September 08, 2026
1 min watch
Key takeaways:
- GLP-1 use among adolescents and young adults with obesity has significantly increased since 2022.
- Metabolic and bariatric surgery has declined during that time.
A retrospective analysis of more than 200,000 adolescents and young adults treated for obesity shows a significant increase in GLP-1 receptor agonist use since 2022, with a corresponding drop in metabolic and bariatric surgery.
“There’s a lot of really strong evidence-based data showing surgery is the most durable and effective intervention for severe obesity in both adults and adolescents,” Sarah E. Messiah, PhD, MPH, associate dean for research at O’Donnell School of Public Health and professor of epidemiology and pediatrics at UT Southwestern Medical Center, told Healio. “Most recently, we’ve had the latest evolution of GLP-1s, and they have taken off like a rocket.”
Data derived from Messiah SE, et al. JAMA Pediatr. 2026;doi:10.1001/jamapediatrics.2026.2828.
To investigate treatment trends among adolescents and young adults, Messiah and colleagues conducted a retrospective analysis of 204,148 individuals aged 13 to 25 years (73.5% female; mean age, 21.3 years) treated for obesity between May 2022 and January 2026. They extracted data from Epic Cosmos, an electronic health record database of more than 300 million patients in the U.S.
Researchers classified treatments as GLP-1s only, metabolic and bariatric surgery only, or a combination of GLP-1s and surgery.
The percentage of adolescents and young adults treated for obesity with only GLP-1s rose from 88.2% in May 2022 to 96.1% in January 2026.
Meanwhile, the proportion of patients who underwent only metabolic and bariatric surgery decreased from 11.6% to 3.7%.
“We pretty much knew we’d see a decline, but we didn’t realize it would be that steep,” Messiah said.
The percentage of patients who received combination therapy remained stable at 0.2%.
Healio spoke with Messiah about these shifting trends, considerations for this patient population and the importance of lifestyle interventions.
Healio: First, what led you and your team to pursue this research?
Messiah: Right now, the estimates are one out of every eight Americans has had some exposure to a second-generation GLP-1 in just the past few years. They were first FDA approved for adults and now we’re in the process of seeing more of these approvals for adolescents.
In parallel to that, we are increasingly getting more access to these large datasets. The one we used for this publication is the largest, with over a billion encounters. It’s just absolutely massive. So, this was a really unique opportunity to get in early and see what is going on with all these medications coming into the pediatric obesity space in the real world, not trials or sponsored research programs. We wanted to see what physicians are doing to help their pediatric patients with obesity.
Healio: The results are pretty striking. What do you think is causing these shifts in use of GLP-1s vs. surgery?
Messiah: We have done analyses in other datasets in adults that showed bariatric surgery utilizations going off a cliff. Clearly, that’s because of the uptake of GLP-1s. It’s a little more complicated in adolescents, because bariatric surgery is covered by insurance in a lot of cases, while GLP-1s are not. It’s still a big access issue, and an affordability one.
What we hear in clinic is that there are two camps: One is that a patient just wants to have surgery and be done with it. They don’t want to be on a medication for the rest of their life. On the other hand, some patients are petrified of surgery.
Bariatric surgery has one of the lowest complication or mortality rates of any type of surgery, especially now that everything is laparoscopic. But people still have fears of surgery.
In another analysis we did, the mean age for bariatric surgery in adolescence was 17.7 years. They’re almost 18. My guess is some of them are saying, ‘I’m almost an adult, where insurance would cover GLP-1s. I want to try that first.’ It may be they’re delaying the decision to have surgery in favor of a GLP-1.
Healio: What about the fairly rare use of combination therapy?
Messiah: It’s the new frontier. There are zero best-practice guidelines out there for this. The fact that it’s happening is so interesting. Nobody has come out with clinical practice guidelines on when you introduce a GLP-1 to an adolescent before bariatric surgery or what is the optimal window, because we have no data to drive those decisions.
The fact that you’re seeing the practice already happening before the data or guidelines are out is really interesting.
Healio: How should gastroenterologists counsel adolescents and young adults on when to potentially transition from medical therapy to bariatric surgery?
Messiah: It comes down to shared decision-making: what is going to work for the family, as well as long-term health outcomes for the patient. It really is turning into more precision obesity care, which is great because we’re getting more and more of these options online. One thing we’ve learned is that this is not one-solution-for-everybody in this space.
Obesity is very complicated and it’s a chronic health condition. It can be driven by mental health just as much as physical health, health history and family history. Parents also come into these conversations with preconceived notions, so a child may have one idea about what they want to do, but the parent has a completely different one.
The gastroenterologist has to balance all of that, and we’re always thinking long term, too. You want to age these adolescents into adulthood where they have the best shot at having a healthy adult life without diabetes or heart disease or even cancer in their late 20s, 30s and so on. That’s the overall goal.
Healio: How do the treatment options compare in efficacy?
Messiah: Bariatric surgery has a strong evidence base for weight loss and comorbidity resolution. If supported by lifestyle change, that can be long term.
This is still early days with GLP-1s and adolescents, so we don’t know yet. That is the million-dollar question right now. We’ve seen it in clinical trials, but even those are limited. What we’re interested in is real-world [evidence], because the volume of uptake of these medications is like nothing we have ever seen before.
We know there are massive adherence challenges. Whether that’s because of side effects or cost, we don’t know.
Healio: What else would you like to emphasize?
Messiah: We can’t throw behavior change and lifestyle out the window with all of this. That is the success, ultimately, of any surgery or medication for obesity. At the end of the day, it has to be supported by lifestyle.
That means dietary changes, physical activity, sleep and mental health. You can’t not consider those. Surgery is a tool; it’s not the end-all solution. If you go into surgery with that approach, you’ll be great. And I think a lot of people do.
We need to do a lot more work in thinking about optimal lifestyle interventions and support interventions for adolescents.
For more information:
Sarah E. Messiah, PhD, MPH, can be reached at sarah.messiah@utsouthwestern.edu.
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