GLP-1 RA prescribing for adolescents with obesity remains low, with persistent disparities

Prescribing of glucagon-like peptide-1 receptor agonists (GLP-1RAs) among adolescents with obesity has increased since late 2022 but remains uncommon overall, according to a national retrospective cohort study published online January 20, 2026, in JAMA Pediatrics.

Using electronic health record data from more than 2 million adolescents aged 12 to 17 years with obesity, investigators found that fewer than 1% received a GLP-1RA prescription during the study period.

The study examined prescribing patterns at the point of care, rather than medication dispensing, to better capture clinical decision-making. As Yuan Lu, ScD, assistant professor of medicine at Yale School of Medicine and senior author, explained, “We want to look at the decision point that the clinicians and family actually face in the clinic. Did a prescription get written?”

Among 2,090,467 adolescents with obesity identified between January 2021 and July 2025, 19,097 (0.9%) received at least 1 GLP-1RA prescription. The mean age of those prescribed therapy was 15.0 years, and nearly 90% had severe obesity. Following the December 2022 approval of semaglutide for adolescent obesity, prevalent prescribing increased from 0.12% to 1.38%, while incident prescribing rose from 0.15% to 0.77%.

Disparities by insurance status and sociodemographic factors

Despite increased uptake, prescribing differed substantially across demographic and socioeconomic groups. After multivariable adjustment, adolescents insured by Medicaid had significantly lower odds of receiving a GLP-1RA compared with those with commercial insurance (adjusted odds ratio [aOR], 0.57). Lower odds of prescribing were also observed among Hispanic/Latino and non-Hispanic Black adolescents, those living in socioeconomically disadvantaged neighborhoods, and those residing in nonurban areas.

“These disparities may reflect differences in patient or parent preferences, affordability, and insurance coverage,” the authors wrote, noting that access appeared most limited among groups already disproportionately affected by obesity and related complications.

Lu emphasized that insurance-related barriers likely play a central role. “The Medicaid gap stood out because it's a clear signal for the structural barriers,” she said. “These barriers often happen at the same time, especially for families who already face multiple constraints.”

Prescribing reflects more than medication eligibility

Unlike prior studies focused on eligibility or pharmacy dispensing, this analysis evaluated whether a prescription was written, capturing upstream factors that shape access. “Prescribing reflects different things,” Lu said. “It reflects the clinical conversation, the assessment of severity, shared decision making, clinician comfort, and also barriers like coverage requirements.”

Although semaglutide uptake increased rapidly after approval, overall prescribing remained low relative to the size of the eligible population. “Clinicians should not interpret this as no need,” Lu noted. “Our cohort includes over 2 million adolescents with obesity, and the evidence for meaningful weight loss is very strong.” She added that low prescribing likely reflects “a mix of real-world constraints, such as access, coverage hurdles, limited specialist capacity, concerns about long term treatment, and variability in clinicians and families’ readiness.”

Practical considerations for clinical practice

Lu outlined several practice-level strategies to address these gaps. “We can normalize the conversation early for adolescents with obesity, especially those with severe obesity,” she said. “GLP-1 RA should be part of an early evidence-based discussion. It's not a last resort.”

She also emphasized the importance of preparing families for potential access challenges. “Families should know that the insurance approval and prior authorization may be part of the process, and it can take time,” Lu said, adding that proactive documentation of disease severity and prior lifestyle interventions may help facilitate approval.

Standardized workflows may further reduce barriers. “The practice would benefit from a standardized pathway,” she said, including clear roles for prior authorization, follow-up scheduling, and monitoring of adverse effects and adherence.

Implications for equity and access

The findings highlight the need for an equity-focused approach to obesity treatment. “If a family has Medicaid, limited English proficiency, or lives in a rural area, clinicians may need to anticipate extra barriers,” Lu said, noting that early involvement of social workers or additional resources may be helpful.

Overall, the study suggests that while GLP-1 RA prescribing for adolescent obesity is increasing, substantial unmet access remains. Addressing insurance coverage policies, administrative burdens, and practice-level workflows may be necessary to ensure equitable access to evidence-based obesity treatments for adolescents.

Disclosure

Lu reports no relevant disclosures.

Reference

Kim C, Sharifi M, Ross JS, et al. GLP-1 Receptor Agonist Prescriptions for Adolescents With Obesity and Associated Disparities. JAMA Pediatrics. Published online January 20, 2026. doi:https://doi.org/10.1001/jamapediatrics.2025.5708