New Anti-Obesity Medications Study Reveals Interesting Insights

A recent study published in the medical journal Obesity revealed that approximately 80% of individuals prescribed anti-obesity medications discontinue usage within one year. Other insights were both unsurprising and yet others, unexpected. Here’s the gist.

Three main findings

The key takeaways are these three main finds, illuminated by health and lifestyle journalist Laura Hensley reporting for Very Well Health,  an online health and medical resource:

The majority of people who are prescribed anti-obesity medication discontinue the drugs at the one-year mark, according to new research

Wegovy (semaglutide), a newer medication, had the highest rate of patient adherence at one year compared to other, older drugs

Researchers suggest that the more effective an anti-obesity drug is, the longer a patient will likely stay on it

The weight-loss medication with the best adherence is…

The research, conducted by the Cleveland Clinic, indicated that at three months, 44% of patients filled their prescriptions, dropping to 33% at six months, and further decreasing to 19% at the 12-month mark. Notably, among the various anti-obesity drugs examined, semaglutide (marketed as Wegovy for weight management or Ozempic for type 2 diabetes) demonstrated the highest patient adherence, with 40% still taking the medication one year after the initial prescription. The study suggests a correlation between the effectiveness of anti-obesity medications and long-term patient adherence.

The study examined various anti-obesity medications, including Qsymia, Contrave, Xenical, Wegovy, and Saxenda, focusing on 1,911 adults with a BMI of 30 or higher who initiated FDA-approved weight management medication between 2015 and 2022. Researchers, using data from the Cleveland Clinic’s electronic health records, found that patients on newer, more effective drugs demonstrated better adherence compared to those on older, less effective medications.

Semaglutide (Wegovy) showed the highest adherence, having been FDA-approved for weight loss in 2021. A 68-week clinical trial revealed that Wegovy users lost an average of 12.4% of their initial body weight. In contrast, Naltrexone-bupropion (Contrave), approved in 2014, had lower adherence, with only about 10% of patients remaining on it at one year. Clinical data on phentermine-topiramate (Qsymia), approved in 2012, indicated varying percentages of patients achieving weight loss milestones over 56 weeks.

Reasons patients stop taking their anti-obesity meds

The Cleveland Clinic study did not directly look into the reasons behind patients discontinuing their anti-obesity medication, but it is suggested that some may have stopped within three months due to drug intolerance or dissatisfaction with early weight loss results. Possible side effects of these medications vary and may include nausea, vomiting, headache, dizziness, diarrhea, numbness or tingling, trouble sleeping, and dry mouth. (That is quite a list.)

Older anti-obesity medications, described as mild stimulants, might induce anxiety or elevate blood pressure. Hensley writes,

“Some of the older anti-obesity medications tend to be mild stimulants. They can create a little bit of anxiety or raise blood pressure,” Vijaya Surampudi, M.D., an assistant professor of medicine in the Division of Human Nutrition who works in the Center of Obesity and Metabolic Health at UCLA, told Verywell.

One of the oral anti-obesity medications does have an anti-addiction medicine in it called naltrexone, so you can’t be on any sort of narcotic painkiller [at the same time]. So if someone needs to have surgery, it’s very difficult to actually be on that anti-obesity medicine,” she said.

Another reason individuals may discontinue anti-obesity medication is the perception that weight management is temporary, as some believe they no longer need the medicine once they reach a comfortable weight. Despite expert opinions viewing obesity as a disease requiring chronic treatment, this mindset persists.

The study by Dr. Gasoyan and colleagues at the Cleveland Clinic did not specifically investigate why individuals stop medication, but they analyzed health insurance coverage’s impact on medication adherence. Reports suggest that some U.S. employers are considering restricting insurance coverage for anti-obesity pharmacotherapy due to perceived unsustainable costs and rapid weight gain after treatment discontinuation. Additionally, patients might stop taking weight management drugs simply because they can no longer afford them.

The study conducted by Dr. Gasoyan suggests that new data on the health benefits of newer anti-obesity medications could influence future coverage decisions by insurance providers. According to Hensley, Dr. Gasoyan said:

Our findings, along with future studies on determinants of non-persistence with anti-obesity medications, could offer opportunities for more nuanced insurance benefit design, incorporating evidence-based usage management tools, rather than limiting or eliminating anti-obesity medications coverage altogether.

The new promising weight-loss drug

The research did not include Zepbound (tirzepatide), a recently approved highly effective anti-obesity drug associated with significant weight loss. Gasoyan anticipates that the positive results seen in the study, where greater medium-term weight loss correlated with higher odds of persistence, could extend to newer drugs like tirzepatide, warranting further exploration in future research.

As parting advice, Dr. Surampudi emphasizes the importance of patient satisfaction with medications, stating that if a patient is unhappy with a specific drug, healthcare providers can work together to find alternative strategies for managing obesity.

Your responses and feedback are welcome!

Source: “Which Anti-Obesity Medication Do Patients Stay On the Longest?,” VeryWellHealth.com, 1/11/24
Source: “Early- and later-stage persistence with antiobesity medications: A retrospective cohort study,” Obesity, 12/6/23
Source: “FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014,” FDA/gov, 6/4/21
Image by Jennifer Burk on Unsplash

Childhood Obesity Specialists Struggle to Get GLP-1 Agonists

This week’s Medscape report by journalist Alicia Ault discusses the latest challenges faced by pediatric obesity specialists in accessing glucagon-like peptide 1 (GLP-1) agonists, medications approved by the U.S. Food and Drug Administration (FDA) for weight loss in adolescents aged 12 years or older. She opens with:

While adults, many of whom don’t meet the clinical definition of obesity, scramble to procure glucagon-like peptide 1 (GLP-1) agonists for weight loss, pediatric obesity specialists said their young patients who could benefit more over the long term often are unable to access the potentially life-altering medications.

The FDA approved two GLP-1 agonists so far — both marketed by Novo Nordisk — for use in adolescents aged 12 years or older: Saxenda and Wegovy. Several pediatricians told Medscape that despite the potential benefits of these medications for young patients with obesity, the increasing demand for GLP-1 agonists has led to supply shortages, making it difficult for pediatricians to initiate new treatments or maintain existing ones.

Ault writes:

The crushing demand for semaglutide in the past year, driving a thriving market in compounded versions and online prescriptions, has made it increasingly difficult to find pharmacies that can fill prescriptions.

Two pediatric specialists, Brooke Sweeney, M.D., medical director of weight management services at Children’s Mercy in Kansas City, Missouri, and Sarah Raatz, M.D., a pediatrician at the University of Minnesota’s Center for Pediatric Obesity Medicine, both said because of the supply issues they can’t prescribe the medication for new patients because then the patients already taking it might not have enough, which may lead to weight loss reversal and other negative outcomes.

Potential benefits appeal to some pediatricians

Ault quotes Susma Shanti Vaidya, MPH, M.D., associate medical director of the IDEAL pediatric obesity clinic at Children’s National Hospital in Washington, D.C., who said that “patients taking GLP-1 agonists in her practice have reduced their body mass index and have seen resolution of prediabetes, diabetes, and fatty liver disease.”

Insurance denials are piling up

Insurance coverage for these medications, even for FDA-approved indications, is also becoming more difficult, with insurers setting weight trajectory thresholds that, if not met, could result in coverage withdrawal. Ault explains:

In January 2023, the American Academy of Pediatrics urged aggressive treatment of childhood obesity, including using FDA-approved medications such as GLP-1 agonists combined with lifestyle and dietary modifications.

The U.S Preventive Services Task Force, however, has issued a draft proposal that recommends a variety of lifestyle and behavior modification interventions for children and adolescents but says the evidence does not yet support recommending bariatric surgery or medications.

Concerns about more restrictions this year

Pediatricians express concerns about potential restrictions in 2024, creating uncertainties for patients who have benefited from these medications. Some of the patients, for example, were told that prior authorization would be required for new prescriptions for a GLP-1 agonist.

Some parents want GLP-1 agonists for their kids, too

Some parents, when they feel they have exhausted all other options for their children, are requesting GLP-1 agonists for their children, emphasizing the life-changing effects reported in some cases. The pediatric obesity specialists quoted in the article cited one such effect as stopping the “food noise” and thus curbing cravings.

In a recent poll by Morning Consult, 65% of parents of children with weight-related issues said they would be interested in GLP-1 agonists for their kids. And a third of parents said “they would be interested in having their children use the drugs if they were available.”

However, there is a need for more data on the long-term effectiveness and safety of these medications in pediatric patients, and clinicians are counseling families that obesity is a chronic disease, requiring lifelong treatment with GLP-1 agonists in some cases.

Your responses and feedback are welcome!

Source: “Pediatric Obesity Specialists Struggle to Get GLP-1 Agonists,” Medscape, 1/8/24
Source: “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity,” American Academy of Pediatrics, 1/9/23
Source: “High Body Mass Index in Children and Adolescents: Interventions,” U.S. Preventive Services Task Force, 12/12/23
Source: “A Third of Parents Are Interested in Weight Loss Drugs Like Ozempic for Their Children,” Pro.MorningConsult.com, 12/4/23
Image by Elena Leya on Unsplash

Tackling the Same Childhood Obesity Issues in the New Year

As we enter the new year, the alarming rise in obesity rates among children is a pressing issue that demands immediate attention and concerted efforts to reverse the trend. Two recent studies found an increase in childhood obesity. However, as usual, there’s a plethora of things we can do to curb it, starting with the parents.

Study finds an increase in childhood obesity in the U.S.

A recent study published in the journal Pediatrics and reported on TIME.com reveals an increase in severe obesity among young U.S. children, challenging earlier hopes that rates were decreasing. The research focused on children aged 2 to 4 enrolled in the Women, Infants, and Children (WIC) program, a government initiative for low-income families.

The study found that after a decline from 2010 to 2016, the severe obesity rate rebounded to 2% by 2020, affecting about 33,000 children in the WIC program. Significant increases were observed in 20 states, with California having the highest rate at 2.8%, particularly impacting Hispanic children.

The reasons behind the increase remain unclear, with experts speculating that changes in daily hardships for families in poverty might be a factor. Policy changes in 2009 were initially credited with the decline in obesity rates within the WIC program, but the study suggests that these measures may no longer be sufficient.

The research has limitations, including a decline in the number of children in the WIC program over the past decade and incomplete information due to the impact of the COVID-19 pandemic in 2020. Despite these challenges, experts consider the study well done and indicative of ongoing concerns about childhood obesity, especially during the pandemic.

… And not just in the U.S.

Health of England’s children at risk from policy inaction on obesity, report finds,” reports The Guardian in its December 2023 article. The gist of it is: A government-commissioned report in England warns that children face risks of diabetes, heart disease, and other health issues due to delaying anti-obesity policies until 2025.

The report highlights the normalization of ultra-processed foods (UPF) and high-fat, sugar, and salt (HFSS) products in children’s diets, particularly among low-income families. Measures such as the evening junk food advertising watershed and bans on online ads and unhealthy buy-one-get-one-free deals have been postponed. The study reveals a rebound in severe obesity rates in children aged 2 to 4, emphasizing the detrimental impact on health, including the increased risk of type 2 diabetes.

The research, conducted by the City, University of London, underscores the challenges faced by low-income families in accessing healthier options, as UPF and HFSS foods become economically preferable. Wealthier families have more resources to stock healthier snacks, avoiding unhealthy retail environments. (Nothing new here.)

The report urges expanding access to Healthy Start vouchers, ensuring a living wage covering a healthy diet’s cost, and regulating misleading front-of-pack health claims. The recommendations align with the 2020 U.K. national food strategy, and the report emphasizes the need for immediate government action to mitigate the appeal and prevalence of UPF and HFSS while improving access to healthier snacks.

What parents can do to tackle childhood obesity in 2024

Hmmm, pretty much the same things they were doing in earlier years. Dr. Andrew Swiderski, a pediatrician at Open Door Family Medical Center in Ossining, quoted in a December 2023 article on Patch.com, says that setting small goals can help parents chip away at childhood obesity going forward into 2024. He elaborates:

I think many New Year’s Resolutions are too ambitious, so people often don’t fulfill their goals… I would say a family goal: some small improvement in their eating habits, maybe a bit more physical activity as a family, more family time with meals together, etc., something that all can be held accountable to and less likely to be forgotten or ignored!

Dr. Swiderski attributes the increase in childhood obesity cases, in part, to the challenges posed by the pandemic, including limited exercise opportunities and constant access to food at home. In his approach, Dr. Swiderski conducts lab tests, discusses dietary habits and lifestyle, and collaborates with patients and their families on a personalized plan. He encourages realistic changes, such as reducing sweet drinks and increasing physical activity. Dr. Swiderski also highlights the importance of sleep and suggests avoiding screen time before bedtime.

The American Academy of Child & Adolescent Psychiatry summarized ways to manage obesity in children and adolescents in its October 2023 article, in an easy-to-comprehend list targeted at parents and other family members:

Ask for professional help
Meet with a nutritionist to help adjust eating habits
Focus on healthy habits as a family unit
Give lots of positive encouragement and choose positive words to reduce the risk of shame
Make sure your child is getting enough sleep
Plan meals and make different selections
Find out what your child eats at school
Ask for help selecting a variety of foods if money is tight
Increase physical activity (especially active playtime for children or sports)
Do not use food as a reward
Attend a support group (e.g., Overeaters Anonymous)

Childhood obesity is a complex issue that requires a collaborative and multi-faceted approach from the ground up (parents). And small changes can be mighty. Let’s start 2024 right.

Your responses and feedback are welcome!

Source: “Severe Obesity Is Increasing in Young U.S. Children,” TIME.com, 12/18/23
Source: “Health of England’s children at risk from policy inaction on obesity, report finds,” The Guardian.com, 12/25/23
Source: “Small Goals To Help Tackle Child Obesity In 2024,” Patch.com, 12/27/23
Source: “Obesity in Children and Teens,” AACAP.org, October 2023
Image by Vitolda Klein on Unsplash

The Effects of Taking Weight-Loss Drugs

December started with breaking news in the realm of weight-loss drugs, making the case yet again that GLP-1 drugs can potentially cause significant adverse side effects and should be approached with caution and under medical supervision.

On December 1, 2023, pharma giant Pfizer announced that it decided to halt the development of the twice-daily version of its experimental weight loss pill due to serious side effects observed in a mid-stage clinical study. Obese patients experienced notable weight loss but struggled with tolerating the drug, primarily facing mild gastrointestinal issues.

Despite the setback, Pfizer still plans to release data on a once-a-day version of the drug in the first half of 2024, which will influence its decision on whether to proceed with a phase three study. The company had hoped to capture a share of the lucrative weight loss drug market, but this development puts it behind competitors such as Eli Lilly and Novo Nordisk, who are working on pill versions of their successful weight loss and diabetes injections.

Pfizer’s stock closed 5% lower after the announcement, impacting its aspirations to rebound from declining demand for its COVID products. CNBC Digital Reporter Annika Kim Constantino wrote that:

The new data is a blow to Pfizer and its hopes to win a $10 billion slice of the booming weight loss drug market, which CEO Albert Bourla previously said could eventually grow to $90 billion.

The side effects spread to stopping taking the drugs, too

As we’ve mentioned in our previous post, not just taking but stopping the meds can have serious negative consequences, too. This has been backed up by both research and observing the patients who have experienced them. The list is rather long and includes weight gain, blood sugar increase, an increase in blood pressure, mood changes, a negative change in cholesterol levels, and so on.

Health.com writer Michelle Pugle wrote about Ozempic in particular:

Experts emphasize that Ozempic is intended for long-term use and should always be used under the supervision of a healthcare professional. Experts recommend people who are going off the drug should enroll in a nutrition program before going off the medication, so they’re better equipped to make healthy choices that support their health needs post-Ozempic.

And yet, the weight-loss drug market is thriving

An investigative report by Chad Terhule and Robin Respaut that was published on the same day of Pfizer’s announcement by Reuters said that the Danish drugmaker Novo Nordisk paid U.S. medical professionals at least $25.8 million over a decade in fees and expenses related to its weight-loss drugs. It concentrated that money on an elite group of obesity specialists who advocate giving its powerful and expensive drugs to tens of millions of Americans.

One such doctor is Dr. Lee Kaplan, the chief of obesity medicine at Dartmouth College’s medical school, and a leading U.S. obesity specialist. Terhule and Respaut quoted him in their piece:

Obesity, he said, should be treated as aggressively as other chronic diseases such as high blood pressure or diabetes — with lifelong prescriptions. “We are going to have to use these medications,” he said at the June gathering, “for as long as the body wants to have obesity.”

Novo’s most lucrative market is, you guessed it, the USA. The authors explain why:

[…] because more than two-thirds of adults are overweight or have obesity and drugs frequently command the highest prices worldwide. Novo charges U.S. customers $1,300 a month for the weekly injection.

The Reuters report also quotes Dr. Arthur Kellermann, a health administrator and former dean of the Uniformed Services University of Health Sciences, the U.S. military’s medical school, who reviewed Reuters’ findings on Novo’s spending.

The company’s large-scale payments to doctors, he said, illustrate a longstanding problem in the drug industry “The pharmaceutical industry still sees value in paying medical thought leaders to promote their products, and too many of them are happy to sign up for a six- or seven-figure check,” he said, calling such lavish payments “morally and ethically way over the line.”

Your responses and feedback are welcome!

Source: “Pfizer to discontinue twice-daily weight loss pill due to high rates of adverse side effects,” CNBC.com, 12/1/23
Source: “Maker of Wegovy, Ozempic showers money on U.S. obesity doctors,” Reuters.com, 12/1/23
Source: “What Happens to Your Body When You Stop Taking Ozempic?,” Health.com, 11/30/23
Image by Diana Polekhina on Unsplash

Can You Stop Taking Anti-Obesity Drugs?

There has been an ongoing debate about whether people taking anti-obesity drugs can stop taking them after their desired effect is achieved, and what happens if they do.

In her recent article, Axios writer Tina Reed discusses an emerging debate around a class of anti-obesity drugs known as GLP-1 agonists, particularly whether patients should expect to take them indefinitely. These drugs, initially used for treating Type 2 diabetes, have gained approval for weight loss. The debate centers on whether treating obesity as a chronic disease means patients should remain on these drugs long-term or if they can eventually stop.

The tension arises from insurers’ concerns about the costly implications of prolonged drug use and clinicians’ uncertainties about whether patients should commit to a lifetime of treatments. Some argue that, like other chronic diseases, it makes sense for patients to stay on the drugs continuously. Others suggest that more data is needed to understand how these drugs affect the brain, proposing the possibility of using them as a bridge to less intense therapies and lifestyle changes.

Studies indicate that many patients stop taking these drugs within a year due to challenging side effects and coverage limits. Some experts suggest the need for clinical studies to explore options like lower doses, switching to less expensive medications, or intermittent drug use to maintain weight loss.

Insurers’ reluctance to cover these drugs for obesity adds to the complexity of the issue. While weaning may be plausible for some patients, there isn’t enough clinical data yet to support taking all patients off the drugs. Regardless of the stance, there is agreement on the importance of strong patient support services to enhance the success of these drugs.

What happens when you stop taking Ozempic?

An uncredited but medically reviewed article on Drugs.com provides information on the potential consequences of stopping the use of Ozempic, an injection used for type 2 diabetes and weight loss. Apparently, if patients discontinue Ozempic, they may experience weight regain within a few months to a year, an increase in blood sugar levels, and potential loss of positive heart health benefits.

The mechanisms of Ozempic involve controlling blood sugar levels, insulin secretion, and digestion, contributing to weight loss by reducing appetite and slowing gastric emptying. Upon stopping Ozempic, these mechanisms cease, leading to an increase in appetite, weight regain, and potential worsening of type 2 diabetes and heart health.

The article discusses a study on the effects of stopping semaglutide, the active ingredient in Ozempic, which showed that individuals who received semaglutide regained some weight after discontinuation, but still had an overall weight loss compared to a placebo group. Additionally, improvements in heart health observed during treatment were reversed after stopping.

Reasons for discontinuing Ozempic include common side effects like nausea, vomiting, and stomach issues. Ways to prevent weight gain after stopping Ozempic include maintaining a healthy lifestyle, consulting with a healthcare professional, prioritizing sleep, meeting with a dietitian, and staying hydrated.

Your responses and feedback are welcome!

Source: “The big question about obesity drugs: Can people ever stop taking them?,” Axios.com, 11/27/2023
Source: “What happens when you stop taking Ozempic?,” Drugs.com, 9/18/2023
Image by Myriam Zilles on Unsplash

In Search of Addiction’s Roots, Part 2

The previous post went into the question of why researchers feel okay about labeling animals’ actions as “inappropriate” when they are just examples of displacement behavior, which is not necessarily a bad thing. If the animal picks a non-violent alternative, even one that only works sometimes, how could that be deemed a failure?

Dueling instincts

An animal has an inborn drive to care for its progeny, but in many species, there is also a proclivity to watch out for and protect the lives of any others of its kind. When an animal is challenged or threatened by a member of its own species, that same protective impulse may kick in, despite the momentary threat of personal violence and the potential extinction of one’s own chain of heredity.

If reverting to a displacement behavior can prevent some violence in the animal world, maybe that is all part of the Big Scheme of Things, too. Some might ask, who gave humans the right to designate avoidance as inappropriate?

Maybe over the millennia, animals have devised little codes that translate to “Do you really want to have a territorial fight right now? Why don’t we just skip it?” and “You’re right. It’s too nice of a day.” Does sleeping or playing dead ever work out? Maybe it’s code for a compromise, like, “Okay, I’ll call you Alpha Boss in front of the others, if you’ll just go away right now.” How much conciliation or compromise or “working it out” actually happens in the wild, and if it does, what’s wrong with that?

Quoting again from Dr. Pretlow’s “A Unified Theory of Addiction,”

It is thought to be due to rechanneling of overflow brain energy to another drive (e.g., grooming drive, feeding drive) when two drives, e.g., fight or flight, equally oppose each other. Nervous energy builds up in the brain to either deal with or avoid the situation, and this excess mental energy is “displaced” to the addictive behavior.

There it is again, the assumption that the most widespread and prevalent oppositional pairing of drives is “fight or flight.” But apparently, there are lots of other drives. How would it sound if someone said, “When two drives, e.g., feeding or sex, equally oppose each other, nervous energy builds up in the brain to either deal with or avoid the situation, and this excess mental energy is ‘displaced’ to the addictive behavior.”

But in humans, a conflict between two drives doesn’t have to get all drastic, or end in carnage. They can decide, “Okay, let’s have sex first and then go out for dinner.” And nobody gets hurt. When a person is in a quandary, a dilemma, or a state of uncertainty about what to do about a difficult situation, there are a few different ways to go.

One is to stay there and stew for a while longer. Another is to convert that overflow mental energy into something else, like a voracious appetite for food, or an overwhelming urge to get drunk or smash something. Another is to displace it into an activity that, while it may not have any effect on the immediate problem, is neutral or even positive, like running around the block a few times. The most appropriate and helpful, of course, is to address the problem.

Your responses and feedback are welcome

Source: “A Unified Theory of Addiction,” Geios.com, 03/09/23
Image by monkeyc.net/CC BY 2.0 DEED

Coronavirus Chronicles — Not Looking Good for Kids

All the comforting stories that people used to tell themselves about COVID-19 having a low impact on children have fallen apart. Kids are in terrible shape. The basic dilemma is that childhood obesity, already at an all-time high when the pandemic struck, is a prominent risk factor for catching the virus.

Although people are likely to lose weight when acutely ill, the effects of “long COVID” are totally designed to create more obesity in the future. When people suffer from circulatory and lung aftereffects, and are so physically depleted that a walk across the room is too much exercise, those who are unable to recover full function will not stay thin for long. The sedentary lifestyle forced onto people who are too weak to meet the demands of daily existence cannot help but lead to another wave of increased obesity.

Scary stories

Meanwhile, journalists report on individual cases that personalize the situation. Michael Daly wrote about a 16-year-old South Carolina boy who lost his appetite and vomited frequently, which are not typical COVID symptoms. He was taken to an urgent care facility and tested negative for COVID and positive for the flu. But over the next week, he just got sicker and was admitted to the hospital — still testing negative for COVID. Then he was airlifted to another hospital, where he tested negative once more — but was diagnosed with MIS-C. Daly writes,

They explained that the condition is a delayed inflammatory response to COVID that can come as if from nowhere weeks or even months after an infection — even an asymptomatic one… The syndrome had simultaneously attacked Branson’s heart, kidneys, and liver.

This led to five days on a ventilator and a 24-hour dialysis treatment. The young patient pulled through and was ultimately discharged from the hospital with eight different prescription medications. Incidentally, a study was in progress at the same time which ultimately pointed to the conclusion that MIS-C is preventable by vaccination against COVID-19.

Professionals and Social Media

Childhood Obesity News has mentioned several times how doctors and nurses are using informal channels like Twitter to quickly spread and collect information about what is going on in emergency rooms, intensive care units, hospital wards, and primary care practices, all over the country and the world.

Dr. Eric Feigl-Ding, for instance, notes that during a two-week period in Utah, 140 children were hospitalized with COVID. At the same time, in Britain, the hospital admissions for children ages 6-17 hit record totals, and the same thing has been happening in South Africa.

Especially for younger children, the notion that the Omicron variant is “mild” begins to appear ludicrous. Little kids struggle to breathe through massive secretions and need supplementary oxygen. A doctor’s wife wrote about a patient of her husband’s, 20 years old and otherwise completely healthy, on ECMO (the machine that does the work of the heart and lungs — in other words, total life-support).

One lung has just about disintegrated. Waiting on transplant but the other lung is going to be gone soon. STOP CALLING IT MILD.

Your responses and feedback are welcome!

Source: “Terrifying Post-COVID Syndrome Makes Comeback in South Carolina Kids,” TheDailyBeast.com,01/22/22
Source: “CDC: Vaccination effective against MIS-C,” musc.edu, 01/11/22
Source: Dr. Eric Feigl-Ding (@DrEricDing), Twitter, 01/22/22
Image by Eden, Janine and Jim/CC BY 2.0

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

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:

Presentations

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.

Food & Health Resources