The Treatment of Extreme Obesity in Adolescents and Young Adults with GLP-1 Receptor Agonists

Approximately 208 000 adolescents and young adults (aged 14–24 years) in Germany are living with severe obesity (BMI [kg/m²] > 99.5^th age- and sex-specific percentile) (1), characterized by continuous and massive weight gain (prevalence of severe obesity among adolescents: 2.25%; German Federal Statistical Office, 2022: 9.24 million adolescents). Due to their severe obesity, these young people experience high levels of morbidity and significant functional restrictions (2). Behavioral treatment interventions aimed at lifestyle modification tend not to have a lasting effect on the weight trajectory of these patients (3). The approval of the GLP-1 receptor agonists liraglutide and semaglutide (approved in 2021 and 2023, respectively) for weight management in adolescents and young adults with obesity means that drugs to support treatment are available in Europe for the first time (4, 5).

Methods

In a retrospective case series, we analyzed the data of eight adolescents (aged 12.0–18.1 years at the time of treatment initiation) with severe obesity (BMI: 35.0–65.1 kg/m²) who were treated at the German university hospitals of Halle and Ulm with liraglutide (n = 7) or semaglutide (n = 1). Eating disorders, psychiatric illnesses, and monogenic forms of obesity were investigated and excluded in all patients. The decision to provide pharmacological treatment with liraglutide or semaglutide was based on the presence of severe obesity, ongoing rapid and substantial weight gain (BMI), and previous unsuccessful therapeutic efforts through lifestyle interventions. Liraglutide was gradually increased from 0.6 mg to 3.0 mg/day, and semaglutide from 0.25 mg to 2.4 mg over 16 weeks. Patients were asked about side effects during medical consultations. Since the adolescents had started treatment with liraglutide or semaglutide at different times, follow-up times varied (7–16 months). During pharmacological treatment, lifestyle improvement counseling sessions with individualized goal setting were conducted at each visit. The patients reported on here comprise all patients that have received this treatment at the two centers.

Results

Since early childhood, the adolescents had all shown a continuous and massive increase in body weight. Treatment with liraglutide (3.0 mg/day) was able to stop the continuous and massive weight gain in all seven patients (four female) and achieve a significant reduction in BMI (− 4.3 ± 2.3 kg/m², minimum: − 1.5 kg/m², maximum: − 8.0 kg/m²). Whereas the average gain in body weight prior to GLP-1 receptor agonist treatment had been + 11.2 ± 5.9 kg/year, body weight went down during therapy by on average −10.3 ± 6.4 kg (Table). Patients reported a significant reduction in feelings of hunger and an improved sensation of satiety. They reported that this enabled them to better implement the recommended lifestyle modifications. Comparable changes could be seen in Patient 8, who was treated with semaglutide.

Table

Body weight before the start of treatment (T0) and at the last examination time point under continuous treatment in eight adolescents (four female) with severe obesity

Patients 5 and 6 reported that after initially regular injections of liraglutide (for 10 and 14 months), injections had become irregular (2–3 injections/week). This was associated with a renewed increase in body weight (Figure). Patient 7 showed a marked weight reduction (−9.8 kg), but the treatment was discontinued after 8 months due to the health insurance provider’s refusal to cover further costs. This was associated with a renewed gain in weight of + 6.4 kg. Side effects are described in the Table.

Figure

BMI trajectories

Discussion

Severe obesity in adolescence is a chronic, progressive disorder. Patients typically have a history of continuous and extreme weight gain that is refractory to lifestyle interventions (3). Due to the high degree of associated morbidity and limitations on participation, effective interventions aimed at preventing further weight gain and reducing weight are needed. Bariatric surgery would be an effective treatment option, but is viewed critically due to the young age of these patients as well its side effects (1).

The follow-up data presented here show that the GLP-1 receptor agonists recently approved for adolescents are of significant clinical relevance in adolescents and young people with severe obesity. Outside of study conditions, the treatment was able to stop the previously significant weight gain in all eight patients. Moreover, continuous administration of the drug was able to achieve considerable weight loss during the observation period. Irregular administration of the drug did not result in sustained weight loss (patients 5 and 6). During the course of patient 7’s liraglutide treatment, the health insurance declined to cover further costs, citing Section 34 (1) sentence 7 of the German Social Code, Book V (SGB V), meaning that the treatment could not be continued. Renewed weight gain was observed.

In the authors’ opinion, treatment with GLP-1 receptor agonists is indicated as part of lifestyle interventions in this special patient group made up of adolescents and young adults with severe obesity and should be discussed before bariatric surgery. Follow-up data on safety and efficacy while under treatment with these drugs should be systematically documented and evaluated over longer periods of time.

Conflict of interest statement
MW and SWB served as consultants to Novo Nordisk, Boehringer-Ingelheim, and Rhythm Pharmaceuticals on the topic of obesity in children and adolescents.

The remaining authors declare that no conflict of interest exists.

Manuscript submitted on 2 July 2024, revised version accepted 3 December 2024.

Translated from the original German by Christine Rye.

Cite this as
Brandt-Heunemann S, Schirmer M, Weihrauch-Blüher S, Wabitsch M: The treatment of extreme obesity in adolescents and young adults with GLP-1 receptor agonists. Dtsch Arztebl Int 2025; 122: 225–6. DOI: 10.3238/arztebl.m2024.0250

References

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