Review finds GLP‑1 weight‑loss drugs lower weight and improve blood sugar in children but raise gastrointestinal side‑effects

Researchers who reviewed clinical trials of GLP‑1 receptor agonists — drugs that mimic a gut hormone to reduce appetite, slow digestion and lower blood sugar — found they produced modest but measurable weight loss and improved glycemic control in children and adolescents with obesity or type 2 diabetes, but were associated with higher rates of gastrointestinal adverse events.

The meta‑analysis, led by investigators at the University of Florida and published in JAMA Pediatrics, pooled data from 18 trials including 1,402 participants aged 6 to 17. Children treated with GLP‑1 receptor agonists for obesity lost an average of 4.72 kilograms and experienced an average reduction in waist circumference of 3.81 centimetres compared with placebo. The review also reported improvements in measures of blood sugar control among those with prediabetes or type 2 diabetes.

Investigators noted that gastrointestinal adverse events — including nausea, vomiting, diarrhoea and constipation — were significantly more common among children receiving GLP‑1 treatments than among those given placebo. The review found no significant differences in reports of depression or suicidal ideation and behaviours between treatment and placebo groups, but authors cautioned that longer follow‑up and larger real‑world studies are needed to assess long‑term safety.

The trials included in the analysis largely tested earlier‑generation GLP‑1 agonists. The researchers and external experts emphasised that newer agents, such as semaglutide (marketed for weight loss as Wegovy and prescribed for diabetes as Ozempic) and tirzepatide (Mounjaro), have produced substantially greater weight loss in adults but have been less frequently studied in paediatric populations to date. Previous adult trials found semaglutide produced about 14 percent average body‑weight loss over 72 weeks, while tirzepatide produced approximately 20 percent over a similar period.

A number of GLP‑1 agonists are available on the National Health Service in England either to treat type 2 diabetes or to manage weight, but current NHS guidance recommends their use in adults. The review’s authors urged that paediatric trials include longer follow‑up and assess effects on growth, puberty and other developmental outcomes before wider use in children is considered.

Naveed Sattar, professor of cardiometabolic medicine at the University of Glasgow, said the meta‑analysis provides useful information but noted its limitations. "Although obesity levels are rising fastest in younger people, the present meta‑analysis looks predominantly at trials with older GLP‑1RAs known to give much lower weight loss than higher doses of semaglutide and tirzepatide, the two most recent licensed drugs of most interest to paediatricians," he said. He added that ongoing trials of newer agents in children with type 2 diabetes are needed and that more safety assessments are required, including potential impacts on growth and puberty and the appropriate duration of treatment.

Public health context underscores the importance of additional evidence. The latest data from England’s national child measurement programme show 22.1 percent of Year 6 pupils (age 10–11) were classified as obese in 2023/24, a slight decline from 22.7 percent the previous year but higher than pre‑pandemic levels. The programme also found that around one in 10 children entering primary school were obese in 2023/24, up from 9.2 percent in 2022/23.

The study authors concluded that GLP‑1 receptor agonists were effective in improving glycemic control, weight and some cardiometabolic outcomes in children and adolescents, but emphasised that gastrointestinal side effects are an important consideration for long‑term use. They wrote that longer follow‑up periods in future trials and more real‑world studies are essential to establish the long‑term effects of GLP‑1 receptor agonists in paediatric populations.

Experts also cautioned against viewing pharmacotherapy as a standalone solution to childhood obesity. Prevention efforts aimed at changes to the broader environment that influence diet and activity levels remain a central public‑health priority, and no country has yet solved the complex problem of rising childhood obesity rates.