Document Type

Article

Publication Date

12-2025

Publisher

BMJ Publishing Group

Source Publication

Evidence-Based Nursing

Source ISSN

1367-6539

Original Item ID

DOI: 10.1136/ebnurs-2025-104495

Abstract

Context

Childhood obesity continues to increase along with the numbers of children with severe obesity and related comorbidities. This meta-analysis1 sought to determine whether or not glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications are safe and effective for children and adolescents.

Methods

Appropriate search and abstraction approaches were used in the meta-analysis of randomised controlled trials making it the highest level of evidence. Included studies were those with participants younger than 18 years with obesity, overweight, pre-diabetes or type 2 diabetes (T2D) assessing GLP-1 RAs alone or with lifestyle modification versus placebo published between 2023 and 2025. Most participants in the included studies were female and white, but children from China, Hungary, India, Israel, Mexico, Russia, South Africa, South Korea and many locations in the USA were included.

Cochrane approaches for risk of bias assessment and statistical analysis were followed and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting of studies included or excluded. The authors sought to include studies with reporting of depression and suicidal behaviour, obstructive sleep apnoea as well as digestive side effects, since the former had not been well delineated in prior systematic reviews. They also included studies with younger children, since the Federal Drug Administration approval may be sought, but current guidelines only allow GLP-1 medications for children 12 and over with obesity (10 and over with T2D).2

Findings

In 1402 children in studies (11 obesity, six T2D, one pre-diabetes) with a mean age of 13.7 (6-17) years, GLP-1 RAs significantly reduced HbA1C, fasting glucose, body weight, BMI and systolic blood pressure. While there were increased gastrointestinal adverse effects, there were no significant differences in other effects, such as suicidal ideation.1

Commentary

It is important that Kotecha et al1 included studies with children from all over the world, since lack of geographic diversity was a concern with recent Cochrane reviews of GLP-1 medication trials with adults.3 As with studies in adults, research independent of pharmaceutical companies is needed. Further qualitative research is also needed regarding children and adolescents’ perspectives on weight loss approaches to best develop effective support and foster resilience.

As with adults, the cost of GLP-1 medications may exacerbate inequities among those facing the highest prevalence of obesity (in the USA, those living in poverty and minoritised groups).4 Insurance coverage varies for GLP-1 medications. By mid-2026, prices in the USA are to be about US$350 per month compared with over US$1 000 per month, and if an oral medication is approved, it will be US$150 per month, and this will be available for Medicaid.5 Similar inequities with bariatric surgery have been found, so long-term comparisons are needed. Longitudinal and follow-up studies are needed, since dosage usually needs to increase and weight gain may occur if the medication is stopped.

It is especially important that children have a nutritionally sound diet while taking GLP-1 medications. Culturally and developmentally congruent counselling regarding mindful eating, portion sizes, sufficient protein, complex carbohydrates, fibre and water intake is crucial.6 Counselling may be needed as children and families consider weight loss options in terms of body image and preparing to address questions that may arise from family and friends as changes to eating and physical activity are initiated. Eating more frequent, small portions can help children overcome potential nausea and vomiting as GLP-1 medications are started or doses are increased, which may help them continue this efficacious therapy. Regular aerobic exercise is important to sustain lean body mass while losing weight. The use of GLP-1 medications in children has increased 600% between 2020 and 2023, so it is essential to prepare children and their families as well as financial support to be successful.

Comments

Accepted version. Evidence-Based Nursing (2025). Online before print. DOI. © 2025 BMJ Publishing Group. Used with permission.

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