Prescriptions for GLP-1 receptor agonists among children ages 8 to 11 with obesity increased dramatically between 2019 and 2026, according to new research. The study raises questions about how quickly these medications are moving into younger age groups and what is known about their use in children who are still growing.

The study, published in Pediatrics , analyzed electronic health record data from more than 3.5 million children ages 8 to 11 with obesity but without diabetes. Overall, 0.6% received a GLP-1 receptor agonist prescription during the study period. Annual prescribing increased from 0.03% in 2019 to 9.3% in 2026, a 310-fold increase.

“I think it is a meaningful shift," said Sarah C. Armstrong, MD, Professor of Pediatrics, Duke University School of Medicine and Chief, Division of General Pediatrics and Adolescent Health, in Durham, NC. "Pediatric obesity treatment has changed rapidly with the availability of highly effective medications, but most obesity medications, including the GLP-1 medications we currently use, are approved for weight management beginning at age 12,” said Dr Armstrong.

The use of weight management medications such as semaglutide (marketed for weight loss as Wegovy), liraglutide (Saxenda) and tirzepatide (Zepbound) to treat adults with obesity has exploded in recent years, with an estimated 11% of American adults currently using the medications. But very little is known about their use in children, particularly “off-label” use in children under the currently approved age cut off of 12 .

“While we have data for daily liraglutide in children 6-11, this has not yet been approved by the FDA. Thus, increasing use in children ages 8–11 suggests that some clinicians and families are considering pharmacotherapy earlier, particularly for children with severe obesity or significant health complications," said Dr Armstrong, who is also the Co-Director of the Duke University Center for Childhood Obesity Research.

GLP-1 receptor agonists, including medications such as semaglutide and liraglutide have had a significant impact for obesity treatment in adults and older adolescents. The medications mimic hormones involved in appetite regulation and can substantially reduce food intake and body weight. That experience may also be influencing decisions about younger children.

“I think several things are happening at once. We increasingly recognize obesity as a chronic biologic disease rather than simply a problem of individual behavior, and GLP-1 medications have demonstrated that obesity can respond substantially to medical treatment,” said Dr Armstrong.

Another contributing factor might be the growing numbers of American adults who are, or have been on GLP-1 medications, with a new poll showing that 15% of American adults are, or have been on GLP-1 medications at some point.

“Many parents are on these medications and have seen dramatic changes for themselves, and they don’t want their children to have to wait so long for treatment," said Dr Armstrong.

At the same time, clinicians are seeing children with increasingly severe obesity and related health problems, potentially creating situations where families and doctors are considering treatments outside their approved age ranges.

“Clinicians are caring for children with severe obesity and serious obesity-related health problems for whom our existing treatment options are effective, just not effective enough for some," said Dr. Armstrong. “That creates understandable interest in whether these medications could help younger children as well.”

What Do ‘Off-Label’ GLP-1 drugs Mean For Younger Children?

The increasing prescribing is notable because GLP-1 medications are not currently FDA-approved for weight management in children younger than 12.

But younger children can be prescribed these medications. Doctors can prescribe medications off-label when they believe there is a medical rationale for doing so. But in this age group, the decision requires careful consideration because children are still undergoing rapid physical and developmental changes.

“I would consider off-label treatment in a child under 12 to be an exceptional, highly individualized decision rather than routine care,” said Dr Armstrong. “It might be considered in a child with very severe obesity and significant obesity-related disease when established treatment approaches have not been sufficient, but only after a careful discussion with the family about the limited evidence in this age group and with close monitoring by clinicians experienced in pediatric obesity treatment.”

Dr Armstrong says decisions should consider age, obesity severity, comorbidities, safety, patient and family preferences, readiness, and access to comprehensive lifestyle treatment.

“My personal practice is to only use off-label prescribing when there are safety data in that age group,” said Dr Armstrong.

What Do We Know About the Safety And Effectiveness of GLP-1 Drugs in Children?

It is important to note that GLP-1 medications aren’t entirely untested in younger children, with some evidence already available for some drugs, and other studies underway.

“We have strong data that daily liraglutide is safe and effective for children aged 6-11 with obesity,” said Dr Armstrong. “We also have data for children with type 2 diabetes and GLP 1 use. However, we do not have published data for use of semaglutide (weekly injection) under age 12,” said Dr Armstrong.

However, Dr Armstrong notes that the results from a large study of children aged 6-11 with obesity treated with semaglutide are expected to be presented at a conference in November and the findings show “good efficacy and safety.”

Why Growth And Nutrition Matter When Considering GLP-1 Drugs in Children

Treating obesity in a child is also different from treating obesity in an adult.

“The major concerns are making sure that weight loss does not interfere with normal childhood growth and development,” said Dr Armstrong. “A medication that substantially suppresses appetite could potentially lead to inadequate protein or micronutrient intake, loss of lean mass, excessive weight loss or restrictive eating patterns.”

GLP-1 medications can also cause gastrointestinal side effects, including nausea, vomiting, diarrhea and constipation. But the concern extends beyond side effects.

“Children are growing physically and developmentally, so the goal cannot be to produce the largest or fastest possible weight loss. The goal is to improve health while supporting normal growth, adequate nutrition and a healthy relationship with food and the body," said Dr Armstrong.

There are also unanswered questions about how suppressing appetite during childhood could affect a child’s longer-term relationship with food, with some concerns that it could increase the risk of the child developing an unhealthy relationship with food, including serious eating disorders.

“The other thing I’d be watching for is the child’s developing taste and relationship with food," said Dr Armstrong. “Hunger is normal for children, and when we suppress it for a long time – what happens? We are not sure about these things, and that is why we really encourage parents to talk with their pediatrician if they are interested in starting something like this, and not using an online prescriber who does not specialize in child growth or know the family.”

Access to GLP-1 Drugs May Be Another Challenge

The study also identified differences in prescribing according to social vulnerability. Children from less socially vulnerable areas were more likely to receive GLP-1 prescriptions than children from more socially vulnerable areas. That finding raises questions about whether access to these increasingly popular medications is being shaped by factors beyond clinical need.

“Yes, access is a major concern. Insurance coverage for obesity medications varies widely, prior authorization requirements can be substantial, and out-of-pocket costs can make treatment inaccessible for many families," said Dr Armstrong, urging more research to confirm the finding and figure out why children from more affluent families are more likely to have access to these drugs.

The reasons could include differences in insurance coverage, access to pediatric obesity specialists, transportation, time available for frequent medical appointments and families’ ability to navigate prior authorization requirements.

“We should be careful not to create a system in which highly effective obesity treatment is available primarily to families with the greatest resources,” said Dr Armstrong.

The Future of GLP-1 Drugs in Younger Children

Ultimately, the increase in prescribing does not answer the question of whether GLP-1 medications should routinely be used in younger children. Instead, it highlights how quickly clinical practice is evolving ahead of the evidence.

“I think it is important not to interpret increased prescribing as evidence that these medications should routinely be used in younger children. It tells us that clinicians and families are already confronting this question in real-world practice, which makes obtaining rigorous safety and efficacy data in younger children even more urgent," said Dr Armstrong.

For parents, that distinction may be particularly important. A prescription trend is not the same thing as an established standard of care and younger children have different nutritional, developmental and medical needs than older children and adults.

“I would also emphasize that obesity medication should never simply be about making a child’s weight lower. In children, successful treatment means improving health while protecting growth, nutrition, physical function and emotional well-being," said Dr Armstrong.