Clinical Realities of Adolescent Care
- Definition of Terms: GLP-1 receptor agonists, such as semaglutide and liraglutide, are injectable medications that mimic gut hormones to regulate blood sugar and suppress appetite. Metabolic and bariatric surgery involves surgical alterations to the digestive system to achieve significant weight reduction.
- Utilization Shifts: Bariatric procedures among eligible teens climbed to 189 per 100,000 by 2022, but subsequently dropped by roughly 29 percent through the end of 2025 following federal drug approvals. Meanwhile, GLP-1 prescriptions surged 35-fold over the study period.
- Coverage Inequities: Privately insured adolescents accessed GLP-1 medications at rates 2.4 times higher than uninsured patients, exposing stark financial barriers across different demographic groups.
Shifting Interventions in Pediatric Healthcare
The study evaluated electronic health records from more than 1.4 million U.S. adolescents who met criteria for metabolic and bariatric surgery.
Investigators at Ann & Robert H. Lurie Children’s Hospital of Chicago examined how clinical practice changed after regulators cleared once-weekly injections for adolescent patients aged 12 and older.
“The motivation behind our paper was to look at the relationship between two exciting developments in the treatment of obesity in adolescence,” said first author John B. Rode, a fourth-year resident physician at Lurie Children’s, as reported by News-Medical. “The first is long-term evidence for the safety and efficacy of bariatric surgery in adolescents, and the other is FDA approval of GLP-1s in this age group.”
Following the introduction of semaglutide for younger cohorts, surgical rates fell 29 percent through the end of 2025. Prescriptions for GLP-1 receptor agonists climbed from 301 per 100,000 adolescents in 2017 to 10,676 per 100,000 by late 2025.
| Treatment Modality | Peak or Final Rate (per 100,000) | Overall Population Uptake (%) |
|---|---|---|
| Metabolic and Bariatric Surgery | 189 (Peak in 2022) | Less than 1% |
| GLP-1 Receptor Agonists | 10,676 (End of 2025) | 4.6% |
| Received Neither Treatment | N/A | 90.4% |
Privately Insured Youths Receive GLP-1 Therapy More Frequently than Others
Despite rising prescription volumes, access remained unevenly distributed across socioeconomic lines. Privately insured youths received GLP-1 therapy at rates 2.4 times higher than uninsured or self-pay patients, and moderately higher than those on public insurance plans.
Bariatric surgery rates, conversely, remained relatively consistent across different insurance categories. Senior author Justin Ryder, collaborated on the research supported by the National Cancer Institute under award T32CA247801.
“Our findings suggest that even though we’ve developed safe and effective treatments for obesity in adolescents, the data indicate that those who qualify likely don’t have access to these treatments,” Dr. Rode stated, as highlighted by Feinberg School of Medicine news coverage.
Contraindications and When to Consult a Doctor
Patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 must avoid GLP-1 receptor agonists. Bariatric surgery is strictly contraindicated in patients with untreated substance abuse disorders, severe unmanaged psychiatric illnesses, or uncorrected coagulopathies. Clinicians urge families to seek immediate medical evaluation if adolescents experience acute abdominal pain, persistent vomiting, signs of gallbladder disease, or rapid psychological distress.
Future Directions in Pediatric Treatment
Researchers emphasized that nine out of ten qualifying adolescents received neither surgical nor pharmacological intervention across the eight-year span.
As childhood obesity rates rise, researchers must determine how GLP-1s might change obesity care, including how they might work alongside metabolic and bariatric surgery, Dr. Rode said. “Most importantly, further research is necessary to understand the reasons behind this lack of access to evidence-based treatments.”
References
- Rode, J. B., et al. (2026). Metabolic and bariatric surgery and GLP-1 receptor agonist use among adolescents. JAMA Pediatrics. DOI: 10.1001/jamapediatrics.2026.4584. JAMA Network
