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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio 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. \u201cThere\u2019s 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,\u201d Sarah E. Messiah, PhD, MPH, associate dean for research at O\u2019Donnell School of Public Health and professor of epidemiology and pediatrics at UT Southwestern Medical Center, told Healio. \u201cMost recently, we\u2019ve had the latest evolution of GLP-1s, and they have taken off like a rocket.\u201d
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%. \u201cWe pretty much knew we\u2019d see a decline, but we didn\u2019t realize it would be that steep,\u201d 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\u2019re 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\u2019s 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\u2019s because of the uptake of GLP-1s. It\u2019s a little more complicated in adolescents, because bariatric surgery is covered by insurance in a lot of cases, while GLP-1s are not. It\u2019s 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\u2019t 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\u2019re almost 18. My guess is some of them are saying, \u2018I\u2019m almost an adult, where insurance would cover GLP-1s. I want to try that first.\u2019 It may be they\u2019re delaying the decision to have surgery in favor of a GLP-1. Healio: What about the fairly rare use of combination therapy? Messiah: It\u2019s the new frontier. There are zero best-practice guidelines out there for this. The fact that it\u2019s 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\u2019re 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\u2019re getting more and more of these options online. One thing we\u2019ve learned is that this is not one-solution-for-everybody in this space. Obesity is very complicated and it\u2019s 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\u2019re always thinking long term, too. You want to age these adolescents into adulthood where they have the best shot at having a healthy adult<\/p>\n","protected":false},"author":1,"featured_media":3609,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3608","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3608","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3608"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3608\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3609"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3608"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3608"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3608"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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