When Dr. Aaron Kelly began studying the effects of GLP-1 weight loss drugs in children with obesity, he thought it would be difficult to recruit patients. The medication he was using required twice-daily injections. But dozens of families signed up.
Since that trial over a decade ago, interest has only surged. Trying to keep up with new research on GLP-1s in kids is like “drinking from a fire hose,” Dr. Kelly, co-director of the University of Minnesota’s Center for Pediatric Obesity Medicine, told me. Several of these drugs are now approved by the Food and Drug Administration for children ages 10 and older with obesity or Type 2 diabetes, and the results so far appear encouraging. Young people seem to experience benefits similar to those seen in adults: improved blood pressure, sugar control and cholesterol levels. The trade-off, as in adults, seems to be mainly short-term side effects, such as nausea and vomiting.
Dr. Kelly is now part of a team running a study on GLP-1s in children as young as 6. If all of that makes you uneasy, you’re not alone. When the American Academy of Pediatrics released guidelines in 2023 suggesting doctors treat childhood obesity more aggressively, including with GLP-1s, they were met with public outcry and debate over whether it was ethical to medicate kids with obesity. Even physicians and researchers who treat children and adolescents with GLP-1s, including Dr. Kelly, mention gaps in the pediatric GLP-1 data as well as questions about whether the drugs interfere with development and how they might affect long-term health.
These are all issues that need to be resolved as GLP-1s become a standard part of the arsenal for combating childhood obesity. But the more I’ve reported on using these drugs in kids, the more I worry that the debates around GLP-1s in children overlook the bigger challenge. The question is not whether we should give these medicines to kids. Though there’s plenty of disagreement, medical groups and parents have already determined that for some children with chronic illness, the benefits outweigh the risks.
The real question is: Why are we even here? Using GLP-1 injections for preventable diet-related diseases in children is a sign of a collective failure to shield the most vulnerable members of our society from the environmental catastrophe that brought us to this point.
Right now, much of the concern around using GLP-1s for children focuses, understandably, on the potential long-term implications. Patients are supposed to take the drugs continually, since the benefits for blood sugar and weight loss wane when treatment stops. But all the available studies follow children and adolescents only up to a year or 18 months. We still don’t know what a lifetime on GLP-1s looks like.
The available studies also focus on the drugs’ effects on blood sugar control and weight loss. How do the medications affect a child’s growth and development? How do they shape growing bones, brains and muscles? What’s their impact on puberty and mental health? What of body image and nutrient intake? We don’t know yet.
Still, the same wary physicians told me that the health effects of diseases like obesity and diabetes are so severe when they start early in life that medical intervention is not just warranted; it’s the ethical approach. Type 2 diabetes, for example, progresses more rapidly and aggressively in young people than it does in adults. The pancreas gives out sooner in childhood, requiring insulin and other medications earlier, and later bringing on potential complications like heart attack, stroke, kidney failure and fatty liver disease. Type 2 diabetes rarely develops in childhood and adolescence without obesity, which itself hampers growth, puberty and development, and is linked to a heightened risk of dozens of diseases and conditions.
All that helps explain why, despite questions and unknowns, pediatric GLP-1 prescribing in the United States shot up nearly 600 percent between 2020 and 2023. The absolute number of kids using these drugs remains small — less than one percent of adolescents with obesity, according to a Centers for Disease Control and Prevention report. But as costs decline and pill versions of GLP-1s become more available, use for everyone is expected to grow.
It makes sense that people would embrace drugs that can help children manage health problems that can follow them the rest of their lives. One patient I spoke to who took one of the drugs at 14 for obesity said she experienced symptoms like vomiting at first, but was happy on the drug as it delivered weight loss.
But while GLP-1s and similar drugs may be powerful tools for individuals, they won’t stop the emergence of diet-related diseases in the population. Treatment is never prevention. It’s important we not lose sight of that.
There’s now unequivocal evidence that humans, across age groups and countries, did not gain weight over the last three decades of the obesity crisis because they became slothful or lazy. They gained weight in large part because of changes to the food environment. Specifically, foods engineered to be overeaten became cheap and ubiquitous. Large portion sizes and fast and ultraprocessed foods became more dominant. For too many families, the most available and accessible meals are obesity- and disease-promoting, devoid of the nutrition kids need to become healthy adults.
Childhood obesity in America is at a record high, according to the C.D.C.’s last count. Between 2021 and 2023, 21 percent of American kids ages 2 to 19 had obesity, compared with 5 percent in the early 1970s. While a small minority of cases are caused by rare genetic conditions or medical disorders, the population increases are driven by how we eat now. Many of the children who need these drugs today, for obesity and Type 2 diabetes, are the victims of a food environment that made it nearly impossible for their parents to feed them in ways that nourished their growing bodies. Only through improving food environments can we prevent more harm.
There are glimmers of hope in the United States that some potential prevention solutions are breaking through. Individuals as diverse as the former Food and Drug Administration commissioner Dr. David Kessler and the health secretary Robert F. Kennedy Jr. argue America needs to fix its food environment to stop diet-related disease from occurring in childhood. Bills have been introduced or passed in states as varied as California and Louisiana to limit ultraprocessed foods and ban certain additives in school lunches.
But these changes are still happening in a patchwork, and not quickly or aggressively enough to improve the trajectory of children’s health. The health secretary’s nutrition rhetoric runs counter to some of the administration’s most significant food policies. More than four million Americans have been pushed off food stamps since January 2025, while the administration ended about $1 billion in programs that helped schools and food banks buy fresh and local food. It’s becoming harder for the most vulnerable in American society to eat the “real food” that new national dietary guidelines promote.
As a child of the 1980s, I was among the first cohort to grow up awash in ultraprocessed foods, the risk of developing obesity and diabetes increasing every year. I was fat, and my childhood suffered as a result. Children today are the first to grow up with access to GLP-1s, a new experiment to help solve the problems created by abundant ultraprocessed foods. While these drugs may eventually help reverse troubling trends, let’s not lose sight of the ultimate goal: preventing children from carrying the burden of avoidable chronic illness in the first place.
