Semaglutide cut %BMIp95 by 22.9 percentage points at 18 months in children and young people with severe obesity
Background
Severe obesity in children and young people (CYP) presents a critical public health challenge, often leading to a high burden of obesity-related complications such as metabolic dysfunction-associated steatotic liver disease (MASLD), dysglycaemia (including type 2 diabetes mellitus), obstructive sleep apnoea, and hypertension. Traditional lifestyle interventions frequently fall short for this population, necessitating more effective pharmacological strategies. GLP-1 receptor agonists like semaglutide offer a promising therapeutic avenue by improving glycemic control and promoting weight loss, making them a focus for managing complex pediatric obesity.
Study Design
This study analyzed data from 406 children and young people (CYP) receiving semaglutide in specialist weight management clinics, matching them to 787 comparator patients. The cohort had a mean age of 15.3 ± 1.7 years (range 11.3-19.5) and presented with very severe obesity, indicated by a mean baseline %BMIp95 of 172.9 (±29.5). Researchers tracked changes in %BMIp95 and BMI at 6, 12, and 18 months to evaluate semaglutide's effectiveness compared to matched controls.
Results
The study revealed a substantial burden of obesity-related complications across all 1,193 participants, with 43.0% experiencing MASLD, 23.2% having dysglycaemia (4.7% T2DM, 18.5% impaired glucose tolerance), 18.9% suffering from obstructive sleep apnoea, and 12.0% diagnosed with hypertension. Additionally, 19.6% of females had polycystic ovary syndrome, and 56.7% had documented depression, anxiety, or self-harm. Semaglutide treatment led to significant reductions in weight metrics over time:
At 18 months, %BMIp95 was 22.9 percentage points lower in the semaglutide group than in matched comparators (95% CI: -27.8 to -18.1), representing a relative reduction of 14.4%. Corresponding between-group differences in BMI were -2.7 kg/m2 at 6 months, -4.0 kg/m2 at 12 months, and -5.2 kg/m2 at 18 months (95% CI: -6.5 to -3.9 at 18 months), representing relative reductions of 7.4%, 10.2%, and 11.2% respectively.
Key Findings
- Semaglutide reduced %BMIp95 by 13.8 percentage points at 6 months compared to comparators.
- Semaglutide reduced %BMIp95 by 19.0 percentage points at 12 months compared to comparators.
- Semaglutide reduced %BMIp95 by 22.9 percentage points at 18 months compared to comparators, a 14.4% relative reduction.
- Semaglutide reduced BMI by 5.2 kg/m2 at 18 months compared to comparators, an 11.2% relative reduction.
- The cohort had a high burden of comorbidities: 43.0% MASLD, 23.2% dysglycaemia, 56.7% mental health issues.
Why It Matters
This updated data provides compelling evidence for semaglutide as an effective intervention for severe and complicated pediatric obesity, a population with limited treatment options. The observed significant reductions in %BMIp95 and BMI over 18 months are clinically meaningful, especially given the high prevalence of comorbidities like MASLD and dysglycaemia in this cohort. Integrating semaglutide into pediatric weight management protocols could substantially improve health outcomes and reduce the long-term burden of obesity-related diseases. This supports the growing use of GLP-1 receptor agonists in younger populations, moving closer to establishing standardized pharmacological approaches for complex cases.
semaglutide
obesity
pediatric-obesity
glp-1-agonist
weight-management
metabolic-dysfunction