Are weight-loss medications and surgery right for teens?

Advances in bariatric surgery and weight-loss medications have made weight management accessible to more adults. But are these approaches effective — and safe — for teens, too?

Weight-management medications, particularly glucagon-like peptide 1 receptor agonists (GLP-1RAs), are the newest tool available to people over age 12 for the treatment of obesity and related conditions.  At Boston Children’s Adolescent Weight-Loss (Bariatric) Surgery Program, clinicians are using both bariatric surgery and GLP-1RAs — along with behavioral and lifestyle approaches — to help teens and young adults manage their obesity.

“Medication and surgery to aid weight loss should not be met with stigma,” explains Dr. Desiree Sierra-Velez, the Center’s medical director. “Weight stigma prevents patients from seeking care, and they shouldn’t be shamed.”

Here, she and pediatric nurse practitioner Annemarie Fayemi answer common questions about these approaches.

What is bariatric surgery?

Bariatric surgery is a surgical procedure to treat obesity and related conditions, such as type 2 diabetes. It has long helped adults achieve lasting positive health outcomes not limited to just weight loss. Over the past 15 years, this approach has also led to sustained, safe results in teens.

Boston Children’s offers two laparoscopic surgeries to eligible teens who have completed an extensive preoperative program: theRoux en-y gastric bypass and sleeve gastrectomy. Both work by changing the anatomy of the gastrointestinal tract to restrict the amount of food eaten and absorbed. They also promote changes to hormones that control appetite, allowing people to feel less hungry and more satisfied with smaller amounts of food. Bariatric surgery can help a patient lose up to 35 percent of their total body weight. 

What are GLP-1RAs?

GLP-1RAs are medications that act like natural hormones to help lower blood sugar levels, slow down digestion, signal feelings of fullness, reduce appetite, and promote weight loss. They were originally used to treat adults with type 2 diabetes, however, studies have shown that they are also safe and effective for teens and young adults who have obesity and related conditions.

GLP-1RAs include liraglutide (Saxenda) and semaglutide (Wegovy). Tirzepatide (Zepbound) is another medication that functions as a GLP1-RA, but also as a gastric inhibitory peptide (GIP) agonist. GLP-1RAs can help patients lose 10 to 25 percent of their total body weight but must be used long term to sustain their effects.

Does GLP-1RA medication replace surgery?

Both Fayemi and Sierra-Velez note that there is a popular misconception that medication is a replacement for surgery, or that medication alone will help patients achieve their weight loss goals. They work best when coupled with lifestyle and behavior change. While these medications can be very effective, not all patients achieve the maximum benefit from them and may still need surgery.

That’s why their team creates individualized treatment plans for each patient. In some cases, patients are treated with medication to reduce weight and improve any health conditions associated with obesity before surgery. There are some occasions, however, where patients see successful and sustained results from GLP-1RAs and choose to leave the program and transition over to a medical weight management program like Boston Children’s EMPOWER Program.

How old do you have to be for bariatric surgery and GLP-1RAs?

Generally, patients 12 and up can be evaluated for surgery and are eligible for GLP-1RA medications.

However, that doesn’t mean they immediately undergo surgery — all patients must participate in monthly visits for at least 6 to 12 months, undergo necessary medical pre-operative evaluations with other specialties, and demonstrate motivation and consistently work towards health-behavior and lifestyle treatment goals.

“We’re looking for sustained results, not something dramatic or harmful,” Sierra-Velez explains.

How do these treatments pair together?

Once they make some nutrition and lifestyle changes, teens may start on a GLP-1RA medication. The medication dosage always begins low and then slowly builds up as tolerated towards a goal dose.

Medication can be useful after weight loss surgery as well. “Some patients regain weight several years after surgery,” explains Sierra-Velez. “In these cases, patients will be prescribed medication to address weight regain and work towards a goal of healthier weight that is sustained over time. However, our team will investigate potential causes of the regain, such as changes in lifestyle, disordered eating, or other potential weight-regain reasons.”

While every patient’s experience is unique and their journey will differ from others, having bariatric surgery and GLP-1RA medication as a tool to support lifestyle and behavior change is a tried-and-true method of effective weight management, which provides a lot of comfort for those who have obesity or related conditions. As always, work with your doctor to find out what would be the best fit for you before making any major changes.

Learn more at the Adolescent Weight Loss (Bariatric) Surgery Program