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• As Ozempic’s Popularity Soars, Here’s What to Know About Semaglutide and Weight Loss JAMA Medical News & Perspectives May 16, 2023 This Medical News article discusses chronic weight management with semaglutide, sold under the brand names Ozempic and Wegovy. Melissa Suran, PhD, MSJ
• Patents and Regulatory Exclusivities on GLP-1 Receptor Agonists JAMA Special Communication August 15, 2023 This Special Communication used data from the US Food and Drug Administration to analyze how manufacturers of brand-name glucagon-like peptide 1 (GLP-1) receptor agonists have used patent and regulatory systems to extend periods of market exclusivity. Rasha Alhiary, PharmD; Aaron S. Kesselheim, MD, JD, MPH; Sarah Gabriele, LLM, MBE; Reed F. Beall, PhD; S. Sean Tu, JD, PhD; William B. Feldman, MD, DPhil, MPH
• What to Know About Wegovy’s Rare but Serious Adverse Effects JAMA Medical News & Perspectives December 12, 2023 This Medical News article discusses Wegovy, Ozempic, and other GLP-1 receptor agonists used for weight management and type 2 diabetes. Kate Ruder, MSJ
• GLP-1 Receptor Agonists and Gastrointestinal Adverse Events—Reply JAMA Comment & Response March 12, 2024 Ramin Rezaeianzadeh, BSc; Mohit Sodhi, MSc; Mahyar Etminan, PharmD, MSc
• GLP-1 Receptor Agonists and Gastrointestinal Adverse Events JAMA Comment & Response March 12, 2024 Karine Suissa, PhD; Sara J. Cromer, MD; Elisabetta Patorno, MD, DrPH
• GLP-1 Receptor Agonist Use and Risk of Postoperative Complications JAMA Research Letter May 21, 2024 This cohort study evaluates the risk of postoperative respiratory complications among patients with diabetes undergoing surgery who had vs those who had not a prescription fill for glucagon-like peptide 1 receptor agonists. Anjali A. Dixit, MD, MPH; Brian T. Bateman, MD, MS; Mary T. Hawn, MD, MPH; Michelle C. Odden, PhD; Eric C. Sun, MD, PhD
• Glucagon-Like Peptide-1 Receptor Agonist Use and Risk of Gallbladder and Biliary Diseases JAMA Internal Medicine Original Investigation May 1, 2022 This systematic review and meta-analysis of 76 randomized clinical trials examines the effects of glucagon-like peptide-1 receptor agonist use on the risk of gallbladder and biliary diseases. Liyun He, MM; Jialu Wang, MM; Fan Ping, MD; Na Yang, MM; Jingyue Huang, MM; Yuxiu Li, MD; Lingling Xu, MD; Wei Li, MD; Huabing Zhang, MD
• Cholecystitis Associated With the Use of Glucagon-Like Peptide-1 Receptor Agonists JAMA Internal Medicine Research Letter October 1, 2022 This case series identifies cases reported in the US Food and Drug Administration Adverse Event Reporting System of acute cholecystitis associated with use of glucagon-like peptide-1 receptor agonists that did not have gallbladder disease warnings in their labeling. Daniel Woronow, MD; Christine Chamberlain, PharmD; Ali Niak, MD; Mark Avigan, MDCM; Monika Houstoun, PharmD, MPH; Cindy Kortepeter, PharmD

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Sodhi M , Rezaeianzadeh R , Kezouh A , Etminan M. Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss. JAMA. 2023;330(18):1795–1797. doi:10.1001/jama.2023.19574

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Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss

• 1 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
• 2 StatExpert Ltd, Laval, Quebec, Canada
• 3 Department of Ophthalmology and Visual Sciences and Medicine, University of British Columbia, Vancouver, Canada
• Medical News & Perspectives As Ozempic’s Popularity Soars, Here’s What to Know About Semaglutide and Weight Loss Melissa Suran, PhD, MSJ JAMA
• Special Communication Patents and Regulatory Exclusivities on GLP-1 Receptor Agonists Rasha Alhiary, PharmD; Aaron S. Kesselheim, MD, JD, MPH; Sarah Gabriele, LLM, MBE; Reed F. Beall, PhD; S. Sean Tu, JD, PhD; William B. Feldman, MD, DPhil, MPH JAMA
• Medical News & Perspectives What to Know About Wegovy’s Rare but Serious Adverse Effects Kate Ruder, MSJ JAMA
• Comment & Response GLP-1 Receptor Agonists and Gastrointestinal Adverse Events—Reply Ramin Rezaeianzadeh, BSc; Mohit Sodhi, MSc; Mahyar Etminan, PharmD, MSc JAMA
• Comment & Response GLP-1 Receptor Agonists and Gastrointestinal Adverse Events Karine Suissa, PhD; Sara J. Cromer, MD; Elisabetta Patorno, MD, DrPH JAMA
• Research Letter GLP-1 Receptor Agonist Use and Risk of Postoperative Complications Anjali A. Dixit, MD, MPH; Brian T. Bateman, MD, MS; Mary T. Hawn, MD, MPH; Michelle C. Odden, PhD; Eric C. Sun, MD, PhD JAMA
• Original Investigation Glucagon-Like Peptide-1 Receptor Agonist Use and Risk of Gallbladder and Biliary Diseases Liyun He, MM; Jialu Wang, MM; Fan Ping, MD; Na Yang, MM; Jingyue Huang, MM; Yuxiu Li, MD; Lingling Xu, MD; Wei Li, MD; Huabing Zhang, MD JAMA Internal Medicine
• Research Letter Cholecystitis Associated With the Use of Glucagon-Like Peptide-1 Receptor Agonists Daniel Woronow, MD; Christine Chamberlain, PharmD; Ali Niak, MD; Mark Avigan, MDCM; Monika Houstoun, PharmD, MPH; Cindy Kortepeter, PharmD JAMA Internal Medicine

Glucagon-like peptide 1 (GLP-1) agonists are medications approved for treatment of diabetes that recently have also been used off label for weight loss. 1 Studies have found increased risks of gastrointestinal adverse events (biliary disease, 2 pancreatitis, 3 bowel obstruction, 4 and gastroparesis 5 ) in patients with diabetes. 2 - 5 Because such patients have higher baseline risk for gastrointestinal adverse events, risk in patients taking these drugs for other indications may differ. Randomized trials examining efficacy of GLP-1 agonists for weight loss were not designed to capture these events 2 due to small sample sizes and short follow-up. We examined gastrointestinal adverse events associated with GLP-1 agonists used for weight loss in a clinical setting.

We used a random sample of 16 million patients (2006-2020) from the PharMetrics Plus for Academics database (IQVIA), a large health claims database that captures 93% of all outpatient prescriptions and physician diagnoses in the US through the International Classification of Diseases, Ninth Revision (ICD-9) or ICD-10. In our cohort study, we included new users of semaglutide or liraglutide, 2 main GLP-1 agonists, and the active comparator bupropion-naltrexone, a weight loss agent unrelated to GLP-1 agonists. Because semaglutide was marketed for weight loss after the study period (2021), we ensured all GLP-1 agonist and bupropion-naltrexone users had an obesity code in the 90 days prior or up to 30 days after cohort entry, excluding those with a diabetes or antidiabetic drug code.

Patients were observed from first prescription of a study drug to first mutually exclusive incidence (defined as first ICD-9 or ICD-10 code) of biliary disease (including cholecystitis, cholelithiasis, and choledocholithiasis), pancreatitis (including gallstone pancreatitis), bowel obstruction, or gastroparesis (defined as use of a code or a promotility agent). They were followed up to the end of the study period (June 2020) or censored during a switch. Hazard ratios (HRs) from a Cox model were adjusted for age, sex, alcohol use, smoking, hyperlipidemia, abdominal surgery in the previous 30 days, and geographic location, which were identified as common cause variables or risk factors. 6 Two sensitivity analyses were undertaken, one excluding hyperlipidemia (because more semaglutide users had hyperlipidemia) and another including patients without diabetes regardless of having an obesity code. Due to absence of data on body mass index (BMI), the E-value was used to examine how strong unmeasured confounding would need to be to negate observed results, with E-value HRs of at least 2 indicating BMI is unlikely to change study results. Statistical significance was defined as 2-sided 95% CI that did not cross 1. Analyses were performed using SAS version 9.4. Ethics approval was obtained by the University of British Columbia’s clinical research ethics board with a waiver of informed consent.

Our cohort included 4144 liraglutide, 613 semaglutide, and 654 bupropion-naltrexone users. Incidence rates for the 4 outcomes were elevated among GLP-1 agonists compared with bupropion-naltrexone users ( Table 1 ). For example, incidence of biliary disease (per 1000 person-years) was 11.7 for semaglutide, 18.6 for liraglutide, and 12.6 for bupropion-naltrexone and 4.6, 7.9, and 1.0, respectively, for pancreatitis.

Use of GLP-1 agonists compared with bupropion-naltrexone was associated with increased risk of pancreatitis (adjusted HR, 9.09 [95% CI, 1.25-66.00]), bowel obstruction (HR, 4.22 [95% CI, 1.02-17.40]), and gastroparesis (HR, 3.67 [95% CI, 1.15-11.90) but not biliary disease (HR, 1.50 [95% CI, 0.89-2.53]). Exclusion of hyperlipidemia from the analysis did not change the results ( Table 2 ). Inclusion of GLP-1 agonists regardless of history of obesity reduced HRs and narrowed CIs but did not change the significance of the results ( Table 2 ). E-value HRs did not suggest potential confounding by BMI.

This study found that use of GLP-1 agonists for weight loss compared with use of bupropion-naltrexone was associated with increased risk of pancreatitis, gastroparesis, and bowel obstruction but not biliary disease.

Given the wide use of these drugs, these adverse events, although rare, must be considered by patients who are contemplating using the drugs for weight loss because the risk-benefit calculus for this group might differ from that of those who use them for diabetes. Limitations include that although all GLP-1 agonist users had a record for obesity without diabetes, whether GLP-1 agonists were all used for weight loss is uncertain.

Accepted for Publication: September 11, 2023.

Published Online: October 5, 2023. doi:10.1001/jama.2023.19574

Correction: This article was corrected on December 21, 2023, to update the full name of the database used.

Corresponding Author: Mahyar Etminan, PharmD, MSc, Faculty of Medicine, Departments of Ophthalmology and Visual Sciences and Medicine, The Eye Care Center, University of British Columbia, 2550 Willow St, Room 323, Vancouver, BC V5Z 3N9, Canada ( [email protected] ).

Author Contributions: Dr Etminan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Sodhi, Rezaeianzadeh, Etminan.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Sodhi, Rezaeianzadeh, Etminan.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Kezouh.

Obtained funding: Etminan.

Administrative, technical, or material support: Sodhi.

Supervision: Etminan.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded by internal research funds from the Department of Ophthalmology and Visual Sciences, University of British Columbia.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement .

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The net-zero transition: What it would cost, what it could bring

In a new report, we look at the economic transformation that a transition to net-zero emissions would entail—a transformation that would affect all countries and all sectors of the economy, either directly or indirectly. We estimate the changes in demand, capital spending, costs, and jobs, to 2050, for sectors that produce about 85 percent of overall emissions and assess economic shifts for 69 countries.

Each of the six articles highlighted on this page provides a detailed look at aspects of the net-zero transition. The full report, The net-zero transition: What it would cost, what it could bring , as well as a PDF summary, can be downloaded for free here.

Six characteristics define the net-zero transition

The transformation of the global economy needed to achieve net-zero emissions by 2050 would be universal and significant, requiring $9.2 trillion in annual average spending on physical assets, $3.5 trillion more than today. To put it in comparable terms, that increase is equivalent to half of global corporate profits and one-quarter of total tax revenue in 2020. Accounting for expected increases in spending, as incomes and populations grow, as well as for currently legislated transition policies, the required increase in spending would be lower, but still about $1 trillion. Spending would be front-loaded—the next decade will be decisive—and the impact uneven across countries and sectors. The transition is also exposed to risks, including that of energy supply volatility. At the same time, it is rich in opportunity. The transition would prevent the buildup of physical climate risks and reduce the odds of initiating the most catastrophic impacts of climate change. It would also bring growth opportunities, as decarbonization creates efficiencies and opens markets for low-emissions products and services. Our research is not a projection or prediction and does not claim to be exhaustive. It is the simulation of one hypothetical and relatively orderly pathway toward 1.5°C using the Net Zero 2050 scenario from the Network for Greening the Financial System (NGFS).

Watch the replay

The net-zero challenge: accelerating decarbonization worldwide.

The seven energy and land-use systems that account for global emissions—power, industry, mobility, buildings, agriculture, forestry and other land use, and waste—will all need to be transformed to achieve net-zero emissions. Effective actions to accelerate decarbonization include shifting the energy mix away from fossil fuels and toward zero-emissions electricity and other low-emissions energy sources such as hydrogen; adapting industrial and agricultural processes; increasing energy efficiency and managing demand for energy; utilizing the circular economy ; consuming fewer emissions-intensive goods; deploying carbon capture, utilization, and storage technology; and enhancing sinks of both long-lived and short-lived greenhouse gases.

The economic transformation: What would change in the net-zero transition

On the basis of this scenario, we estimate that global spending on physical assets in the transition would amount to about $275 trillion between 2021 and 2050, or about 7.5 percent of GDP annually on average. The biggest increase as a share of GDP would be between 2026 and 2030. Demand would be substantially affected. For example, manufacturing of internal combustion engine cars would eventually cease as sales of alternatives (for example, battery-electric and fuel cell-electric vehicles) increase from 5 percent of new-car sales in 2020 to virtually 100 percent by 2050. Power demand in 2050 would be more than double what it is today, while production of hydrogen and biofuels would increase more than tenfold. The transition could lead to a reallocation of labor, with about 200 million direct and indirect jobs gained and 185 million lost by 2050—shifts that are notable less for their size than for their concentrated, uneven, and re-allocative nature.

Sectors are unevenly exposed in the net-zero transition

All sectors of the economy are exposed to a net-zero transition, but some are more exposed than others. The sectors with the highest degree of exposure are those which directly emit significant quantities of greenhouse gases (for example, the coal and gas power sector) and those which sell products that emit greenhouse gases (such as the fossil fuel sector and the automotive sector). Approximately 20 percent of global GDP is in these sectors. A further 10 percent of GDP is in sectors with high-emissions supply chains, such as construction. Each of the most exposed parts of the economy will be differentially affected. The total cost of ownership of EVs could be lower than ICE cars by about 2025 in most regions, even as costs for steel and cement production could rise. Job gains would be largely associated with the transition to low-emissions forms of production, such as renewable power generation. Job losses would particularly affect workers in fossil fuel–intensive or otherwise emissions-intensive sectors.

How the net-zero transition would play out in countries and regions

To decarbonize, lower-income countries and fossil fuel resource producers would spend more on physical assets as a share of their GDP than other countries—in the case of sub-Saharan Africa, Latin America, India and other Asian nations, about 1.5 times or more as much as advanced economies to support economic development and build low-carbon infrastructure. Developing countries also have relatively greater shares of their jobs, GDP, and capital stock in sectors that would be most exposed; examples include India, Bangladesh, Kenya, and Nigeria. And countries like India would also face heightened physical risk from climate change. The effects within developed economies could be uneven, too; for instance, more than 10 percent of jobs in 44 US counties are in fossil fuel extraction and refining, fossil fuel–based power, and automotive manufacturing. At the same time, all countries will have growth prospects, from endowments of natural capital such as sunshine and forests, and through their technological and human resources.

Managing the net-zero transition: Actions for stakeholders

The findings of this research serve as a clear call for more thoughtful and decisive action, taken with the utmost urgency, to secure a more orderly transition to net zero by 2050. Economies and societies would need to make significant adjustments in the net-zero transition. Many of these can be best supported through coordinated action by governments, businesses, and enabling institutions. Three categories of action stand out: catalyzing effective capital reallocation, managing demand shifts and near-term unit cost increases, and establishing compensating mechanisms to address socioeconomic impacts. The economic transformation required to achieve net-zero emissions by 2050 will be massive in scale and complex in execution, yet the costs and dislocations that would arise from a more disorderly transition would likely be far greater, and the transition would prevent the further buildup of physical risks. It is important not to view the transition as only onerous; the required economic transformation will not only create immediate economic opportunities but also open up the prospect of a fundamentally transformed global economy with lower energy costs, and numerous other benefits—for example, improved health outcomes and enhanced conservation of natural capital.

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• Published: 05 June 2024

The urgent need for designing greener drugs

• Tomas Brodin   ORCID: orcid.org/0000-0003-1086-7567 1   na1 ,
• Michael G. Bertram   ORCID: orcid.org/0000-0001-5320-8444 1 , 2 , 3   na1 ,
• Kathryn E. Arnold   ORCID: orcid.org/0000-0002-6485-6065 4 ,
• Alistair B. A. Boxall 4 ,
• Bryan W. Brooks   ORCID: orcid.org/0000-0002-6277-9852 5 ,
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• Karen A. Kidd   ORCID: orcid.org/0000-0002-5619-1358 9 ,
• Unax Lertxundi   ORCID: orcid.org/0000-0002-9575-1602 10 ,
• Jake M. Martin 1 , 2 ,
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The pervasive contamination of ecosystems with active pharmaceutical ingredients poses a serious threat to biodiversity, ecosystem services and public health. Urgent action is needed to design greener drugs that maintain efficacy but also minimize environmental impact.

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Wilkinson, J. L. et al. Proc. Natl Acad. Sci. USA 119 , e2113947119 (2022).

Article   CAS   Google Scholar  

Bouzas-Monroy, A., Wilkinson, J. L., Melling, M. & Boxall, A. B. A. Environ. Toxicol. Chem. 41 , 2008–2020 (2022).

Proposal for a Directive of the European Parliament and of the Council amending Directive 2000/60/EC establishing a framework for Community action in the field of water policy, Directive 2006/118/EC on the protection of groundwater against pollution and deterioration and Directive 2008/105/EC on environmental quality standards in the field of water policy (European Commission, 2022).

Persson, L. et al. Environ. Sci. Technol. 56 , 1510–1521 (2022).

Kidd, K. A. et al. Proc. Natl Acad. Sci. USA 104 , 8897–8901 (2007).

Saaristo, M. et al. Proc. R. Soc. B 285 , 20181297 (2018).

Article   Google Scholar  

Mehdi, H. et al. Sci. Total Environ. 759 , 143430 (2021).

Communication from the Commission. European Union Strategic Approach to Pharmaceuticals in the Environment (European Commission, 2019).

Improving prescribing and medicines use: sustainable prescribing. Royal Pharmaceutical Society (2021); https://go.nature.com/3V4dk8j

Jones, E. R., Van Vliet, M. T. H., Qadir, M. & Bierkens, M. F. P. Earth Syst. Sci. Data 13 , 237–254 (2021).

Bourgin, M. et al. Water Res. 129 , 486–498 (2018).

Somasundar, Y. et al. ACS EST Water 1 , 2155–2163 (2021).

Kümmerer, K. Green Chem. 9 , 899–907 (2007).

Leder, C. et al. ACS Sustain. Chem. Eng. 9 , 9358–9368 (2021).

Puhlmann, N., Mols, R., Olsson, O., Slootweg, J. C. & Kümmerer, K. Green Chem. 23 , 5006–5023 (2021).

Download references

Acknowledgements

We acknowledge funding support from the Swedish Research Council Formas (2018-00828 to T.B., 2020-02293 to M.G.B., 2020-00981 to E.S.M., 2020-01052 to D.C., 2022-00503 to M.M. and 2022-02796/2023-01253 to J.M.M.), the Kempe Foundations (SMK-1954, SMK21-0069 and JCSMK23-0078 to M.G.B.), the Swedish Research Council VR (2022-03368 to E.S.M.), the European Union’s Horizon 2020 Research and Innovation Programme under the Marie Skłodowska-Curie grant agreement (101061889 to M.M.), Research England (131911 to M.J.), the Spanish Ministry of Economy, Industry and Competitiveness (PID2022-139746OB-I00/AEI/10.13039/501100011033 to G.O.), the Australian Research Council (FT190100014 and DP220100245 to B.B.M.W.), the Jarislowsky Foundation (to K.A.K.), a Royal Society of New Zealand Catalyst Leaders Fellowship (ILF-CAW2201 to B.W.B.) and the National Institute of Environmental Health Sciences of the National Institutes of Health (1P01ES028942 to B.W.B.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

These authors contributed equally: Tomas Brodin, Michael G. Bertram.

These authors jointly supervised this work: Klaus Kümmerer, Gorka Orive.

Authors and Affiliations

Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, Umeå, Sweden

Tomas Brodin, Michael G. Bertram, Daniel Cerveny, Jake M. Martin, Erin S. McCallum & Marcus Michelangeli

Department of Zoology, Stockholm University, Stockholm, Sweden

Michael G. Bertram & Jake M. Martin

School of Biological Sciences, Monash University, Melbourne, Victoria, Australia

Michael G. Bertram, Marcus Michelangeli & Bob B. M. Wong

Department of Environment and Geography, University of York, York, UK

Kathryn E. Arnold & Alistair B. A. Boxall

Department of Environmental Science, Baylor University, Waco, TX, USA

Bryan W. Brooks

Faculty of Fisheries and Protection of Waters, University of South Bohemia in České Budějovice, Vodňany, Czech Republic

Daniel Cerveny

Medicinal Chemistry Theme, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia

Manuela Jörg

Centre for Cancer, Chemistry – School of Natural and Environmental Sciences, Newcastle University, Newcastle Upon Tyne, UK

Department of Biology, McMaster University, Hamilton, Ontario, Canada

Karen A. Kidd

Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain

Unax Lertxundi

Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia

Lauren T. May

School of Environment and Science, Griffith University, Nathan, Queensland, Australia

Marcus Michelangeli

Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK

Charles R. Tyler

Institute of Sustainable Chemistry, Leuphana University Lüneburg, Lüneburg, Germany

Klaus Kümmerer

International Sustainable Chemistry Collaborative Centre (ISC3), Bonn, Germany

Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country, Vitoria-Gasteiz, Spain

Gorka Orive

Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine, Vitoria-Gasteiz, Spain

Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain

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Brodin, T., Bertram, M.G., Arnold, K.E. et al. The urgent need for designing greener drugs. Nat Sustain (2024). https://doi.org/10.1038/s41893-024-01374-y

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Published : 05 June 2024

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Surgeon General Issues New Advisory About Effects Social Media Use Has on Youth Mental Health

Surgeon General Dr. Vivek Murthy Urges Action to Ensure Social Media Environments are Healthy and Safe, as Previously-Advised National Youth Mental Health Crisis Continues

Today, United States Surgeon General Dr. Vivek Murthy released a new Surgeon General’s Advisory on Social Media and Youth Mental Health . While social media may offer some benefits, there are ample indicators that social media can also pose a risk of harm to the mental health and well-being of children and adolescents. Social media use by young people is nearly universal, with up to 95% of young people ages 13-17 reporting using a social media platform and more than a third saying they use social media “almost constantly.”

With adolescence and childhood representing a critical stage in brain development that can make young people more vulnerable to harms from social media, the Surgeon General is issuing a call for urgent action by policymakers, technology companies, researchers, families, and young people alike to gain a better understanding of the full impact of social media use, maximize the benefits and minimize the harms of social media platforms, and create safer, healthier online environments to protect children. The Surgeon General’s Advisory is a part of the Department of Health and Human Services’ (HHS) ongoing efforts to support President Joe Biden’s whole-of-government strategy to transform mental health care for all Americans.

“The most common question parents ask me is, ‘is social media safe for my kids’. The answer is that we don't have enough evidence to say it's safe, and in fact, there is growing evidence that social media use is associated with harm to young people’s mental health,” said U.S. Surgeon General Dr. Vivek Murthy . “Children are exposed to harmful content on social media, ranging from violent and sexual content, to bullying and harassment. And for too many children, social media use is compromising their sleep and valuable in-person time with family and friends. We are in the middle of a national youth mental health crisis, and I am concerned that social media is an important driver of that crisis – one that we must urgently address.”

Usage of social media can become harmful depending on the amount of time children spend on the platforms, the type of content they consume or are otherwise exposed to, and the degree to which it disrupts activities that are essential for health like sleep and physical activity. Importantly, different children are affected by social media in different ways, including based on cultural, historical, and socio-economic factors. Among the benefits, adolescents report that social media helps them feel more accepted (58%), like they have people who can support them through tough times (67%), like they have a place to show their creative side (71%), and more connected to what’s going on in their friends’ lives (80%).

However, social media use can be excessive and problematic for some children. Recent research shows that adolescents who spend more than three hours per day on social media face double the risk of experiencing poor mental health outcomes, such as symptoms of depression and anxiety; yet one 2021 survey of teenagers found that, on average, they spend 3.5 hours a day on social media. Social media may also perpetuate body dissatisfaction, disordered eating behaviors, social comparison, and low self-esteem, especially among adolescent girls. One-third or more of girls aged 11-15 say they feel “addicted” to certain social media platforms and over half of teenagers report that it would be hard to give up social media. When asked about the impact of social media on their body image, 46% of adolescents aged 13-17 said social media makes them feel worse, 40% said it makes them feel neither better nor worse, and only 14% said it makes them feel better. Additionally, 64% of adolescents are “often” or “sometimes” exposed to hate-based content through social media. Studies have also shown a relationship between social media use and poor sleep quality, reduced sleep duration, sleep difficulties, and depression among youth. 

While more research is needed to determine the full impact social media use has on nearly every teenager across the country, children and adolescents don’t have the luxury of waiting years until we know the full extent of social media’s effects. The Surgeon General’s Advisory offers recommendations stakeholders can take to help ensure children and their families have the information and tools necessary to make social media safer for children:

• Policymakers can take steps to strengthen safety standards and limit access in ways that make social media safer for children of all ages, better protect children’s privacy, support digital and media literacy, and fund additional research.
• Technology companies can better and more transparently assess the impact of their products on children, share data with independent researchers to increase our collective understanding of the impacts, make design and development decisions that prioritize safety and health – including protecting children’s privacy and better adhering to age minimums – and improve systems to provide effective and timely responses to complaints.
• Parents and caregivers can make plans in their households such as establishing tech-free zones that better foster in-person relationships, teach kids about responsible online behavior and model that behavior, and report problematic content and activity.
• Children and adolescents can adopt healthy practices like limiting time on platforms, blocking unwanted content, being careful about sharing personal information, and reaching out if they or a friend need help or see harassment or abuse on the platforms.
• Researchers can further prioritize social media and youth mental health research that can support the establishment of standards and evaluation of best practices to support children’s health.

In concert with the Surgeon General’s Advisory, leaders at six of the nation’s medical organizations have expressed their concern on social media’s effects on youth mental health:

“Social media can be a powerful tool for connection, but it can also lead to increased feelings of depression and anxiety – particularly among adolescents. Family physicians are often the first stop for parents and families concerned about the physical and emotional health of young people in their lives, and we confront the mental health crisis among youth every day. The American Academy of Family Physicians commends the Surgeon General for identifying this risk for America's youth and joins our colleagues across the health care community in equipping young people and their families with the resources necessary to live healthy, balanced lives.” – Tochi Iroku-Malize, M.D., MPH, MBA, FAAFP, President, American Academy of Family Physicians

“Today’s children and teens do not know a world without digital technology, but the digital world wasn’t built with children’s healthy mental development in mind. We need an approach to help children both on and offline that meets each child where they are while also working to make the digital spaces they inhabit safer and healthier. The Surgeon General’s Advisory calls for just that approach. The American Academy of Pediatrics looks forward to working with the Surgeon General and other federal leaders on Youth Mental Health and Social Media on this important work.” – Sandy Chung, M.D., FAAP, President, American Academy of Pediatrics

“With near universal social media use by America’s young people, these apps and sites introduce profound risk and mental health harms in ways we are only now beginning to fully understand. As physicians, we see firsthand the impact of social media, particularly during adolescence – a critical period of brain development. As we grapple with the growing, but still insufficient, research and evidence in this area, we applaud the Surgeon General for issuing this important Advisory to highlight this issue and enumerate concrete steps stakeholders can take to address concerns and protect the mental health and wellbeing of children and adolescents.We continue to believe in the positive benefits of social media, but we also urge safeguards and additional study of the positive and negative biological, psychological, and social effects of social media.”— Jack Resneck Jr., M.D., President, American Medical Association

“The first principle of health care is to do no harm – that’s the same standard we need to start holding social media platforms to. As the Surgeon General has pointed out throughout his tenure, we all have a role to play in addressing the youth mental health crisis that we now face as a nation. We have the responsibility to ensure social media keeps young people safe. And as this Surgeon General’s Advisory makes clear, we as physicians and healers have a responsibility to be part of the effort to do so.” – Saul Levin, M.D., M.P.A., CEO and Medical Director, American Psychiatric Association

“The American Psychological Association applauds the Surgeon General's Advisory on Social Media and Youth Mental Health, affirming the use of psychological science to reach clear-eyed recommendations that will help keep our youth safe online. Psychological research shows that young people mature at different rates, with some more vulnerable than others to the content and features on many social media platforms. We support the advisory's recommendations and pledge to work with the Surgeon General's Office to help build the healthy digital environment that our kids need and deserve.” – Arthur Evans, Jr., Ph.D., Chief Executive Officer and Executive Vice President, American Psychological Association.

“Social media use by young people is pervasive. It can help them, and all of us, live more connected lives – if, and only if, the appropriate oversight, regulation and guardrails are applied. Now is the moment for policymakers, companies and experts to come together and ensure social media is set up safety-first, to help young users grow and thrive. The Surgeon General’s Advisory about the effects of social media on youth mental health issued today lays out a roadmap for us to do so, and it’s critical that we undertake this collective effort with care and urgency to help today’s youth.” – Susan L. Polan, Ph.D., Associate Executive Director, Public Affairs and Advocacy, American Public Health Association

The National Parent Teacher Association shared the following:

“Every parent’s top priority for their child is for them to be happy, healthy and safe. We have heard from families who say they need and want information about using social media and devices. This Advisory from the Surgeon General confirms that family engagement on this topic is vital and continues to be one of the core solutions to keeping children safe online and supporting their mental health and well-being.” – Anna King, President of the National Parent Teacher Association .

In December 2021, Dr. Murthy issued a Surgeon General’s Advisory on Protecting Youth Mental Health calling attention to our national crisis of youth mental health and well-being. Earlier this month, he released a Surgeon General’s Advisory on Our Epidemic of Loneliness and Isolation , where he outlined the profound health consequences of social disconnection and laid out six pillars to increase connection across the country, one of which being the need to reform our digital environments. The new Surgeon General’s Advisory on Social Media and Youth Mental Health is a continuation of his work to enhance the mental health and well-being of young people across the country.

The full Surgeon General’s Advisory can be read here . For more information about the Office of the Surgeon General, visit www.surgeongeneral.gov/priorities .

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