Prescriptions for Ozempic, Wegovy and other similar drugs used to treat type 2 diabetes and obesity have soared by nearly 600% in adolescents and young adults, a recent study has found. And most of those are for girls and young women, even as questions remain about the long-term impact of the medications, including on reproductive health.
“For over the last 20 years, we have been grappling with the problem of childhood obesity,” said Dr. Joyce Lee, a pediatric endocrinologist at the University of Michigan and lead author of the report recently published in JAMA, the journal of the American Medical Association.
“As pediatricians, I will say that we haven't moved the needle very far in terms of the therapies and the interventions that we've had to offer our patients. So I think it makes sense to me that there's a lot of enthusiasm for this medication because it is so effective for weight loss.”
Using a database of prescriptions from more than 90% of U.S. retail pharmacies, researchers found 30,947 adolescents (12-17 years old) and 162,439 young adults (18- to 24-year-olds) were being prescribed this class of drug (Glucagon-like peptide-1 receptor agonists, or GLP-1RAs) in 2023 alone, with a nearly 600% increase since 2020.
That’s still just a tiny fraction of the 14 million kids and teens in the US who are obese. And an estimated 5,293 children and adolescents between the ages of 10-19 are newly diagnosed with type 2 diabetes annually, according to the CDC.
Still, the drugs’ popularity among adolescents — and their providers — is clearly growing. But GLP-1RAs are only effective so long as you keep taking them, and those who do stop may regain much of the lost weight. So what does it mean to put kids on drugs that are in short supply, are extremely expensive, and have to be taken for the foreseeable future?
“We think of obesity as a chronic disease. So the idea is that if you're going to start the medication and you have weight loss, in order to maintain that weight loss, you will likely need to be on the medication long term,” Lee said. “If you have individuals starting to take the medication at 15, at 16, at 20, are they going to take it for 20, 30, 40 years? I think those are questions that we don't have the answers for yet.”
Most of the kids and teens getting these drugs are girls
Among adolescents aged 12-17, girls received 60% of prescriptions between 2020 and 2023, and young women received 76% of the prescriptions for adults aged 18-25. Lee thinks that “probably reflects some of the societal bias towards weight in the female population in our country.”
“We don't necessarily expect that there are different rates of obesity or type 2 diabetes between the genders across the populations,” she said. “So we really are seeing this disproportionate dispensing towards females in particular … and it really has implications for their long-term health and also reproductive health, because a lot of these girls and young women are of reproductive age.”
While social media is full of reports of the so-called "Ozempic babies" (including women who got pregnant after struggling with fertility issues, like polycystic ovarian syndrome), that may be just a result of the weight loss itself.
“There's also been speculation about whether these medications make birth control pills less effective,” Lee said. “But I think women have to think about this differently because of that potential risk. Primary care physicians, as well as specialists, also have to think about this as they work with this younger population.
Drug costs and shortages limit who can access the medications
The fact that Ozempic doesn’t have FDA approval for those under the age of 18 doesn’t seem to be stopping doctors from writing off-label prescriptions for minors, either.
“We definitely did see increases in Ozempic prescribing, which is actually not at all approved for individuals less than 18,” Lee said. “And we also saw prescriptions for tirzepatide [the active ingredient in Zepbound and Mounjaro, which are also used for type-2 diabetes treatment and weight loss] which, again, are not approved in children 12 to 17. So we do see evidence of off-label prescribing.”
That could be partly due to shortages in the drugs that are approved for kids, including Wegovy.
“We often will think of these medications as equivalent,” Lee said. “And because of shortages of different types of medications, it's possible that providers are using other types of GLP-1 RA medications, because their patients can't get access to certain ones that might be approved.”
Cost is another major factor: currently, a month’s supply of Ozempic or Mounjaro runs about $1,000. While that’s expected to decline in the coming years as more competitors come on the market, many insurers (including Blue Cross Blue Shield of Michigan) are announcing they’ll no longer cover the medications for weight loss.
Others are imposing a two-year limit on coverage, Lee said. Among 12-17 year olds, 43% used commercial insurance to buy the drugs, while 48% used Medicaid, according to the report. (The rest used Medicare, and less than 2% paid cash.)
“A lot of medications now, the cost is being passed onto the patients,” she said. “So even if they do have coverage, they may have a bigger burden. And there may be a group of patients who just can't afford the medication, which is going to potentially exacerbate or lead to disparities in access to the medication.”
