What parents need to know about GLP-1 medications for young athletes

USA Cheer has partnered with TrueSport, to provide new educational tools to equip coaches, parents and young athletes with the resources to build life skills and core values for success in sports and in life. TrueSport, a movement by the U.S. Anti-Doping Agency, inspires athletes, coaches, parents, and administrators to change the culture of youth sport through active engagement and thoughtful curriculum based on cornerstone lessons of sportsmanship, character-building, and clean and healthy performance, while also creating leaders across communities through sport.

GLP-1 drugs like Ozempic and Wegovy have become increasingly common for adults for both diabetes management and weight loss. Even well-known celebrities and tennis star Serena Williams have endorsed GLP-1 drugs, increasing their visibility and normalizing their use. These GLP-1 drugs are becoming more common, both through prescriptions from doctors and via off-label use. They are also now more readily available online, which means that it's become all too easy for your young athlete to access these drugs, with or without a medical professional prescribing them.

Here, U.S. Anti-Doping Agency (USADA) Special Advisor Dr. Amy Eichner is explaining what you need to know about GLP-1s and how these drugs may impact your young athlete.

What are GLP-1s?

Glucagon-like peptide-1 receptor agonists, commonly referred to as GLP-1s (like semaglutide), are drugs intended to treat and manage Type 2 diabetes. Some GLP-1 agonists like Wegovy have been approved by the Food and Drug Administration (FDA) for weight loss, while others like Ozempic and Mounjaro are only prescribed for diabetes patients.

GLP-1s come in injectable form and work by suppressing feelings of hunger, reducing food noise (the constant thinking about food), stimulating the pancreas to release insulin, and slowing the stomach's emptying process so that a person will feel full for longer. All of these effects allow people to eat less, because they simply aren't feeling hunger cues.

Why are athletes interested in GLP-1s?

Unfortunately, the pressure to be thin, especially for young women, is still a problem, and athletes in particular may be susceptible to pressure to lose weight for both aesthetic and sport performance reasons. Social media has also made 'quick fix' solutions like GLP-1s more popular and normal, even for young athletes, Eichner says.

Benefits and Risks of GLP-1 Use for Young Athletes

 The primary benefit of a GLP-1 drug for a young athlete is the treatment and management of Type 2 diabetes. Eichner adds that it's rare that a young athlete should be prescribed a GLP-1 drug solely for weight loss reasons, especially if the athlete is primarily considering a GLP-1 in order to improve sport performance.

"Right now, they're not prohibited because no one has documented a convincing performance edge," says Eichner. "Of course, there is a theoretical performance advantage in sports that have weight classes or sports like cycling and long distance running where weight is a factor, but because the GLP-1s suppress appetite and cause muscle loss as well as fat loss, they aren't necessarily going to improve performance."  However, Eichner also points out that not much is known about potential performance-enhancing effects of GLP-1s, and more research needs to be done. The World Anti-Doping Agency is monitoring these substances.

There are approved GLP-1 drugs for managing Type 2 diabetes in kids older than 10. For young athletes on a GLP-1, parents could face unique challenges in fueling them for sport. Because these drugs reduce appetite, it can be difficult for a young athlete to continue to fuel enough for their training and athletic performance goals. And a young athlete may not be aware of their under-fueling, since the GLP-1s suppress feelings of hunger.

"Athletes who are doing endurance sports are already on such a fine line of energy balance between training and fueling, and the slightest disruption can really be detrimental," Eichner says. Because of this, if an athlete is prescribed a GLP-1, it's important to be aware of the potential for Relative Energy Deficiency in Sport (REDs) due to under-fueling. Your athlete should be working with their doctor and other qualified experts, such as a registered dietitian and their coach, to determine appropriate fueling and training protocols while using the medication.

There are also GLP-1 side effects that may make training difficult: Nausea, diarrhea, and constipation are commonly reported. Eichner notes that there are also rare but more serious side effects, including gut paralysis and vision issues.

"We don't know what the long-term outcomes are going to be, so that is another big concern," Eichner adds. These drugs are fairly new, and the long-term effects, particularly when used by younger people who are potentially still developing and growing, haven't been studied.

Finally, there are potential mental health issues that a young athlete may contend with if they're using or considering a GLP-1 drug. If, after consulting with a doctor, a young athlete is going to begin using a GLP-1 drug, it's important to monitor the mental health and body image of your athlete, as well as their physical health. It’s important to be mindful of their relationship with food, and since GLP-1s suppress appetite, this can make social occasions more difficult to navigate.

Finally, it's important to note that anti-doping organizations like the World Anti-Doping Agency are monitoring GLP-1 usage in elite athletes, and there is the potential that GLP-1s will be banned in sport in the future.

Guidance on Assessing Personal Need

 "GLP-1s do have their place in medicine and for young athletes: If they meet the criteria for treatment with GLP-1 agonists, and they go to an endocrinologist or a doctor who prescribes them, that's fine," Eichner says. "But anything purchased online in the hopes of losing a little weight is bad news."

Unless recommended and prescribed by a doctor, there is no reason your athlete should be seeking out GLP-1s on their own via online sources. Eichner warns that caregivers should be aware that these drugs are readily accessible via illegal online pharmacies, which can look entirely legitimate. It's possible for your athlete to access drugs like GLP-1s from these online pharmacies that dodge regulations by labeling drugs as 'research use' or 'research chemicals.'

"A lot of these online pharmacies are selling GLP-1s that have not been approved in the United States for use," says Eichner. "These experimental drugs should never be used by any consumer."

Ultimately, there are no circumstances where a GLP-1 drug purchased from an online store without a prescription should be used by a young, active athlete. But parents should be aware that young athletes may believe the GLP-1s are an easy way to lose weight. If weight loss is your athlete's goal, it's important to speak not just to their doctor, but also a registered dietitian, psychologist, and their coach in order to decide on the safest, healthiest path forward for your athlete.

Takeaway

Self-administration with a GLP-1 medication purchased without a prescription is never a good idea for a young athletes. If an athlete is prescribed a GLP-1 by a doctor to manage Type 2 diabetes, it's important to be aware of the potential for Relative Energy Deficiency in Sport (REDs) due to under-fueling, so your athlete should be working with their doctor and other professionals to determine appropriate fueling and training while using the medication.

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