Obesity affects approximately 1 in 5 U.S. adolescents and significantly increases the risk for serious health problems such as type 2 diabetes and heart disease. In recent years, the FDA has approved certain medications for obesity treatment for adolescents ages 12-17, including phentermine/topiramate and semaglutide. In 2023, the American Academy of Pediatrics (AAP) updated its guidelines to include pharmacologic treatment as part of a comprehensive, lifestyle-based approach to obesity management.
Despite limited data, recent analyses have shown a 500% rise in GLP-1RA use among adolescents from 2020 to 2023, although BMI and obesity severity were not assessed. The AAP guideline release was linked to increased obesity drug use in youth aged 8-17 without type 2 diabetes.
Researchers analyzed IQVIA Ambulatory Electronic Medical Records (EMR) data, which were used to identify U.S. adolescents aged 12–17 years with at least one health care visit during 2018-2023 in which their BMI was recorded as ≥95th percentile for age and sex (i.e., obesity). Among adolescents included in each year, this analysis identified those prescribed an FDA-approved obesity medication at least once during the calendar year during which obesity was recorded.Â
The primary outcome was whether an adolescent received at least one obesity medication in the year their obesity was recorded. Ongoing prescriptions were tallied annually, with annual rates calculated from 2018 to 2023 by drug type.
Two patient-level models were employed. The first was a generalized linear model utilizing a log link and binomial distribution. This model evaluated the relationship of receiving at least one obesity medication in the year 2023 and age, sex, severity of obesity, and region as covariates. Using the year 2023 was also a consideration, as it was the first year following the release of the AAP guidelines, the most recent FDA approval of semaglutide (Wegovy) for adolescents, and the most current year with encounter-level prescription data. A secondary analysis used the same model to evaluate the relationship between sex, age, region, and the severity of obesity (classified as class 2 or 3) as a binary outcome.
Between 2018 and 2023, among 526,973 U.S. adolescents aged 12–17 with obesity were identified (789,057 person-years), the overall rate of prescriptions for obesity medications was low. It rose from 0.1% in 2020 to 0.2% in 2022, then increased sharply to 0.5% in 2023. In 2023, the adjusted proportion of adolescents who received obesity medications was 301.7% higher than in 2020 (95% CI = 232.8%–385.0%). That year, 57.1% received semaglutide (Wegovy), 37.7% received phentermine or phentermine-topiramate, 11.9% received liraglutide (Saxenda), and 3.3% received other drugs.
Adjusted analysis showed that, compared to boys, younger teens (12–14 years), and those in the Northeast, obesity medication prescriptions were more likely among girls (aPR = 2.05; 95% CI = 1.69–2.49), teens aged 15–17 (aPR = 2.24; 95% CI = 1.83–2.74), and those living in the West (aPR = 2.65; 95% CI = 1.68–4.19), South (aPR = 2.35; 95% CI = 1.51–3.65), or Midwest (aPR = 1.58; 95% CI = 1.03–2.43). Medication use was higher among adolescents with class 2 obesity (aPR = 4.03; 95% CI = 3.03–5.36) and class 3 obesity (aPR = 12.78; 95% CI = 9.82–16.64).
In 2023, severe obesity affected 50% of Black adolescents compared to 39% of White adolescents. However, in analyzing treatment rates among 12,192 Black and 51,900 White adolescents, Black teens were 39% less likely to receive obesity medications (aPR = 0.61; 95% CI = 0.44-0.84), even though they were 27% more likely to have severe obesity (aPR = 1.27; 95% CI = 1.24–1.29).
From 2018 to 2023, obesity medication use among U.S. adolescents remained low but increased remarkably following the release of the 2023 AAP guidelines and FDA approvals. Teens with severe obesity and those in the West and South were more likely to be treated. At the same time, Black adolescents were less likely to receive medication despite higher obesity severity, highlighting the need for more equitable care.
References: Kompaniyets L, Pierce SL, Porter R, et al. Prescriptions for obesity medications among adolescents aged 12–17 years with obesity- United States, 2018–2023. MMWR Morb Mortal Wkly Rep. 2025;74(20):337–344
