Learn how GLP-1 receptor agonists in pediatrics are changing the landscape of adolescent obesity treatment.

Published: August 6, 2025

The treatment landscape for childhood obesity is evolving with the introduction of glucagon-like peptide-1 (GLP-1) receptor agonists in pediatrics. These medications, which have demonstrated substantial efficacy in adults, are now showing promising results in adolescent populations.

“Integrating GLP-1 receptor agonists into pediatric obesity treatment represents a significant advancement in our ability to address a growing public health crisis and improve long-term health outcomes,” said Sara E. Watson, M.D., pediatric endocrinologist with Norton Children’s Endocrinology, affiliated with the UofL School of Medicine.

Obesity in children and adolescents is associated with increased risk for Type 2 diabetes, hypertension and early cardiovascular disease. Early intervention is key to mitigating long-term complications and promoting healthy development.

How do GLP-1 receptor agonists work? GLP-1 receptors, found in the gut, pancreas and brain, play key roles in glucose regulation and appetite suppression.

When activated by GLP-1 receptor agonists, they promote increased satiety, reduced appetite and delayed gastric emptying.

These mechanisms reduce caloric intake and support clinically meaningful weight loss for pediatric patients with obesity.

Defining pediatric obesity

Pediatric obesity is defined using body mass index (BMI) percentiles. A BMI at or above the 95th percentile for age and sex, based on standardized growth charts, is considered obese.

Additional classifications include:

• Class 2 obesity: equal to or greater than 120% of the 95th percentile
• Class 3 obesity: equal to or greater than 140% of the 95th percentile

Food and Drug Administration (FDA) approval and prescribing information

Among the pediatric population, two GLP-1 agonists are FDA-approved as an adjust to lifestyle changes for weight management among adolescents ages 12 and older: liraglutide and semaglutide.

Semaglutide, a weekly injection, has demonstrated superior efficacy in adult head-to-head trials and is becoming a preferred option when accessible.

When prescribing, the initiation phase includes more frequent visits for dose titration, side-effect monitoring and behavioral counseling.

The maintenance phase includes visits approximately every four months once stable. Ongoing assessment of treatment response and lifestyle adherence is necessary, along with monitoring for obesity-related comorbidities.

Common side effects of GLP-1 receptor agonists

Common side effects include nausea and abdominal discomfort. Using these medications may put patients at higher risk of developing pancreatitis or cholecystitis.

While these medications generally are well tolerated, some patients may experience symptoms that require discontinuation.

Contraindications include:

• Personal or family history of medullary thyroid carcinoma
• Multiple endocrine neoplasia syndrome
• Significant delayed gastric emptying (e.g., in Prader-Willi syndrome)

Integration into comprehensive care

The American Academy of Pediatrics guidelines mark a shift in obesity management: Pharmacotherapy may be offered alongside lifestyle modifications at initial presentation, rather than after other approaches have failed.

Lifestyle interventions remain the foundation, including:

• Nutritional guidance to support healthy weight loss
• Physical activity to maintain lean mass
• Family engagement to reinforce behavior changes
• Regular provider follow-up for support and monitoring

Clinical pearls for providers

1. Start early: Do not wait for lifestyle-only failure before initiating pharmacologic treatment.
2. Expect variability: About 20% of patients may show limited response.
3. Reinforce lifestyle: Medications enhance — not replace — dietary changes and physical activity.
4. Monitor nutrition: Caloric reduction may increase risk of nutrient deficiencies.
5. Anticipate insurance challenges: Coverage is inconsistent; manufacturer programs or compounded options may be explored, though cost and safety vary.
6. Coordinate care for procedures: Discontinue GLP-1s in advance of surgeries, in collaboration with anesthesia teams.
7. Think long term: These agents are most effective as part of sustained, comprehensive care.

Research into the use of GLP-1 receptor agonists in younger children is ongoing, including long-term effects. As the evidence base expands, these therapies may become more widely accessible. For now, they offer an important new tool in addressing severe pediatric obesity, potentially delaying or even eliminating the need for bariatric surgery for more patients.