Key takeaways:
- Lifestyle changes remain first-line for pediatric obesity, but caregivers facing food insecurity report significant barriers and limited effectiveness.
- Caregivers’ past experiences with diet-based interventions strongly influence openness to GLP-1 receptor agonist use.
- Trust in medication—including safety concerns and media influence—plays a major role in decision-making for children.
- Beliefs about prioritizing physical health versus socioemotional wellbeing shape preferences for lifestyle-only care or medication.
- Shared decision-making that incorporates family values and structural challenges is critical for equitable pediatric obesity treatment.
Exploring barriers to lifestyle change, building understanding around treatment options, and aligning care with family values are the 3 key points for shared decision-making about using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in children of caregivers with food insecurity, according to a recent study published in JAMA Network Open.1
Lifestyle modifications have remained the first-line method for managing obesity, but limited efficacy has been reported, especially among low-income populations.2 GLP-1 RAs have been highlighted as a potential option for addressing barriers and improving health equity among children with obesity.1
“As new pediatric clinical practices surrounding the use of GLP-1 RAs take shape, it is essential to incorporate the voices of families affected by food insecurity,” wrote investigators.
Assessing the decision-making process
The qualitative study was conducted to analyze the caregiver decision-making process about GLP-1 RA use among caregivers of obese children with food insecurity. Electronic medical records of pediatric gastroenterology visits between January 1, 2022, and October 31, 2023, were assessed for eligible patients.
Participants included caregivers of a pediatric patient with obesity attending at least 2 months of routine physician-recommended dietary changes. These patients also had moderate to high household food insecurity risk and were aged at least 18 years so they could give consent. Family reports were assessed for participant race and ethnicity data.
The semi-structured interviews lasted for 45 minutes and were conducted by a pediatric gastroenterologist with qualitative research training and a research analyst. These discussions occurred over telephone or video from December 1, 2023, to April 30, 2024, and were structured around the Capability, Opportunity, Motivation–Behavior framework.
Data collection and participant demographics
Interviews were also structured around the Theoretical Domains Framework. These frameworks included multiple questions about treatment knowledge, healthy food access, and motivation for sustaining lifestyle change. The Brief Health Literacy Screen and a demographic survey were also administered to participants.
There were 20 caregivers aged a mean 40.5 years included in the final analysis, with 95% of interviews being conducted with a mother and 5% being a mother and father together. Being born outside of the United States was reported in 90% of caregivers, using a language besides English for medical care in 75%, and being at the lowest health literacy level in 70%.
Of children, 65% were Asian, 25% White, and 10% other or unknown race. These patients were aged a mean 12.9 years, and 80% had Medicaid insurance. Engagement in healthy lifestyle choices was reported for a median 1.7 years, during which 1 child lost more than 5% of baseline body mass index .
Key themes influencing caregiver decision-making
Three main themes regarding caretaking decisions were identified:
- Prior experience with lifestyle changes in food insecurity
- Trust in medicine
- Beliefs surrounding optimal care of children
The first theme highlighted increased motivations to persist with a lifestyle-only intervention among caregivers observing meaningful benefits from lifestyle changes. When fresh food diets led to improvements, families expressed pride in these approaches. In comparison, GLP-1 RA was a promising option for caregivers who saw little or no change to child weight.
Significant barriers were also noted. These included high costs and time investment alongside stressful meal planning. Outbursts and strong emotional appeals were often used by caregivers to motivate their children, impacting the entire household.
Medication decisions were also influence by caregivers’ trust in medication use for children. These included significant rates of safety concerns, driven by the drugs’ novelty and media attention.
Additionally, personal or secondhand experiences with weight-related medications influenced trust. This included 1 caregiver reporting increased reluctance to try a weight loss medication before of a prior negative experience with similar medications.
The impacts of beliefs and overall takeaways
Finally, beliefs about optimal care influenced decision making, with caregivers often either prioritizing their child’s physical health or socioemotional wellbeing. An exclusive lifestyle approach was often favored by those prioritizing physical health outcomes, while medication was often seen as a way to reduce financial and emotional strain.
These responses highlighted insights into decision-making about GLP-1a RA use for caregivers of children with food insecurity. Overall, an interplay of past experiences with lifestyle change, trust in medication, and beliefs about childcare was observed.
“A shared decision-making model and clinical education tools that honor these complexities are essential for delivering care that is both effective and equitable and should be the focus of future research,” wrote investigators.
References
- 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
- Dietz WH. We need a new approach to prevent obesity in low-income minority populations.Pediatrics. 2019;143(6):e20190839. doi:10.1542/peds.2019-0839
