GLP-1 drugs like semaglutide (Ozempic and Wegovy) and tirzepatide (Mounjaro and Zepbound) have greatly changed the treatment of obesity and type 2 diabetes for the better. Plenty of adults in the U.S. have taken or are currently taking a GLP-1. And increasingly, so are teens and young children, too.
A study last week, for instance, concluded that while GLP-1 use overall remains rare in young children, it has significantly increased over time. Between 2019 and 2026, the researchers found, 0.6% of children ages 8 to 11 with obesity but without diabetes had been prescribed an off-label GLP-1, while the annual percentage of such children prescribed a GLP-1 dramatically increased year after year. Other recent research has shown a similar rise in GLP-1 use among teens and young adults.
These drugs are addressing a real health issue. About 22% of adolescents ages 12 to 19 are obese, according to the latest data from the Centers for Disease Control and Prevention, as are 21% of children ages 6 to 11. And GLP-1s can certainly be effective for children. Novo Nordisk, the makers of semaglutide, presented new trial data this week showing that 40% of children six to 12 years old were no longer considered obese after 68 weeks of treatment.
In 2023, the American Academy of Pediatrics began recommending that doctors take a more proactive approach to treating childhood obesity, including the use of GLP-1 drugs. Yet other groups like the U.S. Preventive Services Task Force have held off on similar recommendations, citing a lack of data. Semaglutide has also only been approved for children over 12, though Novo Nordisk is seeking approval for younger age groups, while the other major GLP-1-based drug, Eli Lilly’s tirzepatide, is only approved as an obesity treatment for people over 18 (the drug is approved for children with diabetes as young as 10).
For this Giz Asks, we reached out to obesity researchers, pharmacologists, and pediatricians to pick their brains about GLP-1 use in children and teens. What do we know about the long-term effects of these medications in these age groups, what are some important lingering questions left to be resolved, and what do the children who go on these drugs actually report feeling? The following responses have been lightly edited for grammar and clarity.
Sarah Messiah
An epidemiologist and childhood obesity researcher at the University of Texas Southwestern Medical Center. Messiah co-authored a study earlier this year showing a growing rise in GLP-1 use among teens and young adults.
In our recent JAMA paper, we only, at the reviewer’s request, did the upper age limits because of the bariatric surgery aspect. We were also really interested in the combination of those two in our analysis. And that’s important because bariatric surgery is only recommended for 13-years-olds and up. However, I had been doing over the past week an analysis of our local data here at Children’s Health in Dallas, just to see locally what’s going on.
So, I looked at our local prescribing patterns from 2020 to just last month, and after I got your email this morning, I got curious and decided to do a sub-analysis in this younger age group. So we had almost 2,000 kids that have been given a GLP-1 or a GIP since 2020. We had looked at up to age 21, but when you look at age 11 and below, we have 7% that are represented in that group. And they’re mostly being prescribed for obesity and type 2 diabetes.
So my guess is that these are patients who have a strong family history and predisposition for obesity or type 2 diabetes, or where things are progressing even more aggressively. Their pediatricians are saying, “Okay, we want to try a GLP-1 off-label earlier.” And across all these recent studies, you can clearly see that pediatricians are already going down this road, because they’re thinking they’ve got to try things that hopefully work.
One of the other things we were looking at: What are the actual medications? And we are starting to see doctors place their pediatric patients on drugs like tirzepatide, probably because they’re not responding to earlier drugs.
The caveat here is that Children’s Health is a safety net hospital, too. So we have 64% of patients who are on Medicaid. This isn’t just, I don’t want to say, a bunch of rich kids, but it’s not that. We are a referral for a lot of subspecialty care from the community. If a family is going for their annual well-child visit, and the child has an elevated BMI or elevated blood pressure, they may refer them to us at Children’s Health for follow-up care with an endocrinologist or gastroenterologist. And I think a lot of what we’re seeing is that it’s children with class 2 and 3 obesity or other related conditions who are starting on these medications.
But there’s still a lot we don’t know about what’s happening or what happens when a patient stops one of these therapies. Do they start another one? Do they stop because it’s too expensive? Do they stop because of side effects? Do they stop because they’ve lost enough weight? There are all sorts of questions that we have very little information about right now.
I think another obvious question concerns the fact that we’re really moving towards precision obesity care. We’re trying to figure out what medication or therapeutic fits what patient best. Is it a matter of cycling or switching from one to another? Is it just starting them on the most effective one that we know that’s out there? Tirzepatide might be coming down the pike soon for kids. And then we’ve got retatrutide right behind that. I don’t know if retatrutide will ever be approved for children, but the results we’re seeing with adults—it’s crazy what it’s doing. So I bet that finds its way down into kids off-label. The field is moving so fast that it’s just really hard to keep up.
And I think what’s also challenging in pediatrics is you have two layers. You have the parent layer on top of the adolescent or child layer. And we don’t know about what that means, the influence there either. Is it the parent that’s driving this? Is it the child that’s driving this. There’s so many questions about that. So much to learn.
With our JAMA paper, we’re also seeing more and more that children are starting a GLP-1 and then having bariatric surgery. But we don’t know, is it because they’re starting the GLP-1 because they need to get down to a certain weight to qualify for the surgery? Or is it because they tried a GLP-1 and it didn’t work or they didn’t get the response they wanted, so then they moved on to surgery? And then there’s the question of how these drugs might be used after surgery. So these are the studies that need to happen.
I do think one thing that’s really interesting about all this is that this age group is being driven so much by social media. They really are like the TikTok generation. And they come to visits armed with all sorts of info that they have gotten from there. And they really are saying much more loudly what they want for treatment versus a decade ago. Back then, they weren’t showing up with anything and the conversation was very one-sided in terms of the pediatrician saying, okay, we’re going to try this, this, and this. And now it’s very much moved into shared decision-making space.
I think that’s ultimately a good thing. But we need to learn a lot more, a lot more.
Pareeta Kotecha
A graduate student at the University of Florida’s College of Pharmacy. Kotecha was the lead author of a systemic review published last year that examined the effectiveness and safety of GLP-1s in children and teens.
What we know about GLP-1 medications for the treatment of obesity in children and adolescents is encouraging but still incomplete.
Our team recently conducted a systematic review and meta-analysis of 18 randomized clinical trials involving more than 1,400 children and adolescents between 6 and 17 years of age. Importantly, these trials did not all study GLP-1 medications for obesity: 11 were conducted in young people with obesity, six in those with type 2 diabetes, and one in those with prediabetes. Overall, GLP-1 receptor agonists improved both weight-related and metabolic outcomes. Weight and BMI improvements were particularly evident in trials focused on obesity, while improvements in glycemic control were especially relevant in trials involving young people with type 2 diabetes. We also found improvement in systolic blood pressure.
It is also important to recognize that pediatric GLP-1 use does not represent a single indication or age group. In the United States, certain GLP-1 medications are FDA-approved for the treatment of obesity in adolescents starting at age 12, while some GLP-1 receptor agonists are approved for type 2 diabetes starting at age 10. These populations can overlap, since obesity commonly coexists with type 2 diabetes in young people. This makes it important, particularly when interpreting real-world prescribing trends, to understand why the medication was prescribed rather than assuming that every GLP-1 prescription in a young person represents treatment specifically for obesity.
The safety picture also requires nuance. Gastrointestinal side effects were more common with GLP-1 medications, which is consistent with what we see in adults. Reassuringly, in the randomized trials we analyzed, we did not find significant differences between GLP-1 medications and placebo in treatment discontinuation, depression, or suicidal thoughts or behaviors.
At the same time, absence of a statistically significant safety signal does not mean that every potential risk has been definitively ruled out. The duration and size of existing randomized trials may not be sufficient to characterize uncommon adverse events or outcomes that could emerge with longer-term treatment. There are also important outcomes for which evidence remains limited. For example, eating disorders were not reported as an outcome in the trials included in our analysis, so we cannot draw conclusions from these trials about how GLP-1 treatment may affect disordered eating or eating-disorder risk in young people. This is an area that warrants further investigation.
That is why I think the conversation should move beyond whether these drugs are simply “good” or “bad” for children. Obesity itself is a chronic disease with consequences that can accumulate over a lifetime, and effective treatment earlier in life could potentially reduce future metabolic and cardiovascular complications. At the same time, children and adolescents are still growing and developing, and we need better long-term evidence about outcomes such as growth, nutrition, mental health, eating disorders, weight trajectories after treatment discontinuation, and uncommon or delayed adverse effects.
This need for evidence is becoming increasingly important as GLP-1 use among young people rises rapidly. Continued real-world evidence will therefore be critical for understanding long-term safety, treatment patterns, and outcomes in children and adolescents who receive these medications.
Tahniat Syed
A clinical associate professor of pediatrics at the University of Pittsburgh School of Medicine and clinical director for the Center for Adolescent and Young Adult Health at the UPMC Children’s Hospital of Pittsburgh.
I think we know a lot at this point.
First of all, the diagnosis of being overweight or having obesity is something that has been well defined. In pediatrics we use growth percentiles to track weight. And those who track above the 95th percentile are considered to be in the obesity range, as opposed to adults, where we use a body mass index and typically over 30. Children are growing and developing. They’re going through puberty. Their height is changing. So many aspects of their lives are changing pretty rapidly. So you want to make sure that you have the correct diagnosis of obesity and that you’re treating the correct thing. And there are a variety of anti-obesity medications, including GLP-1s.
A GLP-1 drug, its full name is a GLP-1 receptor agonist. We have receptors all throughout your body, including receptors for GLP-1 in particular. So when you’re stimulating this receptor by providing an agonist, what that’s going to do is that it’s going to help your body to actually secrete more insulin to help you digest food. It will slow down the gastric emptying. That helps you feel more full and also acts at the brain level to help with satisfying your hunger. And then it also does some other things that we’re still learning about. So it helps how your metabolism works and potentially increases that a little bit, and it helps with some impulse control.
A lot of times what my patients tell me is that what these drugs really, really help with is, quote unquote, food noise. Without being asked, they’ll comment that it’s quieted their food noise. And we know from the studies that have been conducted since 2021 that these GLP-1 receptor agonists are effective at decreasing weight. We’re seeing meaningful weight loss. Meaningful in the sense that it will help with metabolic conditions if they already have that. And that, in turn, helps in so many other ways.
It’s important to remember that GLP-1 medications for adolescence are indicated for obesity. So it’s not indicated for a patient as treatment for an eating disorder. But does someone with obesity have disordered eating? Typically, they do, because that’s what this food noise is.
There are different forms of eating disorders. A lot of times when people are referring to, quote, unquote, eating disorders, they’re referring to anorexia nervosa, which is when someone has a severe intentional restriction of calories such that they become very underweight, very undernourished. And that’s actually a thought disorder where they believe that they are bigger than what they are, so they restrict calories further to become smaller. But another eating disorder is called binge eating disorder, and that’s where there may be some overlap of what you find when you’re questioning someone who has obesity. There’s also hyperphagia, which refers to having this internal feeling of like needing to eat more and more. There’s sort of this fine line between hyperphagia and binge eating, and then you can also have obesity.
I actually just saw a patient just before I came on the phone with you who came to me for weight management, and she has a binge eating disorder. So I’m treating her binge eating disorder and also uncovered that she has anxiety. Those are the things I’m treating while we get to the point of stabilizing her weight and actually helping her weight to come down a little bit.
Alaina Vidmar
Medical director of obesity medicine and bariatric surgery at Children’s Hospital Los Angeles.
I think first and foremost, it’s important just to acknowledge that pediatric obesity is a complex chronic disease. So we know that it’s not the fault of the young person or their parents; it’s really a sort of difference in their biology, in how their brain controls when they’re hungry and when they’re full and how their body uses their calories for energy. But now we have a growing toolkit of ways to help young people living in larger bodies to achieve greater health over time. It’s really not about the number on the scale or the size of one’s body, but we want to help kids to hopefully prevent things like diabetes, high blood pressure, and high cholesterol from developing over time.
That toolkit has expanded over the last several years to include oral medications and injectable medications, and it’s continuing to expand over time. So we can really take a shared decision-making model to connect with the patient family and understand what is the best tool for us to use for the patient in front of us, while acknowledging that every medication has a different efficacy and a different side effect profile. We can target and really find the best treatment for the kid we’re taking care of.
Certainly we’ve been getting a lot of data quickly over the last few years, which is excellent. But I think the biggest thing we want to understand is: How do we best use the medications for various ages? There are lots of different groups who are studying them in younger kids, teenagers, and just spanning the pediatric lifespan. I also think we want to understand who they work the best for. So are there certain patients who respond better to certain medications, and is there any way to predict which medications are going to have which side effects in which kids? Or the flip of that, can we predict which patients are going to have the best effect from a certain medication? There’s a precision approach that we’re hoping to achieve.
We do have to acknowledge that just like pediatric obesity is a really complex chronic disease, disordered eating is also another complex chronic disease, and kids can be living with both of them simultaneously. So we need to be thoughtful stewards of both how we screen and uncover multiple chronic diseases that a young person could be living with, and then also how our treatments could be either a part of treating both of them or uncovering another disease that needs to be taken care of. I think that comes from really thoughtful histories that we take where we learn about patients—what is their own history, their family history? And then we also have to thoughtfully monitor treatment over time, just like you would with any kind of response to a medication. We want to understand how this medication changes your eating behaviors or your relationship with food. That’s something we can gather so we can help make sure our patients have what they need to be successful.
Lastly, it would be great to understand how we use these medications long-term. I think a lot of us, when we think about obesity as a complex chronic disease, we understand that there’s going to be a cohort of these young people that might need these medications long-term into adulthood. So what does it look like for them? And then what does it look like to take them into a maintenance period? Maybe you need a treatment dose for several years, and then you decrease to a lower dose or [taper off]. And so I think understanding what those algorithms look like and how best to help support patients and families as they’re traversing that would be very helpful.
Giz Asks is a recurring Gizmodo series in which experts answer big questions in their own words, offering a range of perspectives on the ideas, discoveries, and debates that affect our lives and shape our understanding of the world.
