"Drug Manufacturers Can Do the Math."
What we know (and don't) about Ozempic for kids, plus a last-minute Halloween candy pep talk.
Disclaimer: You’re reading this column because you value my input as a journalist who reports on these issues and therefore has a lot of informed opinions. I’m not a healthcare provider, and these responses are not meant to substitute for medical or therapeutic advice.
Post-Publication Note from Virginia: The question about Ozempic and kids below went to press this morning with a typo. Type 2 diabetes occurred in just 0.67 per 1,000 kids aged 10 to 19 had the diagnosis in 2017, not 67. This mistake has been corrected below.
Q: I am in recovery from an eating disorder and have very much healed myself. I have a 3-year-old and I want to make sure he’s allowed to retain the intuitive eating he has at this age.
We had a Halloween event yesterday and I let him eat all the candy he wanted. Then tonight, I let him have as much as he wanted with dinner. He ended up finishing the candy and eating nothing but the candy for dinner.
I didn’t comment. I didn’t say it was bad or junk or anything like that. But is this what I should be doing for him to avoid developing a terrible relationship with food and his body? It seems not great that he ate that much candy yesterday and today.
Yes, this is what you should be doing. And more importantly, your 3-year-old is doing exactly what he should be doing. Which is: Eating that much candy yesterday and today. That’s “today” as inm the day you sent in this question last week, but also as in, this actual day—because here we are, on Halloween proper. So if you’re going trick-or-treating tonight, then he gets to eat a bunch of candy again tonight! And probably tomorrow too.
I answer the Halloween question every year, so if you would like a deep dive into why permission is a more useful approach than restriction, you can read all of that here. I also appreciated
’s sugar deep dive yesterday.But what I really want to consider here is the juxtaposition of your goal ("Help your 3-year-old retain his intuitive eating skills”) with your concern: Seems not great that he ate that much candy.
I think you’re worried that your son’s candy eating has somehow undermined his intuitive eating skills. Intuitive eating often gets misbranded in diet culture as a way to care less about candy and other treats; to free yourself from their evil temptation because you’re only eating for hunger and fullness now and therefore, would only ever crave nutrient-dense foods. But it is not intuitive for humans to have zero interest in candy. By eating a lot of candy when it’s available to him (especially if it often isn’t, or these were new flavors and exciting circumstances), your son is eating intuitively.
The major thesis of my first book was that before the world interferes, almost all of us know how to eat. The mechanics (chewing, wrapper opening) need to be taught, but 3-year-olds have a pretty good innate sense of their hunger, fullness and satiety levels.1 But that doesn’t mean they never eat past the point of comfort, or that if you see a child do that, they have lost their eating instincts. Just like your child might need multiple exposures before they like a food that has a bit of a learning curve (see: many vegetables), they may also need multiple opportunities to eat a highly palatable food (see: candy) before they understand just how much they like it, and what “getting enough” looks like to them.
Eating a bunch of candy is a fairly low-risk way of letting a toddler have some independence, which 3-year-olds are madly seeking much of the time. Assuming you’ve sorted out the choking hazards and aren’t contending with food allergies, the worst case scenario here is an upset stomach, which isn’t fun, but will resolve. After a few days of plentiful Halloween candy, I find that my kids tend to forget it exists or have eaten all of their favorites and are ready to toss the rest. In years when we have a huge haul, we have a free for all (candy bowls on the counter) for a day or two, and then I move their bowls to the snack shelf in our pantry and they can grab a couple of pieces to put in their lunch or have with their afternoon snack. Amy does something similar. Your mileage will vary, of course, but if you find yourself worrying over how much candy your child is eating, consider how you can make it more available, not less.
Q: Why are they testing Ozempic for use in kids as young as 6 years old? (And what do we do about it—except scream incoherently?)
This question is a composite of dozens of DMs and emails you’ve all sent since the news broke that Novo Nordisk is beginning a trial for the use of Ozempic in kids as young as six years old, and Eli Lilly plans a similar trial for Mounjaro. But incoherent screaming did come up more than once. I was hesitant to write about this so soon — before we have published clinical trials to analyze, before the AAP and other major medical organizations have weighed in—but I think we’re screaming fairly coherently, actually. And I want to try to put some words to that scream today.
Prescribing intentional weight loss for six-year-olds is not, and never has been, about health. Even if the drug “works.” Even if side effects prove to be minimal (which we won’t truly know for years.) This is about making money. And making fewer fat people.
And yet: We can be clear-eyed about the intentions of pharmaceutical companies seeking to increase the market size for their most lucrative product, and still hold space for the fact that some families will welcome having Ozempic or Wegovy on the table as a treatment option.