The constant search for effective treatments to address obesity has led to the increasing use of medications based on glucagon-like peptide-1 (GLP-1) receptor agonists designed for type 2 diabetes. These are Ozempic, Saxenda and Wegovy, considered by many as the “lifeline” against this pathology that has tripled worldwide since 1975.
And although the FDA and the European Medicines Agency have ruled out the relationship between GLP-1 medications and suicidal ideation, the truth is that recent research has raised concerns about possible psychological risks associated with these drugs.
Thus, a month ago a study published in ‘Jama Network’ warned of an increase in suicidal ideation in people taking semaglutide (Ozempic), but not in users of liraglutide (Saxenda).
Well, now a new study also published in “JAMA” analyzes this risk among obese adolescents who were prescribed a glucagon-like peptide-1 receptor (GLP1-R) agonist and concludes that these had a lower incidence of suicide ideation or attempts compared to patients who were not prescribed GLP1R and who were treated with a lifestyle intervention.
These results suggest a favorable psychiatric safety profile of GLP1R in adolescents, which is key when childhood obesity currently affects more than 124 million children and adolescents worldwide.
Specifically, the analysis, a retrospective cohort study, was carried out between December 2019 and June 2024. 77,854 patients were initially included.
After exclusion due to lack of follow-up or use of GLP-1R agonists before being diagnosed with obesity, the sample of participants was reduced to 54,164 obese adolescents between 12 and 18 years of age, mostly from the United States.
Of them, 4,052 adolescents who had been prescribed GLP1 and 50,112 who had been recommended an entire lifestyle intervention, but without this drug.
Cohorts were balanced on baseline demographic characteristics, psychiatric medications and comorbidities, and diagnoses associated with socioeconomic status and access to healthcare.
During the 12 months of follow-up, GLP1R prescription was associated with a 33% reduction in the risk of suicidal ideation or attempts (1.45% vs. 2.26%).
Furthermore, the researchers found that These participants had a higher rate of gastrointestinal symptoms (6.9% vs. 5.4%), but with fewer events of acute pancreatitis (0.29% vs. 0.67%).
Besides, No was differences in rates of upper respiratory tract infection diagnoses (10.33% vs. 10.88%).
The study authors also highlight that there was no sign of an increase in suicidal ideation or attempts associated with GLP-1R prescription in all subgroups stratified by sex and race, GLP-1R type, or drug status. diabetes, nor did they see any increase during the different times analyzed during the follow-up not only at one year, but at three years.
The researchers maintain that potential pretreatment trends in suicidal ideation or attempts did not influence the primary outcomes. This analysis revealed no significant differences in the incidence of suicidal ideation or attempts between the cohorts (1.52% vs. 1.64%), providing additional validation that the observed differences were more likely due to GLP-initiation. 1R than to pre-existing conditions.
The prevalence of obesity among children ages five to 19 has increased eight-fold over the past four decades. Predictive epidemiological analysis conducted in 2017 suggested that if these trajectories persist, more than 50% of the pediatric population will be obese by the time they are 35 years old.
Since then, significant increases in Body Mass Index (BMI) have been observed during the covid pandemic, mainly affecting adolescents diagnosed as overweight or obese before the pandemic, underscoring the susceptibility of this population to the influences environmental.
In Europe the situation is repeated, but not so in Spain. Thus, recently a study published in 2023 “Child and Adolescent Obesity” and in which more than 745,000 adolescents from 41 countries in Europe and North America participated, warned of the increase in overweight adolescents who, furthermore, do not perceive it.
On the other hand, it also reported that obesity among adolescents in Spain, Denmark, England and Wales was decreasing.
It is not the only study to point out this decline. Thus, a few months ago the preliminary data from the “Steps 2022” report, prepared by the Gasol Foundation, concluded that obesity and overweight in Spanish minors were slightly decreasing. However, the prevalence of childhood excess weight was still very high: 33.4%.
In any case, obesity during childhood and adolescence has been associated with immediate and long-term adverse outcomes including cardiometabolic complications, type 2 diabetes, liver disease associated with metabolic dysfunction, and premature mortality.
The etiology of childhood obesity is complex and multifactorial. Genetic predisposition to adiposity, an environment that favors weight gain and obesity, and a sedentary lifestyle contribute synergistically to the development of childhood obesity.
Recent studies show that variants in genes active in the neural circuit of the hypothalamus that regulates appetite could be the cause of the feeling of hunger and therefore cause the development of obesity in childhood and adolescence. These findings support the idea that childhood obesity is not the result of a lack of willpower. An idea that is also associated with obesity in adults.