Usage of GLP-1 receptor agonists among children ages 8 to 11 with obesity increased 310-fold between 2019 and 2026, according to a recent cross-sectional analysis, even though these medications lack FDA approval for this age group.
Among more than 3.5 million children in this age bracket, annual GLP-1 prescriptions—covering drugs such as tirzepatide (Zepbound), semaglutide (Wegovy), and liraglutide (Saxenda)—climbed from 0.03% to 9.3% over the study period (P<0.001), wrote Babak J. Orandi, MD, PhD, of NYU Grossman School of Medicine, and colleagues in Pediatrics.
Still, prescriptions remained uncommon. Only 20,282 children diagnosed with obesity received a GLP-1 prescription during the entire study window, representing 0.6% of the total population analyzed. Pediatric obesity affects approximately 20% of U.S. children.
“Although the absolute number of children under twelve being treated with GLP-1s remains small, their use is growing quickly,” Dr. Orandi said. “Maintaining prudent use of GLP-1 therapy is an important strategy in tackling childhood obesity.”
Liraglutide and semaglutide are currently approved for chronic weight management in adolescents twelve years and older. Professional guidelines permit consideration of these medications in children as young as eight, and clinical trials have evaluated tirzepatide, liraglutide, and semaglutide in participants aged six to eleven.
The research team found that physicians appear to be concentrating GLP-1 therapies on children facing the highest immediate cardiometabolic risks rather than applying them more broadly for general obesity treatment.
Roughly 94% of children prescribed a GLP-1 agent were classified as having severe obesity (greater than 120% of the 95th percentile on gender-specific CDC growth charts). Additionally, these children had substantially higher rates of obesity-associated comorbidities compared with non-users:
- Metabolic dysfunction-associated steatotic liver disease: 13.8% vs 3% in non-users
- Hyperlipidemia: 36.9% vs 8.8%
- Hypertension: 12.8% vs 2.5%
- Obstructive sleep apnea: 24.1% vs 7%
- Prediabetes: 25.2% vs 3.6%
GLP-1 prescribing also skewed toward older children (eleven-year-olds compared with eight-year-olds), girls, and patients residing in neighborhoods with lower social vulnerability scores. This last pattern mirrors prior observations in adolescents aged twelve to seventeen and highlights potential inequities in access to innovative obesity treatments.
“As indications for pediatric GLP-1 receptor agonists expand and clinical guidelines endorse earlier pharmacologic intervention, advantages may accrue primarily to children from socioeconomically advantaged backgrounds, possibly widening existing disparities in weight-related health outcomes,” the authors noted.
Co-author Allan B. Massie, PhD, of NYU Grossman School of Medicine emphasized the need for policy action. “Healthcare providers and policymakers share a duty to guarantee that as GLP-1 medications become more prevalent, all young children with obesity who require these therapies can obtain them. Ensuring broad access to these beneficial—yet often costly—treatments beyond those with insurance or the means to attend specialized pediatric clinics is essential,” he stated.
For this retrospective cross-sectional study, investigators examined annual cohorts drawn from the Epic Cosmos Data Science Virtual Machine, encompassing 3,520,531 children with obesity (BMI ≥95th percentile) from January 2019 through June 2026. Conditions were identified via ICD-10 codes, and participants with prior diabetes diagnoses were excluded prior to initiating a GLP-1 agent. Semaglutide emerged as the most frequently prescribed first-line option, whereas liraglutide was least common.
The authors recognized several study limitations, including the possibility that electronic health record prescription entries may not accurately reflect medication dispensing, adherence levels, or treatment duration. Additionally, obesity status, associated conditions, and neighborhood-level social vulnerability might have been misclassified or inadequately documented.
“By capturing rapid expansion in utilization, concentration among children with severe obesity and comorbidities, and nascent differences in access, these findings can inform efforts to promote equitable prescribing practices, refine insurance coverage policies, and provide context for ongoing safety and effectiveness evaluations as use continues to grow,” Dr. Orandi and colleagues concluded.
