Abstract
BACKGROUND AND OBJECTIVES
Clinical practice guidelines for pediatric obesity management allow for consideration of glucagon-like peptide-1 receptor agonists (GLP-1RA) in children ages 8–11. No study has documented secular trends in GLP-1RA prescribing in this group. We hypothesized that there would be a significant increase over time, particularly for children with more severe obesity, greater comorbidity burden, and less socioeconomic vulnerability.
METHODS
This retrospective cross-sectional study of repeated annual cohorts from Epic Cosmos examined GLP-1RA prescriptions (Saxenda, Wegovy, Zepbound) for children (aged 8–11) without diabetes and with obesity from January 1, 2019 to June 17, 2026. A binomial logistic regression model for grouped data was performed to determine whether changes in the proportion of patients prescribed GLP-1RA over time were statistically significant.
RESULTS
Among 3 520 531 children with obesity but without diabetes, 0.6% received a GLP-1RA prescription. Older children (11 years: 79.5/10 000 vs 8 years: 41.5/10 000), female children (75.9/10 000 vs 42.8/10 000), and children with less social vulnerability (low: 76.1/10 000 vs high: 49.2/10 000) were more likely to be prescribed GLP-1RAs. Children with obesity-related comorbidities were substantially more likely to be prescribed GLP-1RAs (188.9/10 000). Prevalent prescribing increased from 0.03% in 2019 to 9.3% in 2026, a 310-fold increase (P
CONCLUSIONS
In this cohort of >3.5 million children aged 8 to 11 with obesity and without diabetes, GLP-1RA prescribing increased sharply from 2019 to 2026 yet remained uncommon, reaching 0.6% of children. Clinicians appear to be reserving GLP-1RAs for those at greatest cardiometabolic risk. Prescriptions are more likely to go to those with less socioeconomic vulnerability.