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Amid a rapid rise in GLP-1 drug prescriptions for children and teens, a new analysis finds that behavioral and lifestyle treatments for childhood obesity outperformed the use of weight-loss drugs alone.
According to a JAMA Pediatrics analysis published last week, adolescents who received structured behavioral and lifestyle interventions without medication saw significant reductions in BMI and improvements in body composition compared with control groups.
The analysis also found that combining lifestyle treatment with medication produced the best results overall — but the authors cautioned that this particular conclusion rested on “a single trial with relatively few participants.”
They said the findings were particularly relevant for situations where “full intensive programs are not available and implies that health care practitioners should avoid prescribing obesity management drugs in isolation.”
The authors also found that obesity treatments using lifestyle interventions preserved muscle mass, while medication-only induced weight loss often leads to a reduction of muscle in children. Studies have found the same to be true for adults.
Much of the paper — and news coverage of it — focused on the authors’ finding that combining drugs with lifestyle treatments produced the greatest effect.
However, the standalone benefit of lifestyle treatment was substantial enough for the authors to conclude that “lifestyle treatment was essential and should form the backbone of any pediatric obesity treatment plan.”
They said it should remain a core component of care even when medications are prescribed.
The authors also noted that while lifestyle interventions were broadly effective, for some children with severe obesity, lifestyle interventions were limited. This may indicate underlying hormonal or metabolic issues that drugs can address. However, they cautioned against any “one-size-fits-all” intervention for childhood obesity.
The findings raise questions about why the drugs are being prescribed so widely to children, given the lack of data on safety and effectiveness.
Doctors admit they don’t know the long-term risks
Pediatrician Dr. Brian Thornburg said the paper’s emphasis on drug outcomes was “another exercise in short-sighted endpoint selection that overstates benefits while ignoring drastic long-term health consequences of GLP-1 drugs — effects on growth, puberty, bone health, lean mass and potential lifelong dependency — that could far outweigh transient wins.”
Thornburg said the authors failed to balance the risks of the drugs in their analysis, and sidestepped the root cause of pediatric obesity, which has tripled since the 1970s: “government-sanctioned ultra-processed foods enriching BigAg, BigFood, BigMed and BigPharma at children’s expense. True solutions lie in restoring nutrient-dense real foods and environments, not layering pharmaceuticals onto a toxic food supply.”
He added that parents and clinicians should demand long-term safety data on the drugs.
Dr. Michelle Perro, co-author of “What’s Making Our Children Sick?” who has long raised concerns about pediatric drug use, said:
“As a pediatrician, I believe childhood obesity is more of an ecologic disease rather than a metabolic one. We cannot medicate our way out of an environment that is making our children sick.”
Even doctors who prescribe the drugs to young kids admit they don’t know the long-term risks.
“We don’t know what the long-term effects could be and that can be scary and unsettling,” Dr. Claudia Fox, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota, told the Wall Street Journal. Fox said the long-term risks of obesity are also serious and may outweigh the risks of the drugs.
Prescriptions soar after AAP recommends GLP-1 drugs for kids
About 20% of U.S. children and adolescents are chronically obese, according to the Centers for Disease Control and Prevention (CDC).
In December 2020, the U.S. Food and Drug Administration approved Saxenda to treat obesity in kids 12 and up. In 2022, the agency approved Wegovy for the same age group.
Weeks later, in January 2023, the American Academy of Pediatrics (AAP) issued new guidelines on childhood obesity — at the time, it was the first update to the guidelines in 15 years — recommending early diagnosis and aggressive treatment.
The AAP recommendations included weight-loss drugs for obese children as young as 8 and consultation for bariatric surgery for children with severe obesity as young as age 13.
Prescribing the drugs to children under age 12 is an off-label use of the drugs recommended by AAP.
It didn’t take long after the AAP issued its recommendations for GLP-1 drug prescriptions for those age groups to skyrocket — they jumped 38% in the first year following the change. MedPage Today reported that prescriptions for two of the drugs jumped 700%.
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BMJ investigation uncovers AAP ties to GLP-1 drugmakers
In July 2025, a BMJ investigation uncovered undisclosed financial ties between the AAP and major drug companies behind blockbuster weight-loss medications.
The BMJ analysis found financial ties between industry and AAP members — including those who wrote the guidelines, those who reviewed them and the organization overall.
The researchers also identified serious irregularities in the guidelines development process. They concluded that the AAP based the guidelines on weak or nonexistent evidence.
The drugs were rolled out and widely distributed with no long-term studies in youth populations. There are concerns that the drugs pose risks to the development of their brains and bones.
Adults and children who take the drugs long-term risk exposing themselves to a host of side effects, ranging from vomiting, diarrhea and nausea, and fainting to serious issues like pancreatitis, stomach paralysis and kidney disease.
People who go off the drugs tend to regain the weight they lost.
A recent study published in the Journal of Toxicology found the drugs have also led to a surge in calls to U.S. poison control from people making dosing errors, according to HealthDay News.
Related articles in The Defender
- ‘Their Rubber Stamp Is Reckless’: After AAP Endorses Weight-Loss Drugs for Kids, Prescriptions Soar
- Weight-loss Drug Prescriptions for Kids and Teens Soar Despite No Safety Data
- AAP Members With Ties to GLP-1 Drugmakers Helped Write Weight-Loss Drug Guidelines for Kids
- Weight Loss Drugs for Kids: A ‘Minefield of Health and Emotional Problems,’ Researchers Warn
- How Much Do Big Pharma Donations Influence AAP Guidelines for Parents?
- Childhood Obesity: Drugs and Surgery Top List of American Academy of Pediatrics New Guidelines
