Study links GLP-1 drugs to higher gallbladder risk in teens and young adults

A research letter published in JAMA Pediatrics reports that young people taking GLP-1 receptor agonists for overweight or obesity had higher rates of gallbladder-related problems — and of surgery to remove the gallbladder — than similar young people who did not take the drugs ^[1].

The analysis drew on the TriNetX Research Network and looked at people aged 12 to 21 who were diagnosed with overweight or obesity between January 2022 and May 2026 ^[1]. The researchers matched 18,759 patients treated with GLP-1 receptor agonists to an equal number of nonusers. The treated group had a mean age of 17.4 years and was 63% girls; the comparison group had a mean age of 17.5 years and was 64% girls. Matching was by age, sex and other health conditions. Median follow-up was 364 days for users and 849 days for nonusers ^[1].

The letter reports results for GLP-1 receptor agonists as a class. It does not give separate numbers for individual medications such as semaglutide (sold as Ozempic, Wegovy and Rybelsus).

In the first analysis, users were significantly more likely than nonusers to have biliary colic or to undergo cholecystectomy, with risk ratios of 1.62 and 1.39. The difference for cholecystitis was not statistically significant in that analysis ^[1]. Time-to-event analyses, which account for how long each person was followed, produced larger estimates: hazard ratios of 2.22 for cholecystitis, 2.92 for biliary colic and 2.39 for cholecystectomy ^[1].

The authors write that the findings "extend the established adult biliary safety signal to a younger population and are consistent with previously published rates" ^[1].

Among the subgroup with class I or II obesity — 8,046 users followed for a median of 387 days and a matched group followed for a median of 903 days — only biliary colic had a significant risk ratio, but the Kaplan–Meier analyses showed significantly higher event rates for cholecystitis (hazard ratio 3.36), biliary colic (2.78) and cholecystectomy (2.93) ^[1].

The authors say the risk probably reflects rapid weight loss, which makes gallstones more likely in children with obesity, combined with GLP-1 effects on how the gallbladder moves. Adult data, they note, point to a drug-related mechanism ^[1]. They also state that the study cannot establish cause and effect and that unmeasured differences between the groups cannot be ruled out ^[1]. There were too few biliary events among participants with overweight or class III obesity for a meaningful analysis ^[1].

Why it matters for patients

Gallbladder disease is already listed as a risk of this drug class in adults, but data in children and teenagers have been scarce as prescribing to minors rises ^[1].

The outcomes studied were cholecystitis (inflammation of the gallbladder), biliary colic (pain usually caused by gallstones) and cholecystectomy (surgical removal of the gallbladder) ^[1]. The letter does not report the absolute number of events in either group, so these figures do not by themselves show how much extra risk an individual young patient faces. Whether the risk differs by medication, dose, or reason for treatment has not been reported.

The authors advise doctors to watch for biliary symptoms when prescribing GLP-1 receptor agonists to young people ^[1].

What happens next

The researchers call for prospective studies that clarify which patients are at highest risk, test whether preventive strategies used in bariatric populations could be applied, and determine whether monitoring protocols can reduce biliary complications ^[1]. No timeline for such studies has been disclosed.