The Weight of the Future: Are We Getting Adolescent Obesity Treatment Right?

Samuel is a 15-year-old European boy who has always been overweight. Over the past year, he’s gained a further eight kilos, and his BMI is now in the obese range. He’s otherwise well and active playing rugby.

His mum comes in with him today. She’s tried reducing food portion size and limiting junk food at home, but with little success. They’re asking what else they can do, and specifically whether a medication like a GLP-1 RA might be an option. They feel they could afford it for about a year to help get him back on track. As the GP, you’re unsure how best to approach this case. What do you think?

Practical clinical pearls:

1. Obesity is common in childhood and adolescence in New Zealand, with Pacific peoples disproportionately affected, followed by Māori. Management should always be approached with an equity and culturally safe lens.
2. Adolescent obesity should be managed as a chronic, lifelong condition rather than a short-term weight-loss problem. Successful treatment usually requires sustained lifestyle change supported by whānau, schools, and healthcare teams.
3. A holistic management plan is essential. Alongside nutritional advice and physical activity, consider psychology input, family-based interventions, group programmes, and addressing sleep, mental health, stigma, and socioeconomic barriers to care.
4. GLP-1 receptor agonists are emerging as an effective option for some adolescents with obesity, but gastrointestinal side effects are common and discontinuation rates remain high. Starting with very low doses and titrating slowly can improve tolerability.
5. Families should understand that stopping GLP-1 receptor agonists commonly leads to significant weight regain, often within a year and sometimes exceeding the original weight lost. Research is ongoing into combining GLP-1 therapy with gut microbiome interventions alongside intensive lifestyle modification, with the hope of improving long-term weight maintenance. Watch this space.

Bio:

Wayne Cutfield is Professor of Paediatric Endocrinology and co-director of the highly successful Gut Bugs Research Programme. He was previously Director of the Liggins Institute and previously Director of a Better Start National Science Challenge. He single handedly established paediatric endocrinology in Auckland which has grown in to a national referral service. His research achievements and leadership in paediatric endocrinology have been widely recognised with the Australia and New Zealand Society for Paediatric Endocrinology and Diabetes Norman Wetenhall Medal for research innovation, the University of Auckland’s Gluckman Medal for outstanding research contribution, the Royal Australasian College of Physicians Child Health Division Howard William’s Medal for clinical leadership and the RACP pinnacle award the College Medal for outstanding impact and leadership in medicine and research. He has published >350 articles in journals that include the New Journal of Medicine, Lancet, BMJ and Nature and has an H Index of 85.

References:

Hashemi, Ladan et al. “Associations between Specific and Cumulative Adverse Childhood Experiences, Childhood Obesity, and Obesogenic Behaviours.” European journal of psychotraumatology 16.1 (2025): 2451480. Web.

Rahimi, Mehdi, Allen Bartley, and Ladan Hashemi. “Childhood Overweight/Obesity amidst Migration, Socioeconomic Factors, and Obesogenic Behaviors: Insights from the Growing Up in New Zealand Study.” Ed. by António Raposo. Advances in Public Health 2023 (2023): 1–10. Web.

Hashemi, Ladan et al. “Associations between Specific and Cumulative Adverse Childhood Experiences, Childhood Obesity, and Obesogenic Behaviours.” European journal of psychotraumatology 16.1 (2025): 2451480. Web.

Listen here:

https://podcasts.apple.com/nz/podcast/the-weight-of-the-future-w-prof-wayne-cutfield/id1845748299?i=1000775543755

https://open.spotify.com/episode/51OZdA07VjFoAAgEIsXhoX?si=158e5ed969174f69

#glp1 #obesitymedicine #universityofauckland