Should Pharmaceuticals Be Used as Weight Loss Interventions for Adolescents Classified as Obese by BMI?

Abstract

Ethically evaluating prescription of weight loss pharmaceuticals for adolescents classified by body mass index (BMI) as obese requires reconsideration of how medicine's overreliance on BMI as a diagnostic criterion supports a weight normative approach to health. This commentary on a case suggests that weight loss is not a safe, effective, or permanent method of health promotion. The unknown extent of pharmacotherapeutics' risks to adolescents in addition to the controvertible benefits of weight loss ethically preclude their prescription, despite scientific consensus to fight obesity by prescribing weight reduction.Case M is a student at Sunnyvale High School. At 16 years old, they are currently enrolled in an intensive health behavior and lifestyle treatment (IHBLT) at the local county hospital. During the pandemic, their body mass index (BMI) increased from 28 to 30, making them a candidate for liraglutide, a glucagon-like peptide 1 (GLP-1) analogue approved by the US Food and Drug Administration (FDA) in 2020 as a weight loss medication in adolescents. As M's primary care physician, Dr B recommends liraglutide as an additional means for preventing M's becoming an obese adult with comorbidities. CommentaryResponding to the title question requires not only evaluating the risks and benefits of pharmacotherapy (particularly in adolescents), but also closely examining weight loss as a health goal. Present clinical practice is "weight normative" 1 in emphasizing weight and weight loss to define health and well-being. There is no more obvious manifestation of this practice than the continued use of BMI to define health status. BMI is based on the ratio of weight in kilograms to height in meters squared and is currently used as the identifying obesity indicator, 2,3 although its value does not reflect significant considerations of the obesity disease state, including peripheral and visceral adiposity, body composition, and metabolic indices. 2,4 Calling attention to how questionable BMI is as a litmus test for obesity are patients classified as overweight or obese (BMI ≥ 25) whose weight, when evaluated by physical

Policy Interventions to Enhance Medical Care for People With Obesity in the United States—Challenges, Opportunities, and Future Directions

“…Current FDA-approved drugs, however, include orlistat, phentermine/topiramate, naltrexone/bupropion, liraglutide, semaglutide, tirzepatide (as of November 8, 2023), and setmelanotide 7,29 For adolescents, the FDA has approved a more limited set of anti-obesity medications: orlistat, liraglutide, semaglutide, and phentermine/topiramate extended-release capsules. 30 The mechanisms of the aforementioned anti-obesity medications are complex and are still actively being researched. Semaglutide, a glucagon-like peptide (GLP)-1 analogue, impacts both appetite and satiety.…”