GLP-1 receptor agonists tied to nutritional deficiencies in children, study finds

Children prescribed a GLP-1 receptor agonist for weight loss, prediabetes, or type 2 diabetes developed a new nutritional deficiency within the first year of treatment in 16.8% of cases, according to a study published in Childhood Obesity.¹ Vitamin D deficiency was the most common finding, diagnosed in 12.4% of pediatric patients within a year of starting therapy.¹

"As appropriate pediatric use of GLP-1s becomes more widespread, we need to understand the risks during periods of rapid growth and pubertal development," said senior author Justin Ryder, PhD, vice chair of research for the department of surgery at Ann & Robert H. Lurie Children's Hospital of Chicago and associate professor of surgery and pediatrics at Northwestern University Feinberg School of Medicine.¹ "Nutrients such as vitamin D, iron and calcium are of particular concern during adolescence, when deficiencies may have lasting implications for skeletal health and overall development."¹

Study design and nutritional deficiency findings in pediatric GLP-1 users

Ryder and colleagues drew on national administrative claims data from 2017 to 2022, covering more than 100 million patients, to identify 2031 GLP-1 users aged 10 to 17 years who met continuous enrollment criteria and had no prior diagnosis of a nutritional deficiency.¹ Liraglutide was the most prescribed agent (78.6%), followed by dulaglutide (10.4%) and semaglutide (9.1%).¹ Within this cohort, 16.8% were diagnosed with a nutritional deficiency in the first year of treatment, most often vitamin D deficiency.¹

Gaps in nutritional counseling during pediatric GLP-1 therapy

Despite the deficiency risk, nutritional counseling was infrequent. Only 5% of patients received counseling within 30 days of starting a GLP-1, and fewer than 25% received it within 6 months.¹ "Nutritional support needs to play a critical role once treatment with a GLP-1 medication is initiated," Ryder said.¹ He added that the goal is to act proactively "as opposed to waiting until a nutritional deficiency is diagnosed."¹

GLP-1 receptor agonists in pediatric obesity and diabetes care

Liraglutide and semaglutide are FDA-approved for adolescents 12 years and older with obesity, with trials underway in children ages 6 to 12.² GLP-1 receptor agonists promote satiety, slow gastric emptying, and enhance pancreatic islet hormone regulation, mechanisms that drive clinically meaningful reductions in BMI and body weight in adolescents but that also suppress overall caloric and nutrient intake.³ A 2025 clinical review in Pediatrics similarly flagged nutrition as an ongoing concern during pediatric GLP-1 therapy, alongside screening for disordered eating.⁴

Interpreting the deficiency risk in a growing, developing population

The deficiency rates reported here are notable because they emerged in a population still undergoing bone accrual and pubertal development, when micronutrient reserves are already being drawn on for growth.¹ Weight loss on GLP-1 therapy tends to include both fat and lean mass, and rapid loss can affect muscle strength or bone density if protein intake and resistance activity aren't maintained alongside treatment.³ The findings reinforce that nutritional monitoring deserves the same attention as dosing and gastrointestinal side effects when these drugs are used in minors.

Limitations of the claims-based analysis

The study relied on administrative claims, which capture diagnosis codes rather than lab-confirmed deficiency in every case and cannot fully account for baseline diet, supplementation, or adherence.¹ The cohort was limited to patients with continuous insurance enrollment, which may not reflect all pediatric GLP-1 users, and the analysis could not isolate how much of the deficiency risk stemmed from the underlying obesity or diabetes diagnosis rather than the medication itself.¹ Longer-term data are needed to determine whether these deficiencies persist beyond the first year or affect growth outcomes.

References

1. Ann & Robert H. Lurie Children's Hospital of Chicago. GLP-1s linked to nutritional deficiencies in children. Newswise. September 21, 2026. Accessed September 22, 2026. https://www.newswise.com/articles/glp-1s-linked-to-nutritional-deficiencies-in-children

2. Zhang YJ, Stefater-Richards MA, Jhe G. GLP-1 receptor agonists in pediatric and adolescent obesity. Pediatrics. 2025;155(4). doi:10.1542/peds

3. Beyond weight loss: optimizing GLP-1 receptor agonist use in children. PMC. Accessed September 22, 2026. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12651817/

4. Harp H. Stop, think, inject — considering the whole patient when using GLP-1RAs. JournalFeed. Accessed September 22, 2026. https://journalfeed.org/article-a-day/2025/glp-1-receptor-agonists-for-peds-stop-think-inject/