Effective obesity treatments reach few eligible teens

Despite the arrival of powerful new anti-obesity medications and growing evidence supporting weight-loss surgery for adolescents, the vast majority of eligible teens are receiving neither treatment, according to a Northwestern Medicine study.

“The motivation behind our paper in JAMA Pediatrics was to look at the relationship between two exciting developments in the treatment of obesity and adolescence,” said first author, Dr John B Rode, a fourth-year resident physician at Ann & Robert H Lurie Children’s Hospital of Chicago. “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.”

In the current study, investigators analysed electronic health records from more than 1.4 million US adolescents who met guideline-based eligibility criteria for metabolic and bariatric surgery between 2017 and 2025. They found that use of GLP-1s, including semaglutide and liraglutide, increased dramatically during the study period, while rates of bariatric surgery began to decline following the approval of semaglutide for adolescent obesity in late 2022.

The investigators found that bariatric surgery use among eligible adolescents increased steadily from 2017 through 2022, reaching a peak of 189 procedures per 100,000 eligible teens.

“Our study found that while bariatric surgery use increased between 2017 and 2022, it subsequently decreased about 29 percent through the end of 2025,” Rode said. “This decline coincided with the FDA approval of semaglutide for adolescents aged 12 or older with obesity.”

At the same time, prescriptions for GLP-1 medications increased sharply. Overall prescribing rates rose from 301 prescriptions per 100,000 eligible adolescents in early 2017 to 10,676 per 100,000 by the end of 2025, a 35-fold increase. Rates were highest among adolescents with the most severe obesity.

However, among the 1.4 million adolescents who qualified for bariatric surgery, less than one percent underwent surgery during the study period, while 4.6 percent received at least one GLP-1 prescription. By the fourth quarter of 2025, more than 1.29 million eligible adolescents, representing 90.4 percent of the study population, had received neither treatment.

“We found that nine out of ten adolescents who qualified for bariatric surgery received neither treatment throughout the whole study period between 2017 and 2025,” Rode said. “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.”

Rode and his collaborators also identified disparities in access to GLP-1 medications. By late 2025, privately insured adolescents were prescribed GLP-1 drugs at rates 2.4 times higher than uninsured or self-pay patients and modestly higher than publicly insured patients. Bariatric surgery rates, however, were similar across insurance groups.

The findings raise concerns that newer obesity medications could be widening existing inequities in care, he explained.

“As rates of childhood obesity continue to rise, further research is needed to understand how GLP-1s might change the landscape of obesity care, including the potential complementary role with metabolic and bariatric surgery,” added Rode. “Most importantly, further research is necessary to understand the reasons behind this lack of access to evidence-based treatments, to make sure that patients receive the care that they need.”

The study was supported by the National Cancer Institute under award T32CA247801.

The findings were featured in the paper, ‘Metabolic and Bariatric Surgery and GLP-1 Receptor Agonist Use Among Adolescents', published in JAMA Pediatrics. To access this paper, please click here (log-in maybe required)