GLP-1 drugs in pediatric obesity

GLP-1 receptor agonists, the drug class behind semaglutide and liraglutide, are no longer adult-only medicines. Regulators in the US and Europe have extended approvals to adolescents with obesity, and a July 2026 review published in Digestive and Liver Disease by Abodi, Agostoni, and Mazzocchi surveys the trial evidence behind those approvals, the safety signals to watch, and the gaps the field has yet to close^[1].

Childhood obesity is a serious public health problem. It tracks into adult cardiometabolic disease, carries psychosocial burden, and responds poorly to lifestyle intervention alone in many patients. The arrival of effective pharmacotherapy changes the clinical calculus, but the pediatric literature is thinner than the adult data, and some of the questions most relevant to long-term prescribing remain unanswered.

Which drugs are approved, and for whom

Liraglutide (Saxenda) was the first GLP-1 receptor agonist to receive a pediatric obesity indication. The European Medicines Agency extended the Saxenda label to adolescents aged 12 and above in 2015 and later added children aged 6 to 11 with a body weight of at least 45 kg^[2]. The pivotal trial, published in the New England Journal of Medicine in May 2020, enrolled 251 adolescents aged 12 to 17. At 56 weeks, 43.3% of those receiving liraglutide achieved at least a 5% BMI reduction versus 18.7% on placebo^[3].

Semaglutide (Wegovy) followed with stronger efficacy data. The FDA approved semaglutide 2.4 mg weekly for chronic weight management in adolescents aged 12 and above in December 2022, based on the STEP TEENS trial. In 201 participants aged 12 to 17, semaglutide produced a mean BMI change of -16.1% from baseline versus +0.6% on placebo at 68 weeks, with 73% of participants on semaglutide achieving at least 5% weight loss^[4]. A 2024 network meta-analysis across 11 randomised trials found semaglutide was associated with approximately 17.67 kg greater weight loss versus placebo, outperforming liraglutide, exenatide, and dulaglutide in head-to-head comparisons^[5].

Safety profile in younger patients

The Abodi et al. review notes that gastrointestinal adverse events are the most frequently reported side effects across the pediatric trials^[1]. In the STEP TEENS trial, GI events affected 62% of participants on semaglutide versus 42% on placebo^[4]. In the liraglutide SCALE TEENS trial, 64.8% of the liraglutide group reported GI adverse events versus 36.5% on placebo, and 10.4% discontinued liraglutide due to adverse events versus none in the placebo arm^[3].

On growth and development, the review concludes there are no consistent impacts documented so far^[1]. That finding comes with an important qualifier: the trial follow-up periods, ranging from 56 to 68 weeks, are short relative to the duration of puberty and skeletal development. The review calls explicitly for longer-term safety data before strong conclusions can be drawn.

The cholelithiasis (gallstone) signal seen in adult semaglutide trials also appeared in STEP TEENS, with 4% of adolescents on semaglutide reporting cholelithiasis versus 0% on placebo. This is worth monitoring in clinical practice.

The psychosocial layer

The Abodi et al. review gives particular weight to concerns that purely pharmacological framing tends to understate^[1]. Stigma around obesity in children and adolescents is well-documented and can compound psychological harm. GLP-1 receptor agonist therapy introduced alongside restrictive messaging about food may increase risk for disordered eating in a population already at elevated risk. Access inequities in pediatric weight-management services can mean the patients with the most complex presentations are least likely to receive these medicines.

The review's position is that pharmacotherapy is an adjunct, not a replacement, for intensive lifestyle intervention. Nutritional guidance, exercise support, and family-centered behavioral support are described as mandatory components of any treatment programme, not optional add-ons.

What the field does not yet know

The 2026 review identifies several open questions^[1]. Long-term safety data past 68 weeks do not exist for pediatric populations. Whether weight loss achieved during adolescence translates to durable cardiometabolic benefit in adulthood has not been tested. Whether the GI tolerability profile improves with extended use, as some adult data suggest, needs confirmation in younger patients. And what happens to weight trajectories after treatment stops is unknown in this age group, though the adult discontinuation data from SURMOUNT-4 suggest substantial rebound.

Ongoing trials are examining combinations of GLP-1 analogues with other drug classes, and separate research is exploring whether the effect size of semaglutide in adolescents changes in the presence of comorbid insulin resistance or fatty liver disease. None of this has read out yet.

What this means for readers

For parents and adolescents exploring treatment options, the short version is this: two GLP-1 receptor agonists carry regulatory approval for teenage obesity in the US and EU, the efficacy evidence is real, the GI side-effect burden is meaningful, and the long-term picture in this age group is genuinely incomplete. Any prescribing decision belongs with a clinician who can assess the individual patient's age, weight, comorbidities, and development stage. Per-country regulatory status is on the semaglutide regulation pages.

This article is for educational and journalistic purposes only and does not constitute medical advice. GLP-1 receptor agonists are prescription medicines in all jurisdictions we track. Pediatric prescribing decisions should involve a qualified healthcare professional with expertise in adolescent medicine or pediatric endocrinology. Always consult a qualified healthcare professional before using any peptide or pharmaceutical product.