GLP-1s reach kids under 12, mostly those at highest risk

Clinical takeaway: GLP-1s are moving into primary care for children as young as 8, concentrated in those with the greatest metabolic burden. No agent is FDA-approved below age 12, so use in this group remains off-label. 

One in five US children has obesity, and the treatment conversation around it has changed faster than at any point in a generation. Weight-loss medications that produced double-digit results in adults moved quickly into adolescent care after regulators approved them. Then the 2023 American Academy of Pediatrics guideline went further, greenlighting clinicians to consider pharmacotherapy for children as young as eight. 

What has happened in children younger than 12 since then had been largely undocumented. Adolescent prescribing has been tracked and shows rapid growth alongside uneven access. But no national data have described whether, and for whom, clinicians are writing GLP-1 prescriptions for younger children, a group with no FDA-approved agent and trials still underway. A national analysis of electronic health records now offers the first look at that prescribing, and the pattern it finds says as much about how clinicians are exercising this new latitude as about how often. 

Across more than 3.5 million US children ages 8 to 11 with obesity and without diabetes, 0.6% were prescribed a GLP-1 receptor agonist through mid-2026. The children who were prescribed one look strikingly different from those who weren't: 93.7% had severe obesity, against 51.5% of unprescribed children, and 65.2% had at least one obesity-related comorbidity, against 19.6%. Prediabetic children were prescribed at the highest rate of any group in the study, nearly 4%, followed by children with hypertension and those with metabolic dysfunction-associated steatotic liver disease. Semaglutide was the most common starting agent. 

Rare as it remains, prescribing is accelerating: prevalence in this age group rose 310-fold between 2019 and 2026. Growth has not been evenly spread. Girls were prescribed at close to twice the rate of boys, 11-year-olds at nearly twice the rate of 8-year-olds, and children in the least socially vulnerable neighborhoods at about one and a half times the rate of those in the most vulnerable, an early echo of the access gap already documented in adolescents. 

The researchers drew on a national electronic health record dataset covering more than 300 million patients, identifying children ages 8 to 11 who met BMI criteria for obesity between January 2019 and June 2026. The analysis was a retrospective cross-sectional design built on repeated annual cohorts. Prescriptions were captured as medication orders, which do not confirm the drugs were dispensed or taken. 

Trials of GLP-1 receptor agonists in children as young as six are already underway, and their results will bear directly on whether FDA extends approvals below age 12. The authors call for sustained monitoring as use expands in this population. How coverage policies respond to these trends may decide whether the access gradient already visible in these first years continues unabated. 

"Physicians and health policy-makers 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," said co-senior author Allan B. Massie, PhD, an associate professor in the Departments of Surgery and Population Health at NYU Grossman School of Medicine. 

Source: Orandi BJ, et al. (2026 Sep 4) Pediatrics. Trends in GLP-1 Receptor Agonist Prescriptions for Children Ages 8-11 with Obesity, 2019-2026