Drugs such as Ozempic and Wegovy, known as GLP-1 receptor agonists, are growing in popularity as treatments for weight loss and control. The rise is affecting not only adults but also adolescents and bariatric surgery patients. Michael Kochis, a resident in the department of surgery at Massachusetts General Hospital, noted that little research has been done on the use of these drugs in adolescent bariatric surgery patients. Kochis and his team examined treatment patterns nationwide, and he spoke to the Gazette about the group’s recent study, as well as safety issues for adolescents in general. This interview has been edited for length and clarity.

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Are these medicines safe for both adults and adolescents?

There is growing evidence that these drugs are safe to use, especially in adults, but more recently in children. Before drugs are approved, studies are conducted to make sure they are safe enough to bring to market. These studies play a role in FDA approval. After approval, they continue to be monitored.

And I think it’s important to note that safety can mean different things to different people. And while there are no obvious problems that would cause these drugs to be taken off the market — which has been the case with other obesity drugs in the past — there are side effects that not everyone tolerates well, like nausea or a constant feeling of fullness. It’s not a panacea with all the benefits and no risks.

In pediatrics in particular, there is far less data on their use in children and young adults because they are not prescribed that often anyway. It is harder to get studies where we can collect huge amounts of data on adolescents.

One area that this research highlights is the fact that these drugs are used in children. It’s really important that we collect data to make sure that there are no differences in the use of the drugs in this population compared to what we know in adults.

Why did you choose bariatric surgery patients for your study rather than general adolescents who may be taking these medications?

Our research group specializes in bariatric surgery. We are hearing more and more about these drugs and that has piqued our interest.

But second, there are a few special issues that need to be considered when using these drugs in children undergoing bariatric surgery, in addition to safety. These relate to the many physiological changes that occur as a result of bariatric surgery, not just weight loss.

The surgeries themselves change the body’s metabolism and hormone levels. It is not known how the changes caused by the surgery affect the hormone levels that these medications affect. Therefore, the questions before surgery, during surgery and after surgery are relevant in terms of the effects of these medications on patients. We asked questions about all three areas.

What did your study reveal regarding the use of these medications?

There were two really important findings. First, these drugs are actually being used in adolescents with obesity who are undergoing bariatric surgery. So basically the cat is out of the bag, it’s already happening.

And the second realization is that there is a lot of uncertainty and differences in the exact ways of doing things between institutions. There is a realization that we do it this way and they do it that way. And nobody really knows what the right or best answer is. We are in uncharted territory.

This creates an opportunity to bring these different groups together in a targeted way and share data so that we can try to establish best practices. This may be based on a consensus on what experts think is the best approach or hopefully – over time – an evidence-based approach. But that could take some time.

What are the benefits and potential dangers of recognizing that there are so many variations?

I think overall it sparks discussion and raises awareness. A lot of these pediatric bariatric centers must be really good at what they do. We specifically looked at the larger centers around the country that often serve as reference points for entire regions.

I suspect that people come to your practice because they think it might be helpful for their patients and they aren’t aware that it’s done differently elsewhere. This study highlights that and will hopefully start a discussion so that different providers start talking to their colleagues and asking questions.

Most likely, you do things differently than your colleagues, so why don’t we start talking about it and sharing our experiences to try to find the best practices?

The problem with this is that you may conclude that one approach is better than others. When there is variety, there may also be variation in the quality of treatment. Once we have a better understanding of the optimal use of these drugs before, during and after surgery, there will be opportunities for standardization of treatment.

What else do we need to learn?

Above all, more data is needed. I also hope that this will be an opportunity for different institutions to come together and work together. We are working on both of these things.

Pediatric surgery is generally relatively small; fortunately, children and adolescents often do not require as much surgery as adults, so it is a great place for collaboration and knowledge acquisition.

There are a few collaborations of children’s hospitals and surgeon networks across the country. At Mass General, we are currently working on creating another collaboration that focuses specifically on metabolic and bariatric surgery in children. We are working on creating databases where we can bring together all of the data from our individual institutions – about how we treat these patients before surgery, what we do during surgery, and how they do after surgery – to agree on what data we are collecting and how we can evaluate it over time.

We can ask some really good research questions that we would never get answers to (with as much detail and judgment) if any of our institutions were doing the exact same study alone. More efforts like this will be helpful in providing the high-quality evidence we need to make informed decisions about how to best care for patients.

Is there anything parents should consider when considering these medications for their children?

I’m glad you brought that up. One of the findings of the study is that, in the absence of strict guidelines or criteria, some providers’ practices were influenced in part by patients or families.

The use of these medications should be part of an interdisciplinary discussion with the patient’s pediatrician, family doctor, obesity doctor and, if necessary, a surgeon.

Every patient has their own circumstances, so I would tell parents that it’s good if they see advertisements in the news or on social media about the medications that are available to them, but then bring that background knowledge into an informed conversation with your doctors. Just because you’ve heard that some celebrities have used these medications and had certain experiences with them doesn’t mean they’re right for everyone or should be used in your situation. You can really only determine that based on a comprehensive conversation with your doctors.