GLP-1 use rising rapidly among US adolescents and young adults

Adolescents and young adults in the US are increasingly using popular GLP-1 weight-loss drugs alone or in conjunction with metabolic and bariatric surgery (MBS) to manage obesity, according to a study by UT Southwestern Medical Center (UTSW) researchers.

Severe obesity among adolescents and young adults has increased substantially over the past two decades, currently affecting about 9% of people ages 12 to 18. Among adults, the rate of severe obesity increased from 5% to 10%.

To assess how the availability of GLP-1RAs has shifted clinical approaches to obesity management within that population, researchers analysed records from more than 204,000 13- to 25-year-olds treated for obesity between May 2022 and January 2026 in Epic Cosmos, a US-based electronic health record database.

"This research is the first national-scale Epic Cosmos analysis, to our knowledge, to characterise real-world use of combined GLP-1RA therapy and MBS among adolescents and young adults with obesity," said lead author, Dr Sarah Messiah, professor of epidemiology and associate dean for research in the Peter O'Donnell Jr School of Public Health at UT Southwestern.

In 2025, Messiah's team published another study using a different database that found weight-loss surgery rates had increased 15% among adolescents and young adults in the US between 2021 and 2023. However, subsequent approval of certain GLP-1RAs for adolescents in December 2022 coincided with changing treatment patterns.

The UTSW research revealed that exclusive GLP-1RA use among those treated for obesity in this age group rose from 88.2% between May and November in 2022 to 96.1% between June 2025 and January 2026. At the same time, MBS rates decreased from 11.6% to 3.7%. The study also found that combining surgery and GLP-1RAs in adolescents and young adults held steady at 0.2% during both periods.

"Our team's study captures an inflection point in paediatric obesity treatment," said Messiah, who is also a professor of paediatrics and director of the UTSW Child and Adolescent Population Health Program. "While only a small proportion of adolescents and young adults currently receive both therapies, combination treatment was virtually non-existent before GLP-1 medications became widely available. We're now seeing clinicians integrate these therapies in different ways as obesity care continues to evolve."

These findings point to the need to establish evidence-based clinical protocols in this rapidly evolving area of medicine.

"The study advances the field by showing that obesity treatment sequencing strategies are already emerging in routine clinical care, even though evidence-based guidance for how to combine or sequence these therapies in youth remains limited," Messiah said. "These findings highlight the urgent need for evidence-based guidance for when GLP-1RAs should be used relative to bariatric surgery in adolescents and young adults, including whether medications are most effective before surgery, after surgery, or as part of combination therapy."

The findings were reported in the paper, ‘GLP-1 Receptor Agonist and Bariatric Surgery Utilization Among Adolescents and Young Adults’, published in JAMA Pediatrics. To access this paper, please click here