Weight loss drugs for adolescents: The phenomenon that is starting to worry experts

In recent years, weight loss drugs (injections and pills) have taken a central place in the treatment of obesity and have become a significant tool both among adults and among adolescents. Parallel to the therapeutic progress, evidence of the development of eating disorders in adolescents following rapid weight loss due to taking the drugs is beginning to emerge. Although this is a medical subject that is still in the initial stages of understanding, it is raising interest and concern among professionals.

In recent decades, the medical world has been dealing with a consistent rise in obesity rates, including among adolescents. A large part of the population is currently in higher weight percentiles than in the past, and phenomena of overweight and even extreme obesity have become more common. In this reality, weight loss drugs have entered as an effective medical solution, first for adults, and later also for adolescents. However, adolescence is an especially sensitive period. Hormonal changes, alongside the rapid development of the body and mind, create a situation in which any radical change in weight — and in particular rapid loss — can affect physical and mental balance.

In some cases, such processes can lead to the development of eating disorders. Here, atypical anorexia enters the picture — a situation in which all the criteria of anorexia are met in terms of behavior, thoughts, and medical risks, but the weight after the loss is normal or even high. Patients in this state may suffer from low pulse and blood pressure, fainting, cessation of menstruation in girls, as well as obsessive preoccupation with food and extreme fear of weight gain, even if they are not in a state of classic underweight and the disease is not visible to the eye.

Into this medical space, another factor has entered in recent years: weight loss drugs. Drug treatments sometimes cause rapid and significant weight loss, and if the treatment is not accompanied by organized medical monitoring, a risk of developing patterns of an eating disorder may be created, especially among adolescents.

Atypical anorexia: a complex of physical and behavioral signs

In the medical literature to date, isolated reports of cases of the development of eating disorders in the context of drug treatment for weight loss are documented. However, in the field, medical sources report similar phenomena, and the assessment is that this is an incipient phenomenon that is expected to expand over time. The central challenge in these situations is diagnosis. Sometimes, although the weight appears normal or even high, clear signs of an eating disorder exist: sharp weight loss in a short period of time, increased physical activity, avoidance of entire food groups, and sometimes also physical symptoms such as low pulse (which does not stem from increased physical fitness, but from abnormal weight loss), a drop in blood pressure, and fainting. In girls, cessation of menstruation is another significant warning sign.

Sometimes, even the environment — parents, patients, and even medical teams — has difficulty identifying that this is a problematic medical situation, precisely because the weight is not low. But in atypical anorexia, the definition does not depend on weight alone, but on a complex of physical and behavioral signs.

Drug treatment, especially among adolescents, requires close medical and parental monitoring, since at young ages the ability for self-control is limited. It involves medical, nutritional, and emotional support that includes ongoing assessment of the physical and mental state, alongside active involvement of the parents and the medical team. The monitoring includes control over the rate of weight loss, eating patterns, physical activity, and physical and emotional changes, and is a central and basic part of ensuring safe and effective treatment.

When a suspicion of an eating disorder arises in the context of drug treatment, sometimes a decision will be made to stop the drug treatment alongside the start of treatment for the eating disorder. In these cases, the weight gain back is not a side effect, but part of the treatment and recovery. One of the central challenges today is determining the healthy target weight: the point of balance between avoiding obesity and preventing an eating disorder. It is important to emphasize: this is a developing field, with only preliminary reports in the medical literature. However, in the clinical world, the understanding is strengthening that there may be many more cases, and that there is a need for higher vigilance, especially in the combination of drug treatment with rapid weight changes in adolescence.