Use of Weight-Loss Drugs Increased Among US Adolescents After AAP Guideline Release

In the years following the release of the American Academy of Pediatrics (AAP) clinical practice guideline recommending early intervention for childhood obesity, including pharmacotherapy for adolescents, new research shows a significant increase in antiobesity drug prescribing but from a low baseline.1

In January 2023, the AAP issued a policy statement recommending that physicians offer weight-loss medication to adolescents aged 12 years or older and evaluate teenagers for bariatric and metabolic surgery.2

In a large retrospective cohort study of 310 503 children and adolescents aged 8–17 years with obesity and no type 2 diabetes (T2D), researchers evaluated real-world treatment initiation using electronic health record data from a US health system collective. The analysis compared rates of new nutrition counseling and pharmacotherapy prescribing before and after the AAP guideline.1

Across the full study population, incident pharmacotherapy prescribing rose significantly after the guideline publication (odds ratio [OR], 1.65; 95% CI, 1.23–2.21), with a continued monthly upward trend (OR, 1.05; 95% CI, 1.03–1.07). Still, only 0.4% of participants with no prior antiobesity drug exposure received a prescription during the visit or within 14 days.1

Nutrition referral or counseling, recommended as the first-line intervention by the AAP, remained more common but changed minimally in the same timeframe. Among those with no prior nutrition treatment, 9.7% received a referral or counseling; however, there was no significant immediate change following guideline release (OR, 1.05; 95% CI, 0.98–1.12) and only a modest increase in monthly trend (OR, 1.01; 95% CI, 1.00–1.01).1

Metformin was the most prescribed pharmacotherapy overall, though its proportion of use declined after the guideline release (80.2% to 63.0%), while semaglutide prescribing increased from 2.5% to 26.8% (P < .01). Prescribing was more common among adolescents, females, and those with higher BMI percentile.1

The study authors note that absolute pharmacotherapy use remained low despite the relative increase and highlighted continued barriers to obesity treatment in pediatric populations, including clinician and caregiver reluctance, limited access to intensive lifestyle treatment, and insurance coverage challenges.1

"Future research should explore clinician and family preferences for obesity treatment options and understand how families balance trade-offs between treatment attributes such as time, cost, safety, uncertainty, and short- and long-term effectiveness. Implementation work is needed to improve treatment access," investigators concluded. "Further, consistent documentation of nonpharmaceutical treatment will aid surveillance. Continued monitoring of obesity treatment in this population is needed given the rapid changes in evidence, approvals, and access to evidence-based obesity treatments."1

References:

1. Rodriguez PJ, Do D, Gratzl S, et al. Shifts in US pediatric obesity treatment after the AAP guidelines. Pediatr Open Sci. Published online August 1, 2025. doi:10.1542/pedsos.2025-000623
2. Halsey G. American Academy of Pediatrics landmark obesity guidelines recommend proactive, aggressive approach. Patient Care Online. January 9, 2023. https://www.patientcareonline.com/view/american-academy-of-pediatrics-landmark-obesity-guidelines-recommend-proactive-aggressive-approach