Weight-loss drugs such as semaglutide have attracted enormous attention among adults, but researchers are increasingly asking whether they can safely help younger people living with obesity.
A new analysis suggests GLP-1 medicines can produce meaningful weight loss in adolescents without diabetes, although important questions remain about long-term use.
The findings were presented at the International Congress on Obesity 2026 in Mexico City. Dr. Manpreet Kaur Oberoi of the University of Western Ontario and colleagues reviewed the available randomized clinical trials involving children with obesity who did not have diabetes.
GLP-1 medicines work by acting like a hormone the body naturally releases after food enters the digestive system. Among other effects, this hormone sends signals related to fullness and helps regulate how quickly food leaves the stomach.
Because people may feel satisfied with less food, GLP-1 drugs can lead to substantial weight loss. Well-known medicines in this family include semaglutide and liraglutide, while exenatide is another member of the same drug group.
Obesity during childhood is not simply a cosmetic concern. Severe excess weight can increase the chance of high blood pressure, liver disease, joint problems, sleep difficulties and metabolic disease, and it may continue into adulthood.
At the same time, children cannot simply be treated as smaller adults. Their bodies and brains are developing, their nutritional needs change as they grow, and doctors must consider physical health, emotional well-being and family circumstances when recommending treatment.
Several GLP-1 drugs are now approved in some places for obesity treatment beginning at age 12. However, the evidence in young people is much smaller than the enormous amount of attention these medicines have received in adults.
To see what the research currently shows, Oberoi’s team searched PubMed/MEDLINE, CENTRAL and Embase through May 2025. They looked specifically for randomized controlled trials involving children with obesity but without diabetes.
The search initially produced 1,095 records, but only nine studies met the final requirements. This highlights how limited the pediatric evidence remains, because many studies involved diabetes or did not meet the researchers’ other criteria.
The nine included studies involved 756 participants aged between 6 and 18. Most were teenagers, with an average age of approximately 14 to 15 years.
The trials differed considerably in size and length. Four small studies included only 12 to 44 participants and lasted five to 24 weeks, while five larger studies involved 55 to 251 participants and continued for 52 to 68 weeks.
Researchers studied three different GLP-1 medicines. Five trials tested liraglutide, three tested exenatide and one tested semaglutide.
When all studies were combined, GLP-1 treatment improved children’s weight status compared with placebo or standard care. The average difference in body weight between groups was a little over five kilograms, or about 11 pounds.
The researchers also examined BMI-SDS, sometimes called a BMI z-score. Unlike simply looking at kilograms, this measure considers how a child’s body size compares with other children of the same age and sex while normal growth is occurring.
Children taking GLP-1 medicines showed greater improvements in this measure. That suggests the treatment effect was not simply the result of changes that would normally happen as children grew older or taller.
Semaglutide stood out with the largest reported average weight difference, at about 17.75 kilograms or 39 pounds. Exenatide was associated with about 3.53 kilograms of weight reduction relative to comparison groups, and liraglutide with about 3.12 kilograms.
However, semaglutide should not automatically be declared the winner based on those numbers. Only one semaglutide trial was included, and comparing results from separate studies is less reliable than directly assigning similar participants to different drugs in the same trial.
The analysis also found modest changes in cardiovascular measures. Systolic blood pressure dropped by an average of 2.24 mmHg, and the three studies reporting heart rate showed an average reduction of 2.83 beats per minute.
Children receiving GLP-1 treatment also reported better health-related quality of life. The researchers said their review was the first they knew of to report combined findings on heart rate and quality of life for children receiving these medicines.
Side effects remain an important part of the picture. Nausea was significantly more common and occurred at roughly three times the rate seen in children receiving placebo.
Vomiting and diarrhea also appeared numerically more common, although the evidence did not show a statistically significant increase. Serious events including pancreatitis, gallstones and appendicitis were rare and occurred at similar rates in treatment and control groups.
These results are reassuring in the short and medium term, but rare side effects can be difficult to detect in a total study population of only 756 people. This is one reason much larger studies are important before firm conclusions about long-term safety can be made.
The inclusion of children as young as six also requires context. GLP-1 medicines are not generally approved for obesity in children under 12 simply because younger participants appeared in research trials.
Clinical trials can test medicines in younger age groups under close medical, ethical and regulatory supervision. The purpose is to establish safety, effectiveness and appropriate dosing before regulators decide whether wider use should be permitted.
The review has several strengths, including its focus on randomized trials and its combined assessment of weight, blood pressure, heart rate, quality of life and adverse events. Yet the small number of eligible studies, differences between trials and limited follow-up prevent the research from answering some of the biggest questions.
Doctors still need to know what happens after several years of treatment and what occurs when young people stop taking the medicine. Questions about weight regain, growth, muscle and bone health, nutrition, emotional health and very rare complications deserve careful study.
The findings therefore provide support for GLP-1 treatment in appropriately selected adolescents rather than a blanket recommendation for children. Medication for pediatric obesity should be considered within comprehensive medical care that also addresses nutrition, activity, sleep, family support and any related health conditions.
Overall, the evidence is promising, especially for adolescents aged 12 and older, but it remains much thinner than the evidence in adults.
GLP-1 drugs may become an increasingly important part of pediatric obesity care, but longer and larger studies are needed to make sure the benefits remain worthwhile as young patients grow into adulthood.
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Source: University of Western Ontario.
