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Weight Limit is a series that examines the rise of weight loss drugs like Wegovy and how they impact young people. This story looks at the mental health impact these drugs can have on teens, and what that means for those taking them.
Ever since kindergarten, Natalie knew she looked different from her peers. “Everyone was really tiny and really stringy and I was like, hello…” she says, laughing and looking down at her feet. Natalie, now 12, sits in an office chair, fingers fidgeting in her lap, as she talks to her mom Kailey about her weight. The topic wasn’t frequently brought up in their household when Natalie was younger, Kailey says, but Natalie is a preteen in America with access to social media and the internet and television — like so many people her age, she’s conscious of her body, and what others might think of it.
“You never see big celebrities who people say are hot,” Natalie says. “You only see really skinny people.”
Natalie started rapidly gaining weight when she was about 4 years old, her mom remembers, gaining about 20 to 30 pounds a year until age 7, when Kailey brought her to her first specialist. After many tests, Natalie was diagnosed with Polycystic Ovary Syndrome (PCOS) — a condition that causes a hormonal imbalance and can have many symptoms, including weight gain, and which is often accompanied by insulin resistance. At 8, Natalie started taking metformin, a drug meant to treat Type 2 diabetes that can also ease PCOS symptoms, but it wasn’t helping with her weight, Kailey says. Still, there weren’t really any other medication options for a pre-teen whose weight kept climbing thanks to a little-understood hormonal disorder.
But recently, that all changed. In December, 2022, Wegovy, a weight loss medication and sister drug to the extraordinarily popular Ozempic, was approved for use in children as young as 12. One month later, in January, 2023, the American Academy of Pediatrics (AAP) changed their recommendation on how to treat obesity in children, moving away from their “watchful waiting” strategy and toward aggressive intervention. Kailey watched all this happen and called Natalie’s doctor. After a few months (and Kailey using a similar drug herself as a test), Natalie’s doctor prescribed her Wegovy.
“I haven’t, like, lost a ton, but I think I lost a decent amount,” Natalie says about her weight loss since starting Wegovy in June. “It’s not something that happens really quickly. It doesn’t sound like a lot, but I look a lot littler and I feel better. It doesn’t just help with your weight, it can help with your confidence, too.”
After its approval for teens and the new AAP recommendations, young people joined the crush of Americans using semaglutide and other GLP-1 agonists (the class of drugs that Ozempic and Wegovy belong to) to lose weight. Whenever a new drug is approved for young people, it comes with many concerns — is it safe? What are the long term effects? — and semaglutide has been no different. Experts worry both about the long term impact of being overweight, and of taking drugs that we haven’t seen the effects of after years, never mind decades, of use. But since the new drug in question is for weight loss, some experts have raised different concerns: with use during a critical and fragile developmental time, how are these drugs and the weight loss associated with them impacting young people’s mental health? In a culture steeped in “doublespeak” that often conflates weight and health, it’s a question Doreen Marshall, PhD, CEO of the National Eating Disorder Association, says is one worth asking.
“There’s a concern that what might be underlying the pursuit of [weight loss] is not necessarily connected to health,” Dr. Marshall tells Teen Vogue, “putting [young people] at risk of, or even reinforcing, an eating disorder.”
Wegovy was approved for use in adolescents after 201 young people ages 12-17 completed a 68 week trial. Its approval came a little more than year after the drug was approved for use in adults, and five years after Ozempic was approved for use in adults to manage Type 2 diabetes. Wegovy is specifically prescribed for weight loss, while Ozempic (which contains the same active ingredient but at a lower dose) is for diabetes management.
Melissa Crocker, MD, a pediatric endocrinologist at Boston Children’s Hospital and assistant professor of pediatrics at Harvard Medical School, says Wegovy works by influencing how our bodies regulate feelings of fullness.
“It’s mimicking a hormone our stomach naturally makes that helps us feel more full and slows down digestion so we stay full longer,” she says. For teens and adults, this can reduce appetite and cravings, leading to weight loss.
In addition to counseling teens on weight management through diet and exercise, Dr. Crocker prescribes Wegovy to some young people to manage weight-related health issues, which she says are becoming more common among teens. “There are some really serious complications of unhealthy diets and weight gain, and we’re starting to see them more in the teen population; more Type 2 diabetes, high blood pressure, high cholesterol,” she says. “That is pushing us to be more concerned and more interested in finding ways to help this population to prevent these scary complications.”
Dr. Crocker says these drugs do come with risks. A “large percentage” of patients experience gastrointestinal issues like nausea, diarrhea, and stomach aches, she says. These symptoms ease over time for some, though others, Dr. Crocker says, may not be able to tolerate them. Wegovy shouldn’t be prescribed to anyone with a family history of medullary thyroid cancer, as it could put them at risk of developing it. Beyond these shorter term risks, though, Dr. Crocker says it’s not clear what impact Wegovy might have on patients using it long term — especially teens, who might use the drug for decades and decades to come.
“We don’t have a lot of long term data in teens at all, and not even significant data in adults. We know the shorter term risks and complications and we don’t have any current reason to expect any longer term complications that we’re aware of, but there will be more answers as the research [continues],” she says. But, this is the case for many drugs, and a quandary pediatricians grapple with frequently. “Almost all of our recent medications that we use in pediatrics don’t have long term data because the pharmaceutical industry is a very active, successful industry that has been able to develop a lot of medications. There’s no way we can wait for 80 years of data,” Dr. Crocker continues. “That’s a general question and issue that plagues us as pediatricians. We’re looking at a child that has decades and decades of life ahead of them and we can’t wait that long [to prescribe].”
But especially when it comes to weight loss, there’s more than just the physical to consider. Dr. Crocker says considering the mental health of the patient is crucial, something Dr. Marshall, the CEO of the National Eating Disorder Association, stresses, particularly for young people who she says are more vulnerable to social comparison.
“When we think of overall health, we should be talking about mental health,” she says. “When you think about how decisions about health get made, a lot of times, around body size, those decisions aren’t made looking at the full picture."
Emmalea Zummo’s main goal on Wegovy was to improve her health and manage the symptoms of her PCOS — one symptom of which was weight gain. She was one of the 201 teens in the Wegovy trials, and over the course of a year, Emmalea, now 19, says she lost 70 pounds using Wegovy.
“I had struggled with obesity since the fourth grade, with kids being mean,” she says. “I was doing this [trial] in my high school years, when kids are prime to be rude. It’s easy to take it out on targets like me, whose weight fluctuated.”
In a slimmer body, Emmalea says she felt better about herself and her classmates noticed her weight loss, many of the mean comments easing up (though some, she says, made fun of her for being skinny, too). But when the trial ended and Emmalea had to stop taking Wegovy, she started quickly gaining weight back.
“That’s when I moved into developing an eating disorder,” she says. “I saw the numbers on the scale going up and it was a very hard adjustment because people notice these things.”
Research suggests that most people who stop taking Wegovy regain much of weight they had lost while on the drug. Dr. Marshall worries that many people might not understand that Wegovy could require long term use to maintain weight loss. And for people vulnerable to eating disorders, Dr. Marshall says losing a large amount of weight can reinforce the idea that being thin is inherently valuable — something that’s difficult to grapple with if the weight starts coming back.
“What we really need to understand better is how people who have an undiagnosed eating disorder, how [these medications] intersect with that. My guess would be, in many instances, these may be very harmful if a person has an eating disorder or a developing eating disorder,” she says.The widespread availability of these drugs “might end up reinforcing for some people the thing they're trying to address.”
After watching the weight she lost creep back on, Emmalea says she tried to control it via diet and exercise. When nothing worked, it took a toll on her mental health, particularly as her peers responded to her changing body. “One minute I was this circus act, then I was so pretty — but to the point where it seemed suspicious — then back to this circus act.”
As experts grapple with this new medication and our growing understanding of both the risks and benefits, something else is happening in the background: despite many claiming a rise in body acceptance, people’s bodies are visibly shrinking and young people are taking notice.
Over the last few years, these drugs have gained in popularity, becoming highly sought after because of their ability to induce weight loss, and not just in people who have weight-related health issues. Rumors spread about celebrities using Ozempic to slim down quickly, and talk about the drug became nearly unavoidable on TikTok. This rise in talk about weight loss drugs coincides with the already-existing pressure young people feel to look a certain way, one dictated heavily by their peers.
“In school, kids have that mentality that what they see online, everybody has to be skinny, everybody has to look like this,” Natalie says about how her peers think about what kind of bodies are most desirable. Still, Natalie believes a few things about weight: First, that you’re probably more fixated on your weight than other people are. Second, that expectations that call for body uniformity can be “unrealistic.” She says that her friends don’t really comment on her weight, or her weight loss, and that her primary goal in taking Wegovy was to manage her PCOS. Still, her mom Kailey says that shortly before Natalie started taking Wegovy, she came home from school upset about her weight.
“It wasn’t until she got into middle school when she started talking to me about her size,” Kailey says. “She was suddenly very aware that she wasn’t the same size as her peers. She started using the vocabulary — ‘I want to be skinny.’”
Emmalea, too, started taking Wegovy to address a medical concern. But, she’d also felt ostracized by her classmates as a result of her weight. Anyone who has felt like an outsider in middle school can relate intimately to this feeling of wanting to fit in, and beyond Natalie and Emmalea, we’re seeing that desire play out in the larger cultural conversation around GLP-1s and weight loss.
Many have talked about these drugs as game changers for health, touting their potential to ease the complications that can come with being overweight. And, research suggests that’s true. But in the same breath, some of these concerns about the health of fat people also offer a socially acceptable outlet for fatphobia. This falls under what writer Lisa Miller called a familiar “doublespeak” in an article about teens in the age of Ozempic for The Cut. Miller used the example of the AAP guidelines on childhood obesity. “The guidelines’ authors, they pointed out, claimed to focus on ensuring children’s health but had devoted most of the document’s 100 pages to addressing their size — a doublespeak familiar to anyone who grew up under the rule of quick-fix diets and faddish drugs.”
For Nancy Crimmins, MD, a pediatric endocrinologist at Cincinnati Children’s, disentangling the desire to be thin with the need to be healthy is a top priority, but one that’s particularly difficult, especially when dealing with teens. It’s not realistic, she says, to think that the desire to be thin doesn’t play some role in young people seeking out these medications, even if it’s a medical necessity.
“Developmentally, to ask a 14, 15, 16-year-old girl to have health motivation as their main driver is probably not realistic,” she says. “I always feel like, as a provider, that’s my job. I need it to be about health.”
In her practice, Dr. Crimmins is seeing families asking directly for weight loss medications for their teens. In these cases, she investigates where the ask is coming from — is it the teen or the parents asking, and what prompted them to ask? In addition to a full medical screen, she says she also wants to know how much outside pressure is factoring into the desire to take weight loss medication. “There’s so much bullying and fat shaming that goes on in this age group from multiple sources,” she says.
That bullying can be quite distressing. Research has shown that weight stigma can result in poorer mental health outcomes in teens. Like Natalie says, taking Wegovy has helped with her confidence, a benefit that can’t be overstated for a young person. Emmalea, too, says she felt better both mentally and physically while taking the drug — it’s just that once she stopped taking it and those effects were gone, the readjustment was devastating.
While Dr. Crimmins says the desire to be thin alone is not a reason to prescribe a weight loss medication, she does wonder to what degree mental health and outside pressures — which she acknowledges as quite real — should play into prescriber decisions.
“It’s easy to know the place of these medications when you have weight-related disease. But if I have someone come in with severe depression, suicidal ideation, and weight is a big part of that, that’s where I struggle,” she says. “Obviously, a mental health provider would be pulled into that. But those providers don’t know how to write those prescriptions.”
That’s the real tough question. It would be silly not to acknowledge that thinness is prioritized in our society; and, it would be even sillier to pretend that teen girls don’t want to pursue thinness in order to fit in (something research bears out), or as an answer to weight-based bullying. So, is it a teen’s fault if they want to conform to that pressure? Or is it a reasonable response to a barrage of media and influence and family pressure and teasing at school telling them that their bodies are wrong and should be changed?
It’s an issue Dr. Crimmins says she struggles to deal with. “I think as a society, we need to step back and say, why is this happening that these girls feel so much pressure and that this stigma continues to go on?” she says. “Social media and media and the arts as a whole have played such a huge role in creating this culture. As a provider, my job is to assess what’s playing into this ask [for weight loss medication] and making sure that, health wise, those things are being addressed. If [the patient] is like, ‘I feel these societal pressures,’ why? Then, getting the mental health piece in there. But it’s frustrating to work against this culture. I can’t top that. There’s all this going on on the outside, then I’m over here on the health end, and these families and girls are in between.”
For Dr. Marshall, the concern is that the rise of drugs like Wegovy — when not used for medical reasons — might reinforce this culture that glorifies being thin, and conflates it with being healthy.
“This idea of pursuing thinness for the sake of thinness is reinforcing this idea of a body ideal, where there’s value placed on being a lower weight,” Dr. Marshall says, concerned about the message it may send when drugs like Wegovy and Ozempic are used solely to achieve thinness. “We know that [size] often isn’t what tells us about a person’s health. [We need to] move away from this idea from weight loss being good and weight gain being bad, that a person’s body size has a value attached. [Drugs like Ozempic] kind of reintroduce that idea.”
Natalie, too, is concerned about the way people talk about Ozempic and other similar drugs. She wishes the focus weren’t on thin people using it to get thinner, but on people like her who are using it to address a medical issue.
“I see a lot about skinny celebrities on Ozempic who want to lose more weight. Those article shouldn’t be the ones that are out. Ozempic was made for diabetes. Though weight loss is a side effect, it can [help] things like PCOS and diabetes,” she says. “I think the way that people are paying attention isn’t how they should pay attention.”
So, how do we disentangle our thoughts about weight from our decades-old societal obsession with thinness when it comes to this new class of weight loss drugs? That, Dr. Crocker says, is something that will require much, much more investigation.
“This is a really new area that I think will have a lot of post hoc analysis. A lot more research needs to be done. It’s changing the landscape of how people want to address these problems,” she says. “I worry that people think this is a quick fix, and I think part of that is the landscape of how that makes people feel about their bodies. It is hard to feel comfortable in something that everyone is trying to change.”
Read the rest of the series here:
Ozempic Is Highlighting How We Link Our Worth to Our Body Size
Nearly 1 in 10 Teenagers Have Turned to Pills for Weight Loss, Research Shows
We Don't Always Know What's In Those Cheaper Ozempic "Dupes"
Diet Culture History: From Ancient Greece to Ozempic
Young People Are Struggling to Get Ozempic for Diabetes Because of the Drug's Popularity
