The magnitude of the childhood obesity problem in our country is almost as hard to believe as it is depressing.
Two big items in the news recently illustrate a lot about where this problem is and where it’s going.
The first is a clinical trial looking at the impact of obesity medication in kids.
The second is an announcement of a new lunch product marketed for kids from some of the biggest YouTube stars in the world, Mr. Beast, Logan Paul, and KSI.
One takeaway from these news items is that the default environment sets us up for obesity and chronic illness, so this probably is going to get worse before it gets better.
A second takeaway is that you’ll probably see more and more children treated with medications like Ozempic.1
Another is that no one is looking out for you and you need to be your own advocate because almost everyone is willing to healthwash their products to make a buck.
Let’s take a look at each of these stories in more detail.
The SCALE Kids trial heralds the era of Ozempic for kids
To be fair, this study didn’t really look at Ozempic, it looked at a drug in the same class, but the end result is likely the same - more and more kids are going to be offered injections of medications for weight loss.2
The SCALE Kids trial looked at the impact of liraglutide (sold under brand names Saxenda and Victoza) on obesity in children age 6-12 years ago.
Liraglutide is in the Ozempic class of drugs, the GLP-1 agonists. These drugs are pretty astounding in how they’ve been able to help adults with obesity.
The kids enrolled in this trial were not diabetic, but they did have a BMI at or above the 95th percentile for age and sex.3
Liraglutide is a once daily injection (Ozempic/Wegovy and Mounjaro/Zepbound are once weekly), and the protocol started at a low dose which was gradually increased.
They measured weight, BMI, weight circumference, blood pressure, hemoglobin A1c - a pretty good list of metrics, although it would have been useful to include a body composition analysis so that we could see the impact on bone mineral density or muscle development.4
They seem to work in kids to lower BMI and slow weight gain compared to a placebo treatment:
The participants receiving liraglutide also had reduction in waist circumference (suggesting visceral fat loss)5 and blood pressure (suggesting reduced cardiovascular risk).
Unsurprisingly, there were more GI side effects in the treatment group compared to placebo.
So the top line result is this: liraglutide lowers BMI in children between ages 6-12 over about a year while reducing waist size and lowering blood pressure slightly.
This means more kids getting weight loss drugs
In terms of where this is going, I want to emphasize a paragraph from the discussion section of this paper:
“A large trial evaluating BMI among a German population-based sample of 51,505 children showed that almost 90% of children with obesity at 3 years of age had overweight or obesity in adolescence; the investigators concluded that among adolescents with obesity, the most rapid weight gain had occurred between 2 and 6 years of age.28 Therefore, clinical management of obesity should consider the most appropriate timing for treatment initiation and continue throughout life.5”
Whenever you’re looking at an intervention like this, you want to weigh the positives and the negatives.
One argument that you will probably hear made is that treating obesity at a younger age may have a bigger impact long term impact on chronic disease risk than treating it later, and so we should seriously consider more pharmacologic efforts to treat kids at risk for these bad outcomes.
The counterargument is that we don’t know what we don’t know about the long term impact - how does this impact bone density, muscle mass, puberty, fertility, or a million other things?
Like all interventions, there’s probably a large amount of individual variation in the benefits and the risks, and so this is a patient/parent-doctor conversation about what to do.
But when positive data like this comes out, the end result is that more of these medications are going to be prescribed.
You also shouldn’t be surprised if a trial like this influences clinical practice guideline recommendations on the treatment of obesity in children.
As the heading to this section goes, this means more kids getting weight loss drugs.
If a trial like SCALE Kids is a step to telehealth “innovation” pushing these drugs on lots of kids like we’ve seen with adults, that’s a really alarming outcome.
Read Mike Albert on this for a smart perpective.
An unrelated-but-related story - YouTube stars have teamed up to feed your children something marginally healthier than Lunchables
Mr. Beast, Logan Paul, and KSI, some of the biggest YouTube stars alive, have teamed up to launch a pre-made children’s lunch offering called Lunchly designed as a competitor to Lunchables.
Lunchly comes in 3 varieties - Pizza, Turkey Stack ‘Ems, and Fiesta Nachos.
You can see the nutritional info below as well as how it compares to Lunchables.
With a health difference this small between the products, I’m pretty surprised that the Lunchly folks wanted to show a direct nutritional comparison:
When you’re marketing a product as healthier, it takes quite a bit of hubris to tout your electrolytes and gloss over your high quantities of sodium.6
But this is where we are as a society - a mediocre food product that’s a tiny bit healthier than a product consumed by millions can healthwash itself as being a big health upgrade.
Lunchables has huge market share and is going to be a part of school lunches across the country
Lunchables has a huge partnership with schools across the country.
This isn’t just bad because of what is on the label.7
Lunchables products have more sodium than the nutrition facts report, and, according to Consumer Reports, these products sometimes have cadmium and lead in them.
So when there was a bit outcry about how Lunchly isn’t all that healthy, here is what one of its founders had to say as a defense:
It’s an interesting argument - if this is a bit better than a widely distributed product, does that make it good?
Will the net societal impact of success by Lunchly actually end up being positive?
I don’t really know and I think that where you come down on an argument like that is a judgment call.
But imagine having a gigantic platform like these folks do and then using it to make a slightly-less-objectionable Lunchables competitor.
There’s a big difference between designing a product that you really want (or would feed to your own kids) and using your notoriety to peddle something like Lunchly.
It’s pretty depressing.
The bottom line here - no one is looking out for you or your family. You are your own advocate
I understand the arguments in favor of prescribing GLP1 agonists to children and switching your kids from Lunchables to Lunchly.8
But it’s a sad commentary on the health of our society that these are the debates we are having.
I think there’s a big unknown of giving these drugs to children - we don’t know what we don’t know and that long term unknown is concerning.
While it’s possible that early treatment of obesity in kids will pay big dividends in long term health outcomes, there’s also a possibility that it won’t and the only people getting dividends are the folks who have stock in Novo Nordisk.
And it’s also possible that in the long run, Mr. Beast’s argument will be right - Lunchly will be a net positive for kids and they will use their margins and economies of scale to continuously iterate and provide a healthier option.
But I doubt it.
Remember, food companies will always figure out creative ways to engineer products that we can’t stop eating.
The fact that something is better for you doesn’t mean it’s good for you.
At the end of the day, you have to be your own advocate because drug companies and food companies are going to look out for their own bottom line.
Which is alarming and I’m not sure worth the risk, which we will talk about in this article.
Perhaps lifelong injections of medications.
I’m aware that BMI is not a perfect indicator of someone’s health. But put me in the BMI defending group - I think the criticisms are overblown and the measurement is pretty useful for the vast majority of people. It tends to fall short in athletes and people with very high muscle mass, which is a tiny slice of the population. Most people with a high BMI have too much body fat.
The concern about how these drugs impact bone density and muscle growth are some of my major reservations about the unknown impact of these drugs in developing bodies.
Visceral fat loss is the type of fat loss you want to see.
It’s interesting that the drinks have a lot of potassium in them - you can look up the ingredients/nutrition facts from Prime and you see a lot of potassium. There’s a hypothesis that some hypertension is driven by an imbalance between sodium and potassium intake, and so theoretically this might mitigate blood pressure increases. It’s still a guess and a gamble, but I found this information on the nutrition to be interesting.
And to be clear: what they admit is in the food on the label is bad for you.
There’s a huge debate in some circles about the causes of obesity and the magnitude of individual responsibility. It’s hard to say that a kid between ages of 6 and 12 is obese because of their own lifestyle choices. The fact that millions of kids are being fed Lunchables on a regular basis is just very sad. And switching them to Lunchly isn’t any less sad.