By Andrea Petersen | Photography and video by Audra Melton for WSJ
WINDER, Georgia -- Ayden Gatlin-Wright lay down on the living room sofa and pulled up his shirt to expose his stomach to get an injection of a weight-loss drug.
"Ow," Ayden yelped, cartoons playing in the background. He is 9 years old.
Ayden and twin brother Kayden are part of a growing epidemic of childhood obesity. Traditional weight loss methods don't work well for many children, particularly those with severe obesity.
Now, even elementary schoolers are being put on popular weight-loss drugs such as Wegovy.
By prescribing GLP-1 medications early, doctors say they aim to prevent lifelong obesity and complications such as Type 2 diabetes and high blood pressure, which are showing up in teens and even younger children.
These drugs aren't yet approved for obesity in patients this young. And without further studies, it isn't certain that young children can safely use the medications for weight loss without compromising a critical period of growth for their bones and brain.
But doctors prescribing the drugs off-label say the risks of obesity complications for some patients are too serious not to try a treatment that can be so effective. These medicines are approved for obesity in kids as young as 12 years old in the U.S. and are being tested in children as young as 6.
"I see kids who have developed Type 2 diabetes at 10, 11 years old," said Dr. Jessica Reilly, medical director of the Strong4Life pediatric obesity clinic at Children's Healthcare of Atlanta, where she treats Ayden and Kayden. "They need help so desperately."
Intensive behavioral treatment programs that focus on diet and physical activity for children with obesity can be hard to find, often aren't covered by insurance and generally lead to only very modest weight loss -- a 1% to 3% decrease in body-mass index is typical, doctors say. Other drugs often used in young kids, such as stimulants, might not be effective enough either. Meanwhile, doctors who are prescribing GLP-1s to younger children say they are seeing BMI decreases of up to 20% and sometimes more in some patients.
The negative health effects of obesity, including cardiovascular disease and Type 2 diabetes, can emerge much earlier than previously understood. Pediatric obesity specialists say they are seeing high blood pressure, poor blood sugar control and liver dysfunction in children as young as 4. And newer research has found that children with obesity generally don't grow out of it.
Still, doctors are torn about putting growing children on GLP-1s. Some worry that insufficient calorie and nutrient intake could compromise bone growth, puberty and brain development. People tend to regain the weight they lost when they go off the medications. No one knows the potential consequences of being on these drugs for decades starting in childhood.
"We do not have enough evidence to safely prescribe under 12 at this point" for obesity, said Dr. Sarah Hampl, who is part of the pediatric obesity program at Children's Mercy Hospital in Kansas City, Mo., and was the lead author of the American Academy of Pediatrics' clinical practice guideline for treating obesity in children and adolescents. "I think that potential is there for positive impact, but there are not enough studies yet."
The AAP guideline recommends that pediatricians provide intensive behavior treatment for children 6 and older with overweight or obesity, or refer the children to other healthcare professionals who can deliver it. Children 12 and older with obesity should be offered medication as well, the guideline says.
About 21% of U.S. children and teens ages 2 to 19 have obesity, according to data collected between 2021 and 2023 by the Centers for Disease Control and Prevention. Obesity rates in the U.S. took off beginning in the 1980s. In the 1970s, only about 5% of children and teens had obesity.
Doctors who are prescribing GLP-1s to children under 12 say the all-but-certain health problems that occur with severe obesity might outweigh their worries about potential unknown long-term effects of the drugs.
"We don't know what the long-term effects could be and that can be scary and unsettling," said Dr. Claudia Fox, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota, who is working on clinical trials of GLP-1s for children. "I do know that having obesity when you're 7, especially severe obesity, is very likely going to lead to for sure a reduced quality of life, premature mortality likely, really not a good life."
Fox has been prescribing GLP-1s for a few younger children with obesity and the results have been "transformative," she said. The BMI of one 10-year-old Fox is treating has dropped by about 30% since she has been on the medication, Fox said.
Novo Nordisk said it doesn't encourage off-label use of its obesity medications. The company's Wegovy injection and Saxenda drugs are approved for obesity in adolescents as young as 12 in the U.S. and are being tested in children as young as 6 with obesity. Eli Lilly's Zepbound is approved for adults, and the drugmaker is studying its obesity medications in children ages 6 and up -- including teenagers. "Lilly does not promote or encourage use of any Lilly medicine outside of its FDA-approved indication," an Eli Lilly spokesperson said.
GLP-1s are approved in the U.S. for children 10 and older with Type 2 diabetes.
Latrail Gatlin and Alexander Wright adopted the twins at birth. The boys were about 4 years old when they started rapidly gaining weight. Sometimes they would eat so much in one sitting that they would throw up. They were so hungry at bedtime that they would cry.
Working with their children's pediatrician and a nutritionist, the couple tried feeding their sons more frequent, smaller meals. They limited portion sizes and allowed ice cream only once a week. They switched to sugar substitutes such as Splenda. They enrolled the boys in karate classes.
But the twins' BMI kept increasing dramatically. When the boys were 6, their pediatrician referred them to the Strong4Life program, offered about an hour and 20 minutes from their home. Demand is so high, it took the family about a year to get in for an initial appointment.
At Strong4Life, they learned that the boys have a genetic mutation that affects the perception of fullness and increases the risk of obesity.
The knowledge was a relief for Wright, who is 48 and took a medical retirement in 2023 from his job in the federal government. "I always felt defeated as a parent -- it's my fault. Maybe I'm doing something wrong," he said.
At age 7, the boys' weight was already affecting their health. Their A1C, a measure of blood sugar, was elevated. There were signs of liver dysfunction and worrisome cholesterol findings.
Reilly put the boys on a medication typically used to treat seizures that can also make people feel full sooner and reduce cravings. It is often used off-label in younger children with obesity. Kayden and Ayden, who have ADHD, were also on a stimulant. Doctors use stimulants in younger children with obesity, even if they don't have ADHD, because the medication can suppress appetite.
Gatlin and Wright doubled their efforts to get their children to eat healthy and exercise. They began cooking most meals at home, using olive oil instead of butter, and doing family workouts. But Ayden and Kayden's weight continued to climb. "They were still moving up the chart to the point that it was alarming," said Wright. The boys' weight was affecting their ability to run and play.
At an appointment in January, Wright and Gatlin asked about GLP-1s. The couple knew the drugs weren't approved for children so young, but nothing they had tried so far was working for the boys. "They were discouraged. Why are we putting in all this effort and we're not seeing any results?" said Gatlin, who is 41 and works in healthcare.
Gatlin and Wright were also worried about the twins' mental health. The boys have been bullied for their size, their fathers say, with kids calling them names. The name-calling hit Ayden especially hard, Gatlin said. "He would come home and just cry, like, literally cry for hours."
The boys started with .25 milligrams of Wegovy, then moved up to .5 milligrams and, in May, to a 1 milligram weekly shot.
The medication "helps us make healthy choices," Wright said they explained to their boys.
The twins have experienced some side effects, their fathers say. When they started the medication and when changing to a new dose, they sometimes had a bout of vomiting or diarrhea about 48 hours after the shot.
Gatlin and Wright say they have seen big changes since starting the medication. The boys are less hungry and not snacking as often. They are more confident and their grades have improved. "They see themselves changing. They're more motivated to change, more motivated to eat healthy and to read labels," said Wright. Kayden played basketball at recess for the first time. "They are more energetic. They are more outgoing."
And they have shed pounds: Ayden's BMI dropped by 5% and Kayden's by 7% in their first two months on Wegovy.
The couple pay about $700 out-of-pocket for four weeks of Wegovy for their two sons. They have had to cut costs elsewhere and take some money out of their retirement savings.
Temptation is everywhere. On a recent Thursday afternoon, Ayden pushed a cart at the Ingles grocery store in Winder. The family was picking up some ground beef and taco shells for dinner that night. Walking through the store, the boys wanted soda. They wanted candy bars and grabbed them off the shelf and mimed taking bites. "Guys, it's a no," said Gatlin.
Gatlin and Wright hope their sons won't be on Wegovy forever. Maybe three years, Wright says. "They can learn to manage themselves, the exercise, the healthy habits, read their bodies properly," he said. "The goal is for them to learn that, you know, as they grow, this is going to be their life."
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