Cost comparison: oral vs injectable semaglutide — my results so far

This is genuinely one of the harder clinical decisions in pediatric endocrinology right now, and the fact that you're thinking about it carefully speaks well of you as a parent.

Let me lay out the evidence as objectively as I can:

The STEP TEENS trial (published in NEJM, 2022) randomized 201 adolescents aged 12-17 with obesity to semaglutide 2.4mg vs placebo for 68 weeks.[1] Key results:

• BMI reduction: -16.1% with semaglutide vs +0.6% with placebo
• Body weight reduction: -14.7% vs +2.8%
• Improvements in cardiometabolic risk factors (waist circumference, lipids, HbA1c)
• Safety profile was broadly consistent with the adult trials
• GI side effects were the most common (nausea ~40%, vomiting ~27%)

The 2-year extension data presented at ENDO 2024 showed sustained benefits with continued treatment. Importantly, linear growth (height) was NOT impacted — this was a key concern going in.

What we DON'T know: long-term effects beyond 2 years in adolescents, impact on puberty timing (no signal so far but limited data), effects on bone mineral density during peak bone accrual years, and whether early use alters the trajectory of adult obesity.

The AAP released updated clinical practice guidelines in 2023 recommending pharmacotherapy for adolescents with severe obesity (BMI ≥120% of the 95th percentile), which your son likely meets at his current stats.[2]

My personal take: at a BMI of ~38 at age 15 with documented failure of behavioral interventions, the metabolic risk of untreated obesity is substantial and well-documented. The risk-benefit calculation favors treatment in most cases.

Parent here. My daughter started Wegovy at 14 (she's now 16). I agonized over this decision for months. Here's our experience:

She's gone from 212lbs to 164lbs over 18 months. She went from being the kid who refused to go to pool parties to joining the swim team. Her grades went up. She smiles more. She told me last month that she "finally feels like a normal teenager."

Side effects were rough for the first 2 months — lots of nausea, some vomiting, she missed a few school days. But her body adjusted and she's been fine since then. She's on 1.7mg (we tried 2.4 but the nausea was too much so we stepped back down).

Do I worry about long-term unknowns? Every single day. But I also watched my kid be miserable for 6 years and I watched behavioral interventions fail despite our whole family committing to them fully. At some point you have to weigh the known harm of doing nothing against the theoretical risk of doing something.

Whatever you decide, you're not a bad parent. This is a hard call with no perfect answer.

I'm 19 now but I was put on liraglutide (Saxenda) at 16 by my peds endo. Switched to sema at 17 when it got approved for teens. I'm glad my parents agreed to it. I lost 73lbs total over 2 years and kept most of it off.

The one thing I'll say is make sure your son is mentally ready for it. Not just the side effects but the identity shift. I'd been "the big kid" my entire life and suddenly I wasn't. That was harder to deal with than I expected. People treated me differently. Some friendships changed. I needed therapy to process it honestly.

Also he should know going in — if he stops, there's a high chance of regain. The STEP TEENS extension showed that kids who discontinued at 68 weeks regained about 2/3 of the weight by week 120. This might be a long-term or lifelong medication. He should be ok with that concept before starting.

Previously posted:

if he stops, there's a high chance of regain. The STEP TEENS extension showed that kids who discontinued at 68 weeks regained about 2/3 of the weight

This is actually my biggest concern. Are we signing our kid up for a lifetime dependency on a medication? What happens when he's 25 and his insurance changes? Or when he's 30 and there's a shortage? Or a different political administration restricts access?

I feel like the medical system is great at starting kids on things but not great at having an exit strategy.