Opinion: I studied GLP-1 use in children. The results are reassuring

Writing as a transplant surgeon, obesity medicine specialist, health services researcher, and associate professor at NYU Langone, Babak J. Orandi says his transplant patients are getting younger, with many in their 30s and 40s whose organ failure can be traced back to childhood obesity. Obesity itself can also be a barrier to transplant, compounding the crisis it created. He cites data showing that adolescents with severe obesity are up to nine times more likely to develop chronic kidney disease in young adulthood even without diabetes or hypertension, and that childhood fatty liver disease increases mortality risk 40-fold and has become the fastest-growing cause of liver transplants in young adults. These findings led him to pursue additional training in obesity medicine so he could reach patients before they need a transplant.

He acknowledges it would be alarmist to tell parents their child may one day need a liver transplant, but notes that 20% of U.S. children have obesity and that the consequences cannot be ignored. His research team recently published a study showing a 310-fold increase in GLP-1 receptor agonist prescriptions for children ages 8–11 with obesity since 2019. Several drugs in this class are approved to treat obesity in adolescents 12 and older, but none are currently approved for younger children. He says FDA approval for younger children could lead to broader insurance coverage and help narrow the access disparities found in the study, but it could also open the door to broader, more liberal use in less severe cases—something not justified without long-term data on how these medications affect growth and puberty.

When the American Academy of Pediatrics published obesity management guidelines including recommendations about GLP-1s in 2023, public reaction was intense. Orandi says he understands the discomfort, since the idea of a child receiving an injection for weight loss strikes at a deep desire to let children be children. But he argues the data show a more nuanced picture: among more than 3.5 million children ages 8–11 with obesity in the study, only 0.6% received a GLP-1 prescription. He calls that number too low, noting that the majority of children with severe obesity and its complications were never prescribed a GLP-1. Pediatrician colleagues are carefully reserving these medications for children at greatest risk, with 94% of children prescribed GLP-1s having severe obesity. These children already manifest adult diseases stemming from obesity, including sleep apnea, prediabetes, hypertension, metabolic dysfunction-associated steatotic liver disease (previously called fatty liver disease), and hyperlipidemia.

He acknowledges that concerns about “medicalizing” childhood are legitimate, but the excerpt ends as he begins to argue that children with obesity complications have already been affected by serious disease.