An almost 18-year-old female came to clinic ostensibly for weight management with approval from her parent. She said she did little exercise preferring to play video games, and continued to have poor nutritional intake. “I just want the shot. My aunt started on them and she’s lost a lot of weight. I just want to do that too,” she said.
The past medical history showed her to have increasing weight over the past few years with a body mass index (BMI) of 28.6 kg/M The family history was positive for obesity, type 2 diabetes, and heart disease. The review of systems revealed that she endorsed tiredness with additional exercise, no problems with sleeping, headache, abdominal pain, or joint problems. The pertinent physical exam had a heart rate of 84, blood pressure of 118/76, with normal respirations and temperature. Her height was 165 cm, weight 80.8 kg with a BMI of 29.7 kg/M The diagnosis of continued elevation in body mass and serious obesity. The pediatrician discussed healthy lifestyle again along with referral to the cardiometabolic clinic for weight management including possible medication management. The adolescent asked, “Aren’t you going to give me the shots?” and when the pediatrician said that he would not be, the adolescent said “I just want the shots and I’m not going to do any exercise, or do anything else.” The pediatrician tried to re-engage with the adolescent, but she would not re-engage. As she left, he reminded her of her health maintenance visit that was due in 4 months and the issue could be discussed at that time as well.
Discussion
Obesity management takes a multidisciplinary approach including nutritional counseling, increased activity, mental health support, and potential medication and surgical interventions (i.e. bariatric surgery). Glucagon-like peptide-1 receptor agonists (GLP-1s) are similar to a type of gut-derived hormone which help with regulating metabolism though “…increased insulin secretion and sensitivity to delayed gastric emptying and promotion of postprandial satiety.” GLP-1s (e.g. exenatide, dulaglutide, liraglutide, tirzepatide, semalutide) were approved for type 2 diabetes for about 20 years, and for weight management for about 10 years. Semaglutide (Wegovy® Ozempic®) was approved for adults in 2017 for type 2 diabetes, in 2021 for weight management and for lowering the risks of cardiovascular problems in 2024. GLP-1 cost can be significant ranging $500-1600/month depending on the medication, dose and potential insurance coverage.
Learning Point
One 2024 study found that dispensing of GLP-1s significantly increased from 2020-2024 for adolescents and young adults ages 12-25 years. For adolescents (12-17 years) the number of prescriptions is substantially lower (N=30,947) than for young adults (18-25 years, N=162,439). About 46% of the prescriptions were dispensed in the US South, and the last GLP-1 dispensed was most commonly semaglutide. For both groups the most common prescribers were endocrinologists, nurse practitioners and family medicine physicians. Pediatricians prescribed 3415 prescriptions for adolescents and 2067 for young adults, or ~2.8% of all prescriptions. The American Academy of Pediatrics State of the Art Review noted that “[GLP-1] are relatively new and expensive, and initiating treatment typically requires subspecialty and/or multidisciplinary care.”
A 2021 meta-analysis for children and adolescents < 18 years found that GLP-1s were "...safe and effective in modestly reducing weight, BMI and glycated hemoglobin A1c, and systolic blood pressure in children and adolescents with obesity in a clinical setting...." Nausea was a common side effect. Lifestyle interventions amplified the weight-reducing effects of GLP-1s in the pediatric age group. Currently Federal Drug Administration approved GLP-1s in pediatric age range are liraglutide injected daily for patients 10 years and older for type 2 diabetes since 2019, with generic approval in 2024. It is also used for patients 12 years and older for severe obesity since 2020 with a BMI of > 30 kg/M Because of the GLP-1 use expansion and significant costs, the FDA recently is warning about unapproved GLP-1s being used for weight loss.
Questions for Further Discussion
Related Cases
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: Obesity
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
To view videos related to this topic check YouTube Videos.
FDA approves weight management drug for patients aged 12 and older. December 4, 2020. Accessed August 4, 2025. https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-weight-management-drug-patients-aged-12-and-older
Ryan PM, Seltzer S, Hayward NE, Rodriguez DA, Sless RT, Hawkes CP. Safety and Efficacy of Glucagon-Like Peptide-1 Receptor Agonists in Children and Adolescents with Obesity: A Meta-Analysis. J Pediatr. 2021;236:137-147.e13. doi:10.1016/j.jpeds.2021.05.009
Cardiometabolic Health Congress. In the first big pharmaceutical development of 2023, Novo Nordisk announced that the U.S. Food and Drug Administration (FDA) has approved an expanded indication for semaglutide as the first injectable antiobesity prescription medication for use in pediatric patients. January 6, 2023. Accessed August 4, 2025. https://www.cardiometabolichealth.org/article/fda-approves-semaglutide-for-pediatric-patients/
Lee JM, Sharifi M, Oshman L, Griauzde DH, Chua KP. Dispensing of Glucagon-Like Peptide-1 Receptor Agonists to Adolescents and Young Adults, 2020-2023. JAMA. 2024;331(23):2041-2043. doi:10.1001/jama.2024.7112
Commissioner of the FDA Approves First Generic of Once-Daily GLP-1 Injection to Lower Blood Sugar in Patients with Type 2 Diabetes. FDA. December 27, 2024. Accessed August 4, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-once-daily-glp-1-injection-lower-blood-sugar-patients-type-2-diabetes
Stefater-Richards MA, Jhe G, Zhang YJ. GLP-1 Receptor Agonists in Pediatric and Adolescent Obesity. Pediatrics. 2025;155(4):e2024068119. doi:10.1542/peds.2024-068119
Author
Overweight and obesity are health problems that are increasing with a 1 in 5 prevalence of pediatric obesity. Data from 2017-20 estimated that 19.7% of US children were obese, and “[o]ne study estimated that about 57% of the population of US children in 2016 would live with obesity by the time they were aged 35 years.” Multiple studies have shown that overweight and obese children have a high likelihood of becoming obese adults. They are more likely to have “type 2 diabetes mellitus…, hypertension, hyperlipidemia, metabolic-dysfunction-associated steatotic liver disease…., and obstructive sleep apnea, among other conditions.” Pediatric and adolescent mental health can also be affected with “…increased risk of anxiety, depression, social isolation, and peer victimization.””
The use of GLP-1s is quickly and significantly expanding in the adult population and already changes are seen in the adolescent and young adult populations.
1. What are your current practices and planned future practices for GLP1s?
2. What are indications for use of metformin? A review can be found here
3. How do you manage other obesity-related problems such as hypertension?
Disease: Obesity
Symptom/Presentation: Obesity
Specialty: Endocrinology | General Pediatrics | Pharmacology / Toxicology
Age: Teenager
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa