For decades, doctors have treated obesity in children and teens as if the condition were simply the result of a failure of willpower. 

Eat less. Move more. Try harder. 

But now 'miracle' weight loss drugs known as GLP-1s that have helped millions of adults lose weight are increasingly being prescribed to children. Some GLP-1s, like Wegovy, are approved for obese adolescents aged 12 and older. Other weight loss medications are reportedly being prescribed off-label. 

While I don't recommend weight-loss medication to patients under 18 in my practice (my malpractice insurance doesn't cover it), the short-term benefits of the treatments are clear, but that doesn't mean that there aren't serious risks.

In a landmark 2021 trial of semaglutide (the active ingredient in Wegovy), obese teenager participants lost an average of 16 percent of their body weight, dramatically outperforming lifestyle intervention alone. 

Beyond shrinking waistlines, losing weight can also positively impact blood pressure, insulin resistance, fatty liver disease and long-term health trajectories.

GLP-1 usage among this adolescent cohort surged 600 percent between 2020 and 2023, according to the Journal of the American Medical Association and it's no wonder why.

The need is real: The Centers for Disease Control found that more than 20 percent of teenagers are now obese, up from just five percent in the 1970s. But while the benefits of GLP-1s can be substantial, their long-term side-effects are still unclear. 

Physicians do not know, for instance, how ongoing appetite suppression might affect bone growth, the ability to absorb nutrition or brain development. As doctors, we must be honest about these uncertainties.

For the moment, we don't know how long teenagers should stay on GLP-1s because most adolescent trials have only followed patients for roughly one to two years, not five or 10, which would provide greater insight into long-term effects. 

What obesity specialists increasingly believe, however, is that for many patients, GLP-1s may function more like a chronic disease treatment than a short-term intervention, similar to blood pressure or cholesterol medication. 

Even if aided by increased exercise and behavior modification, young people growing up on GLP-1s might never be able to go off them without gaining weight, because the drugs can degrade the body's natural metabolism. 

Also uncertain is the impact of GLP-1s on teenagers dealing with eating disorders, such as binge eating and bulimia. 

In my own practice, adult binge eaters have described a dramatic reduction in food cravings and compulsive eating after starting GLP-1 medication. There is biological logic behind this. 

Studies have found abnormalities in the hormones that control satiety in binge eaters. Weight-loss medications can counter this condition by enhancing feelings of fullness and decreasing the intense reward signals associated with food. But here too, caution is essential.

Not every eating disorder is driven by hormones. Some are triggered by anxiety, self-destructive compulsions, body image distortion or an intense fear of weight gain. Particularly in adolescents, these psychological drivers may be more important than the biological ones.

In fact, for vulnerable young people prone to unhealthy relationships with food, appetite suppression alone is unlikely to fix underlying triggers. Concerningly, they may even make things worse.

Weight-loss drugs should never be viewed as a universal solution.

If a 15-year-old has severe obesity, fatty liver disease, prediabetes and years of unsuccessful dieting, I may understand why physicians might consider GLP-1 medications.

If a teenager is trapped in a cycle of binge eating that is destroying their quality of life, I can also see why physicians and researchers are eager to investigate whether GLP-1s could help.

But, again, caution is key. Young patients need careful screening, close medical supervision and psychological support.

They also must be informed that obesity  is a condition that requires ongoing attention.

Despite their very real uncertainties, GLP-1 medications may ultimately prove as promising for treating overweight teens as they now do for adults. But until the science is more definitive, when it comes to children and young adults, 'promising' should never be confused with 'proven.'