Nanette Ryan

Semaglutide, marketed as Wegovy, Ozempic, and Rybelsus, is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) that has attracted significant global attention for its appetite-suppressing and weight-loss effects. Approved for pediatric use in children aged 12 and older, Wegovy has been described as a “miracle drug” and hailed as a potential solution to the so-called “obesity epidemic.” However, prescribing medication to children raises complex ethical questions, including how best to respect young patients’ autonomy and promote their well-being. This paper focuses on one such concern: the “argument from virtue.” According to this view, Wegovy represents a morally problematic approach to weight loss because it circumvents the development of character traits—such as self-control and resilience—that are seen as integral to autonomy. We critically examine this argument, rejecting the claim that there is a single morally “right way” to lose weight, and argue that Wegovy, when prescribed within a supportive framework, may help children build and exercise autonomy. We review the drug’s function and efficacy, analyze how it might promote or hinder autonomy, and offer recommendations to support ethical prescribing practices that align with respect for children’s agency.

Räsänen and Ahola-Launonen recently offered a commentary on an ethical analysis I co-authored with Julian Savulescu on the use of semaglutide-based weight-loss drugs such as Ozempic. In this response, I continue the discussion by engaging their concerns about the narrow framing of our analysis with respect to the structural determinants of health and the conditions of autonomy, as well as the role of race, class and gender in shaping stigma and access to treatment. I argue that Räsänen and Ahola-Launonen’s critique and the conclusion they draw are largely in alignment with our paper and that the absence in our account of a more expansive conception of autonomy and a broader discussion of race, class and gender are fair criticisms. In what follows, I add nuance to these dimensions and caution against critiques of unjust structures that risk reproducing injustice by inadvertently denying the agency, self-respect and inclusion of marginalised groups.

Semaglutide, sold under the brand names of Ozempic, Rybelsus and Wegovy, is one of the most popular drugs on the market. Manufactured by Novo Nordisk, semaglutide is the newest in a family of glucagon-like peptide-1 receptor agonists used most commonly to treat type II diabetes. To date, the results of semaglutide for the treatment of type II diabetes have been overwhelmingly positive. It is for the drug’s effects on appetite suppression and weight loss, however, that have led its surge in popularity, with many hailing semaglutide as the new ‘miracle drug for weight loss’. Despite its popularity, both the governmental and popular reception to the drug has largely been mixed. In this paper, we address a range of ethical concerns and argue that while many are legitimate, they do not provide conclusive reason not to prescribe semaglutide for weight loss.

Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA) marketed as Wegovy, has gained international attention for its appetite-suppressing and weight-loss effects. Approved by the U.S. FDA in 2022 for paediatric use in children aged 12 and older, Wegovy has since received similar approvals in several countries. Despite this, uptake among youth has been limited. While some clinicians advocate for broader paediatric use of Wegovy as an underutilised tool to address obesity, others urge caution citing concerns regarding its long-term safety, efficacy, and appropriateness in growing children. When prescribing medication to children there are many ethical dimensions to consider. This paper focuses on the risks, side-effects, and unknowns of Wegovy as a barrier to use in paediatric care. We argue that, while long-term effects remain uncertain, this uncertainty alone should not preclude its use in children.

Semaglutide (Wegovy), a glucagon-like peptide-1 receptor agonist (GLP-1 RA), has attracted global attention for its appetite-suppressing and weight-loss effects. Approved by the U.S. FDA in 2022 for adolescents aged 12 and older, it has since been authorized in several other countries. Despite this, its use among youth remains limited, with ongoing concerns about its long-term safety, efficacy, and suitability during periods of growth and development. Advocates see Wegovy as an important tool for addressing pediatric obesity and its psychological burdens, while critics caution against widespread use in such a vulnerable population. This paper examines an underexplored ethical dimension of Wegovy’s use in children: its impact on mental health. We argue that Wegovy may offer mental health benefits for children—such as reducing weight stigma, improving self-esteem, and avoiding invasive interventions such as bariatric surgery. However, these potential benefits are constrained by barriers to access, supply shortages, risks of misuse, and the possibility of reinforcing stigma and class-based discrimination. In light of these considerations, we argue that while Wegovy offers promising health benefits for children, its long-term effects on growth, development, and mental health remain uncertain, warranting further study before definitive policy decisions are made. If future evidence confirms its value, it is our view that access should be equitable and accompanied by reforms to reduce stigma, regulate prescribing, and prevent misuse. Until then, clinicians should prescribe cautiously, ensuring clear medical need and implementing safeguards against risks such as weight regain, treatment interruption, and bias in care.

Räsänen and Ahola-Launonen recently offered a commentary on an ethical analysis I co-authored with Julian Savulescu on the use of semaglutide-based weight-loss drugs such as Ozempic. In this response, I continue the discussion by engaging their concerns about the narrow framing of our analysis with respect to the structural determinants of health and the conditions of autonomy, as well as the role of race, class and gender in shaping stigma and access to treatment. I argue that Räsänen and Ahola-Launonen’s critique and the conclusion they draw are largely in alignment with our paper and that the absence in our account of a more expansive conception of autonomy and a broader discussion of race, class and gender are fair criticisms. In what follows, I add nuance to these dimensions and caution against critiques of unjust structures that risk reproducing injustice by inadvertently denying the agency, self-respect and inclusion of marginalised groups.

Semaglutide, marketed as Wegovy, Ozempic, and Rybelsus, is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) that has attracted significant global attention for its appetite-suppressing and weight-loss effects. Approved for pediatric use in children aged 12 and older, Wegovy has been described as a “miracle drug” and hailed as a potential solution to the so-called “obesity epidemic.” However, prescribing medication to children raises complex ethical questions, including how best to respect young patients’ autonomy and promote their well-being. This paper focuses on one such concern: the “argument from virtue.” According to this view, Wegovy represents a morally problematic approach to weight loss because it circumvents the development of character traits—such as self-control and resilience—that are seen as integral to autonomy. We critically examine this argument, rejecting the claim that there is a single morally “right way” to lose weight, and argue that Wegovy, when prescribed within a supportive framework, may help children build and exercise autonomy. We review the drug’s function and efficacy, analyze how it might promote or hinder autonomy, and offer recommendations to support ethical prescribing practices that align with respect for children’s agency.

Supporting the development of children’s autonomy is widely recognized as a fundamental good. Despite this, social practices that reflect and reinforce patriarchal gender norms are ubiquitous. These norms, however, curtail the development and exercise of children’s autonomy by constraining their opportunities along gendered lines and promoting falsehoods about “natural” identity expression. In recognition of these limitations, many parents across the political spectrum are pushing back against patriarchal gender norms in their parenting approaches. One particular model that aims to fully embrace a progressive parenting methodology is the “gender-open” model of parenting (GOP). Broadly, the GOP methodology involves withholding disclosure of a child’s biological sex as assigned at birth from public knowledge. With the necessary support, this approach aims to encourage children to choose their own gender in their own time. Advocates of this model claim that adopting the GOP ensures a child’s autonomy in self-expression. But despite these claims, none of the advocates clearly articulates how the model promotes children’s autonomy. My aim in this paper is to demonstrate how the GOP protects and promotes children’s autonomy in robust ways, making a strong case for its adoption.

Semaglutide, sold under the brand names of Ozempic, Rybelsus and Wegovy, is one of the most popular drugs on the market. Manufactured by Novo Nordisk, semaglutide is the newest in a family of glucagon-like peptide-1 receptor agonists used most commonly to treat type II diabetes. To date, the results of semaglutide for the treatment of type II diabetes have been overwhelmingly positive. It is for the drug’s effects on appetite suppression and weight loss, however, that have led its surge in popularity, with many hailing semaglutide as the new ‘miracle drug for weight loss’. Despite its popularity, both the governmental and popular reception to the drug has largely been mixed. In this paper, we address a range of ethical concerns and argue that while many are legitimate, they do not provide conclusive reason not to prescribe semaglutide for weight loss.

When we raise children what we are typically aiming for is a kind of flourishing; we want children to live well as children, and to grow to become adults who live well too. Undoubtedly, part of what we are aiming for when we aim for a child’s flourishing is that they meet their developmental milestones well, and that they succeed among their peers. We are also generally interested in how a child regards themselves; we want children to believe that they have value, and that what they care about has value too. We also typically want children to have an appreciation for their relative value among others; that they are important among many other important beings, and we want them to act well in that knowledge. Of course, not all persons who raise children aim for those ends. Some do not care for how a child conceives of themselves, or whether the child flourishes at all. Others care for their children, and how they conceive of themselves, but aim poorly. As result, some children come to believe that they only deserve love and kindness when they succeed at meeting a caregiver’s ends. Some children come to believe that they have no worth at all. And yet other children, rather than believing they are unworthy, come to regard themselves as of superior worth; as children, for example, who bully and sneer at other children for being a different race, a different class, gender, ability, etc. may. When a child comes to understand themselves in these terms, we typically see it at best as morally problematic, and at worst as a tragedy. Despite our interest in children’s self-conceptions, and the vast literature on how to conceive of and regard children, there is relatively little regarding how children should conceive of and regard themselves. In order to explain how children should conceive of themselves it is my contention that a new account of self-respect is needed for the context of childhood; one that is responsive to the moral value of children, as well as their developmental capacities to recognize that value. Given that developmental psychology is complex and subject to significant variation as children develop, my aim in this paper is to offer a snapshot of what I take self-respect to amount to in early childhood. In particular, I focus on an account fitting for children between three to six years of age.