Prescribing GLP-1 drugs to treat adolescents with obesity involves some unique considerations, according to experts, including many unknowns about the potential long-term health impacts – both positive and negative – in patients so young.
“We don’t know if there’s a differential effect of starting the medication at a younger age versus an older age,” said researcher Dr. Joyce Lee, a professor of pediatrics and communicable diseases at the University of Michigan School of Public Health. “One might hope that if the medications are initiated and there’s successful weight loss, perhaps that creates a new opportunity for that younger individual to enter into a more healthy lifestyle approach going into young adulthood. But, again, we don’t know.”
Despite the unknowns, Lee and colleagues in a 2024 study published in The Journal of the American Medical Association that found prescribing GLP-1 receptor agonists increased nearly 600% among adolescents and young adults in the US from 2020 to 2023.
Just as interest in these drugs to treat obesity in adults is growing exponentially, the use in adolescents may be driven by changing attitudes about obesity, reinforced by research as well as updated clinical guidelines for clinicians who treat young people with obesity.
The biological underpinnings of obesity
The CDC estimates that about 20% of US adolescents ages 12 to 19 have obesity, putting them at short- and long-term risk for chronic conditions such as cardiovascular disease, type 2 diabetes and mental health issues.
Previous protocols to treat obesity in this age group focused on lifestyle changes around diet and physical activity. The American Academy of Pediatrics still recommends intensive health and lifestyle counseling to treat obesity in young people. But the Academy updated its clinical guidelines in 2023 to consider medication for those over age 12. This is the same year the FDA approved use of the GLP-1 drug semaglutide, or Wegovy, for weight loss in 12- to 17-year-olds with obesity.
The new guidelines recognize that the old protocol may have only a modest impact and, rather than relying solely on counseling and lifestyle changes, a more proactive approach may be necessary.
“One thing that is clear to me is that [GLP-1s] are changing the conversation as to what obesity is and is not,” said Aaron Kelly, a professor of Pediatrics and the co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota Medical School. “The evidence is pretty clear that obesity is not someone’s fault; it’s not about will power or laziness or people not trying hard enough. Really, it is the convergence of underlying biological predispositions, genetics, merging with an obesity promoting society. It’s not the individual’s fault.
“I think [what the success of GLP-1s in helping people lose weight] underscores is how biology is really at play here,” Kelly said. “People’s attitudes and beliefs about obesity are changing because of this.”
New research shows the benefits of treating adolescents with GLP-1s
Regardless of how it’s achieved, the benefits of successful weight loss in those with obesity are numerous, according to experts.
“If you effectively treat obesity and reduce excess adiposity there are countless downstream positives for other health outcomes,” Kelly said, listing conditions that may be affected by sustained weight loss, including type 2 diabetes, chronic kidney disease, sleep apnea, heart attack and knee osteoarthritis pain. “The list goes on,” he said.
Kelly and colleagues published a study in Diabetes Care in November last year that found that the GLP-1 semaglutide was an effective treatment in adolescents with obesity, and resulted in improved insulin sensitivity and cardiometabolic risk factors.
Another December 2025 study, published in JAMA Network Open, showed a link between GLP-1s and effective treatment of asthma in adolescents.
“Previous studies in adults have suggested that GLP-1 receptor agonists may be associated with improved asthma control and a reduced risk of asthma-related outcomes,” said co-author Dr. Linshien Fu. “However, because childhood asthma is largely driven by type 2 immune pathways and differs pathophysiologically from adult asthma, it was important to assess whether similar associations could be observed in pediatric populations using real-world data.”
The results of the study found that for those young people with difficult to control asthma who find sustained weight-loss difficult, GLP-1s may be a good option.
“Although this was an early observational study, the findings suggest that GLP-1 receptor agonists may offer an additional therapeutic consideration in this difficult-to-treat population and may help inform clinical decision-making in real-world practice,” Fu said.
Kelly highlighted the ripple effect of improved health outcomes once obesity is addressed, making effective treatment in adolescence even more crucial.
“I think most of us who do this work in pediatrics are, instead of just treating pediatric obesity…we’re really treating life-course obesity,” he said. “And most of us believe that if we get started early, if we can utilize treatments that really help put these kids on a healthy trajectory so they may never develop knee osteoarthritis or [have a] heart attack; they may never develop diabetes. So, that’s really the focus – beyond weight. What other things can we improve?”
Overcoming multiple barriers
Interest in and the use of GLP-1s continues to grow, but some clinicians and caregivers are still hesitant and access to these drugs can be difficult.
Lee said there are more barriers to pediatric use of the drugs. “I think pediatricians – I think all primary care physicians – feel as though they need an upskilling with regard to use of these medications,” she said. “But in kids, in particular, I think there’s probably an opportunity with regard to knowledge and understanding of how to prescribe…but also more of a question about whether these medications should be started in kids because the implication is that these kids might have to be on the medications lifelong to see the positive effects.”
That is the most pressing question most pediatricians have, Kelly noted.
“The short answer is that most of the evidence is telling us it will be lifelong,” Kelly said. “Maybe not that specific medication, but it’s pretty clear right now that obesity is a chronic disease. So, we use an analogy – blood pressure medication. The effect only happens while you’re on the drug.”
He added that pediatric providers want to be conservative and careful, especially because there isn’t a lot of data on medium- to long-term use. Most studies in young people lasted about a year or 18 months. “So we have a lack of information about the long-term safety and effectiveness of these medications,” he said.
Kelly pointed out that GLP-1s have been approved for treatment of diabetes for decades and “there’s reassurance, at least in adults, that over years and decades that the safety profile looks pretty good, however, we don’t have much data in a 15-year-old, for example.”
Kelly and his team are setting up clinical registries to record when these medications are used in pediatric settings. The goal is to follow children over years or decades to create evidence about long-term effects. Research also is looking into whether it is possible to taper dosages over time and still maintain weight loss benefits.
Kelly is the principal investigator in the largest clinical trial yet looking at obesity medication and adolescents, thanks to a $16.8 million research grant from the Patient-Centered Outcomes Research Institute. This study seeks to identify the optimal combination of medication and lifestyle modification counseling. For teens, 26 to 52 hours of intensive lifestyle counseling a year is recommended. The study, which will include 1,000 teenagers nationwide with obesity who are taking Wegovy, will look at whether 26, 13 or four hours of counseling in conjunction with the medication will result in sustained improvements.
Caregivers, too, may be reluctant to move to medication. A January study published in JAMA Network Open found that caregiver decision-making about using GLP-1 receptor agonists for children with obesity is shaped by prior experiences with lifestyle interventions, general trust in medications and beliefs about the best path for their child’s well-being.
Caregivers who saw positive results from dietary changes were more motivated to continue with lifestyle-only approaches, while those who encountered limited success were more open to considering GLP-1 medications. Safety concerns, media influence and personal or secondhand experiences with weight-related drugs also played a major role in their decisions.
Ultimately, the interplay between family values and structural challenges, such as food insecurity, underscores the importance of shared decision-making in treatment choices.
Even if physician and caregiver hesitation to prescribing a GLP-1 to an adolescent patient is overcome, access to these medications due to cost and insurance coverage is yet another barrier.
“There are FDA approved indications for these medications for obesity, but it’s a little bit like the wild, wild west as to which drug is going to be covered by which insurer for a particular patient,” Lee said.
Costs for these drugs may be starting to drop, however, and new formats are becoming available. In January, Novo Nordisk’s first oral version of Wegovy hit the marketplace, making it an option for individuals who may have been reluctant to use an injectable version, something that may make a difference for young people.
Still the bar to access for those who may benefit remains high.
“Right now these medications are available to people who can afford them,” Kelly said. “But that goes against what we know about obesity. Obesity is greater among populations that don’t have access to [these drugs]. As a researcher who has dedicated their career to this and worked hard to get them FDA approved, it’s really hard to watch when the people who need these treatments the most are not able to get them.”