- Prescriptions for GLP-1 drugs surged 310-fold (from 0.03% to 9.3%) among kids ages 8 to 11 with obesity, despite a lack of FDA approval in this age group.
- Most kids who received GLP-1 drugs had severe obesity and comorbidities, indicating that these agents are usually reserved for high-risk children.
- Prescriptions favored socioeconomically advantaged families, raising concerns about widening disparities in pediatric obesity care.
Prescribing GLP-1 receptor agonists to children ages 8 to 11 years with obesity surged 310-fold since 2019, despite a lack of FDA approval in kids under 12, a large cross-sectional analysis showed.
Among over 3.5 million children in this age group, annual prescribing of GLP-1 drugs — including tirzepatide (Zepbound), semaglutide (Wegovy), and liraglutide (Saxenda) — increased from 0.03% in 2019 to 9.3% in 2026 (P<0.001), reported Babak J. Orandi, MD, PhD, of NYU Grossman School of Medicine in New York City, and colleagues.
Even so, overall prescribing remained low. Just 20,282 children with obesity (0.6%) received a GLP-1 prescription across the entire study period, they noted in Pediatrics. The prevalence of pediatric obesity in the U.S. is 20%.
“While the absolute number of children under the age of 12 receiving GLP-1 treatment is still low, GLP-1 use is accelerating rapidly,” Orandi said in a statement. “The careful use of GLP-1s remains a valuable tool in confronting the obesity epidemic among young Americans.”
Currently, liraglutide and semaglutide are approved for chronic weight management in adolescents ages 12 and older.
Guidelines allow for consideration of use in children as young as 8, and liraglutide, semaglutide, and tirzepatide have been studied in kids ages 6 to 11, the researchers pointed out.
The findings suggest “that clinicians are largely reserving GLP-1 receptor agonists for patients at greatest immediate cardiometabolic risk rather than for broader obesity management,” they added.
Nearly 94% of children prescribed a GLP-1 drug had severe obesity (>120% of the 95th percentile on sex-specific CDC growth charts). Children were also more likely to receive a prescription if they had any obesity-related comorbidity (65.2% of GLP-1 users vs 19.6% of non-users), including:
- Metabolic dysfunction-associated steatotic liver disease: 13.8% vs 3%
- 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 drug use was also higher among older children (11-year-olds vs 8-year-olds), girls, and those living in areas with lower social vulnerability. The latter finding points to “emerging inequities in access, consistent with data in adolescents ages 12 to 17,” Orandi and team noted.
“As pediatric GLP-1 receptor agonist indications expand and guidelines endorse earlier pharmacotherapy, benefits may preferentially accrue to socioeconomically advantaged children, potentially widening disparities in obesity-related outcomes,” they wrote.
Co-author Allan B. Massie, PhD, also of NYU Grossman School of Medicine, emphasized the need for policy intervention. “Physicians and health policymakers alike have a responsibility to ensure, as use of GLP-1 medications continues to rise, that all young children with obesity who need these drugs have access to them and that these valuable and sometimes costly treatments become available to more than those who have access to health insurance and can afford to visit pediatric clinics,” he said in a statement.
For this retrospective cross-sectional study, the researchers analyzed repeated annual cohorts from the Epic Cosmos Data Science Virtual Machine, evaluating 3,520,531 children with obesity (BMI ≥95th percentile) from January 2019 to June 2026.
Diagnoses were identified using ICD-10 codes, and children were excluded if they had a diabetes diagnosis prior to starting a GLP-1 agent. Semaglutide was the most common initial prescription, whereas liraglutide was the least common.
The authors acknowledged several limitations to their analysis, including that electronic health record prescription orders may not reflect actual medication dispensing, adherence, or duration of use. Also, obesity status, comorbidities, and neighborhood-level social vulnerability may have been misclassified or incompletely captured.
“By documenting rapid growth in use, concentration among those with severe obesity and obesity-related comorbidities, and emerging gradients in access, these findings can guide efforts to promote equitable prescribing, refine coverage policies, and contextualize safety and effectiveness as use expands,” Orandi and co-authors concluded.
