Kathryn M. Stephenson, MD, MA, discusses GLP-1 RA decisions for pediatric obesity

In a recent Contemporary Pediatrics interview, Kathryn M. Stephenson, MD, MA, discussed emerging insights into how caregivers with food insecurity perceive the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for pediatric obesity and how clinicians can better support shared decision-making in this population.

Stephenson explained that the study aimed to understand how families evaluate whether GLP-1 RAs are an appropriate option for their children. Three major themes emerged. First, caregivers weighed prior experiences with lifestyle changes.

Families who had positive experiences—such as successful weight loss, improved confidence, or broader household behavior changes—were often less inclined to consider medication. In contrast, those who had struggled with lifestyle interventions or experienced limited success were more open to GLP-1 RAs as an additional tool.

The second theme centered on trust in medication. Some caregivers viewed GLP-1 RAs as faster, more reliable, and more effective than lifestyle changes alone. Others expressed hesitation, citing concerns about long-term safety, duration of treatment, and the relative novelty of these medications in pediatric obesity care.

The third theme reflected deeply held values and beliefs about what constitutes optimal health for children. Caregivers differed widely in whether they prioritized body mass index reduction, emotional well-being, stress levels, confidence, or a sense of normalcy, underscoring that “what’s best” is not universally defined.

To support decision-making, Stephenson emphasized the importance of aligning clinical conversations with established decisional conflict frameworks. These emphasize 3 pillars: understanding family context and prior experiences, clarifying values and perceived benefits and risks of each option, and supporting the decision-making process itself. She highlighted the clinician’s role as a guide or “librarian,” presenting balanced information and helping families identify the most personalized fit rather than applying a one-size-fits-all approach to obesity treatment.

Access remains the most significant barrier to GLP-1 RA use, as many insurance plans do not cover these medications, leaving families with prohibitive out-of-pocket costs. Additional barriers include clinician discomfort and uncertainty about when and how to introduce medications alongside lifestyle interventions. Stephenson noted that increased openness to family perspectives may help reduce these barriers over time.

Finally, she stressed the need for further research on long-term risks and outcomes of GLP-1 RAs and for the development of decision-support tools. A key takeaway from caregiver interviews was frustration with repeated assumptions of low motivation. Families described being highly motivated and valued having their experiences acknowledged. Stephenson concluded that listening, validation, and openness to alternative tools can be as impactful as the treatment options themselves.

No relevant disclosures.

Reference

Stephenson KM, Schwartz NRM, Person H, et al. Perceptions of GLP-1 RA use for children with obesity among caregivers with food insecurity: a qualitative study. JAMA Netw Open. 2026;9(1):e2552825. doi:10.1001/jamanetworkopen.2025.52825