GLP-1 Drugs for Teens: What Parents Should Know in 2026

If your teenager’s pediatrician has raised the possibility of a GLP-1 medication, you are facing a decision that did not exist a few years ago. This article lays out what is approved, what the trials found, what the pediatric guideline says, and which questions the researchers themselves say are unanswered.

None of this is medical advice. Where this article describes how a medicine is used, it is summarizing the FDA-approved prescribing information and Instructions for Use, not giving instructions: follow your child’s own prescription and their clinician. Decisions about medication for a child belong to you, your child and their clinician.

Which GLP-1 drugs are actually approved for young people?

Four approvals matter here, and they are easy to confuse because the brand names overlap.

Wegovy (semaglutide 2.4 mg injection) is indicated for weight reduction and long-term weight maintenance in pediatric patients aged 12 years and older with obesity, defined as a BMI at or above the 95th percentile for age and sex, alongside a reduced-calorie diet and increased physical activity [1]. The FDA approved this in December 2022.

Saxenda (liraglutide 3 mg injection) was approved for adolescents aged 12 and older with obesity on December 4, 2020, making it the first GLP-1 drug in this space [2].

Mounjaro (tirzepatide injection) is indicated as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes [3]. The FDA approved that pediatric expansion on December 19, 2025. Note the indication carefully: it is for blood sugar in type 2 diabetes, not for weight management.

Zepbound (tirzepatide injection), the obesity-indicated tirzepatide product, states plainly that safety and effectiveness have not been established in pediatric patients [4]. It is adults only.

Ozempic and Rybelsus are also adults only. So are Wegovy tablets: the Wegovy label says safety and effectiveness of the tablets have not been established in pediatric patients [1].

What did the adolescent trials actually find?

Semaglutide: STEP TEENS

STEP TEENS randomized 201 pubertal adolescents aged 12 and older with a BMI at or above the 95th percentile, 2:1 to semaglutide 2.4 mg or placebo for 68 weeks, after a 12-week lifestyle run-in, with lifestyle therapy in both arms [1]. The Wegovy label reports the results directly: mean BMI change was -16.1 percent with semaglutide versus +0.6 percent with placebo (difference -16.7 percentage points, 95 percent CI -20.3 to -13.2), and 77.1 percent of the semaglutide group achieved at least a 5 percent BMI reduction versus 19.7 percent on placebo [1].

Those are large numbers, comparable to what adults achieve. Some context the headline figure omits: mean baseline weight was 108 kg and mean BMI 37; 79 percent of participants were White, 8 percent Black or African American, 2 percent Asian and 11 percent Hispanic or Latino; and 86.7 percent of those who finished were on the full 2.4 mg dose [1].

Liraglutide: SCALE TEENS

SCALE TEENS was a 56-week double-blind randomized placebo-controlled trial in 251 adolescents aged 12 to 17, published in the New England Journal of Medicine in 2020: 125 received liraglutide 3.0 mg daily and 126 placebo, both with lifestyle therapy [5].

The primary endpoint was the change in BMI standard-deviation score, where liraglutide beat placebo by an estimated -0.22 (95 percent CI -0.37 to -0.08, P=0.002) [5]. In more familiar terms, the estimated difference from placebo was -4.64 percentage points for BMI and -4.50 kg for body weight (-5.01 percentage points in relative terms). A BMI reduction of at least 5 percent occurred in 43.3 percent of the liraglutide group versus 18.7 percent on placebo, and at least 10 percent in 26.1 versus 8.1 percent [5].

That is a materially smaller effect than semaglutide’s 16.1 percent BMI reduction, on a daily injection rather than a weekly one. Gastrointestinal adverse events were more common with liraglutide (64.8 versus 36.5 percent), and 10.4 percent of the liraglutide group discontinued because of an adverse event versus none on placebo [5]. After the drug stopped, BMI standard-deviation score rose more in the liraglutide group than in the placebo group [5].

Tirzepatide in youth-onset type 2 diabetes: SURPASS-PEDS

SURPASS-PEDS was a phase 3 double-blind placebo-controlled trial across 39 sites in eight countries, running 30 weeks followed by a 22-week open-label extension [6]. Ninety-nine participants aged 10 to under 18, with a mean age of 14.7 and a mean baseline HbA1c of 8.04 percent, were randomized to tirzepatide 5 mg, tirzepatide 10 mg or placebo.

At week 30, the pooled tirzepatide group reduced HbA1c by 2.23 percent versus a 0.05 percent increase on placebo, an estimated treatment difference of -2.28 percentage points [6]. BMI fell 7.4 percent on 5 mg and 11.2 percent on 10 mg, versus 0.4 percent on placebo. Glycemic effects were sustained to 52 weeks. The most common adverse events were gastrointestinal, all mild to moderate, and they decreased over time. Two patients in the 5 mg group stopped because of an adverse event, and no deaths were reported [6].

This trial is the basis for the Mounjaro pediatric expansion.

Children under 12: SCALE Kids

SCALE Kids is the only published randomized trial of a GLP-1 drug in children aged 6 to under 12 [7]. Eighty-two children with obesity were randomized 2:1 to liraglutide 3.0 mg or maximum tolerated dose, or placebo, plus lifestyle interventions, for 56 weeks with 26 weeks of follow-up.

At week 56, mean BMI change was -5.8 percent with liraglutide versus +1.6 percent with placebo, a difference of -7.4 percentage points [7]. A BMI reduction of at least 5 percent occurred in 46 percent of the liraglutide group versus 9 percent on placebo. Gastrointestinal adverse events were more common with liraglutide, 80 percent versus 54 percent, and serious adverse events were reported in 12 percent versus 8 percent [7].

The Wegovy label states that safety and effectiveness have not been established in pediatric patients under 12 [1]. Any GLP-1 prescribing to a child under 12 in the US is off-label.

What does the American Academy of Pediatrics recommend?

The AAP published its first comprehensive clinical practice guideline on childhood obesity in January 2023 [8]. Two statements matter most for parents.

Key Action Statement 12 says pediatricians and other primary health care providers should offer adolescents 12 years and older with obesity, meaning a BMI at or above the 95th percentile, weight loss pharmacotherapy according to medication indications, risks and benefits, as an adjunct to health behavior and lifestyle treatment [8].

A separate consensus recommendation says providers may offer children aged 8 through 11 with obesity weight loss pharmacotherapy, on the same adjunct basis [8]. This is a weaker recommendation, and it does not change the fact that no GLP-1 drug is FDA-approved for obesity under age 12.

The guideline is equally clear about what medication is not. It states that “no current evidence supports weight loss medication use as a monotherapy,” and that pediatricians who prescribe should provide or refer to intensive behavioral interventions for patients and families [8].

The guideline defines that intensive treatment concretely: intensive health behavior and lifestyle treatment is most often effective when delivered face-to-face, engaging the whole family, with at least 26 hours of nutrition, physical activity and behavior change lessons over 3 to 12 months [8].

The American Diabetes Association’s 2026 Standards of Care Section 14 adds a diabetes-specific recommendation: a GLP-1 receptor agonist and/or an SGLT2 inhibitor should be considered in children and adolescents with type 2 diabetes of approved ages if glycemic goals are not met on metformin, graded A [9].

What side effects should we expect?

The Wegovy label reports that adverse reactions in pediatric patients aged 12 and older were generally similar to those in adults, with specific exceptions: adolescents had greater incidences of cholelithiasis (gallstones), cholecystitis (gallbladder inflammation), hypotension (low blood pressure), rash and urticaria (hives) than adults [1].

Gastrointestinal effects dominate everywhere. In SCALE Kids, 80 percent of the liraglutide group had gastrointestinal adverse events [7]. In SURPASS-PEDS, gastrointestinal events were the most common and all were mild to moderate [6].

For teens who also have type 2 diabetes, the label adds a specific instruction, and it is addressed to prescribers rather than to families: monitor blood glucose before and during treatment, and consider reducing the dose of any concomitant insulin secretagogue such as a sulfonylurea, or insulin, to reduce hypoglycemia risk [1]. Nothing in the labeling asks a parent or patient to change an insulin or sulfonylurea dose.

What about mental health?

This is a reasonable worry, because adolescent obesity itself is associated with higher rates of depression and suicidality.

A retrospective chart review at the Medical College of Wisconsin, published in September 2026, looked at 44 adolescents aged 12 to 21 with obesity treated with liraglutide or semaglutide between June 2022 and December 2024 [10]. Among those with paired PHQ-9 depression screening scores (n=15), the median score fell from 6 to 1, and the change was independent of BMI change. Among those with paired suicide screening data (n=23), no increase in suicidality or new suicidal ideation was observed [10].

The authors describe this as a small, exploratory review supporting short-term psychosocial safety, and call for larger prospective case-control studies [10].

For context: the FDA removed the Suicidal Behavior and Ideation warning from the Wegovy label in January 2026 [1].

None of that means every teenager will feel better. It means the available evidence has not shown short-term psychological harm.

What is genuinely unknown?

Three things, and they are worth taking seriously.

Bone and muscle development. Adolescence is the window for peak bone and muscle mass accrual. A 2026 perspective in Childhood Obesity, written by clinicians at Le Bonheur Children’s Hospital, Children’s Hospital Los Angeles and Children’s Hospital of Philadelphia, argues that GLP-1-associated weight loss during this period may attenuate that accrual, potentially reducing peak musculoskeletal capacity and increasing later frailty risk [11]. Their recommendation is to pair medication with prescribed resistance training, weight-bearing activity and adequate protein intake. A 2026 commentary in the Journal of Pediatric and Adolescent Gynecology makes the same bone argument and adds that no data exist on reproductive outcomes after adolescent exposure [12].

Both pieces note that the pediatric trials so far show no short-term effect on growth or pubertal development [11][12]. The concern is about what happens over years, and nobody has measured that.

Eating disorder risk. The same commentary flags that potent appetite suppression in a population uniquely vulnerable to body image pressure raises concerns about misuse or worsening of disordered eating [12]. There is no established US screening standard for prescribing in this context.

What happens after. The AAP guideline itself names sustained weight maintenance after pharmacological treatment ends as a persisting gap, along with long-term safety data and efficacy in younger children [8][13].

What does real-world use look like?

Two studies give a sense of practice outside trials.

A multicenter retrospective study across Johns Hopkins, Cincinnati Children’s and Yale examined 74 patients aged 21 and under who started tirzepatide [14]. Median age was 18.4 years, 86.5 percent had type 2 diabetes and 78.4 percent had already been on a GLP-1 drug. At a median first follow-up of 102 days, BMI fell from 42.7 to 42.0, and among those with type 2 diabetes HbA1c fell from 8.0 percent to 7.2 percent while basal insulin dropped from 59.7 to 43.9 units a day [14]. Prior GLP-1 use and partial nonadherence predicted smaller HbA1c reductions.

A nationwide Icelandic cohort followed 113 children aged 12 and older with grade 2 obesity who received subsidized semaglutide between March 2021 and June 2025 [15]. Before treatment, their BMI relative to the obesity threshold was climbing 0.29 percentage points per month. On semaglutide the trajectory reversed to -0.86 percentage points per month, and 63 percent achieved reductions exceeding 10 percentage points [15]. The authors attribute high treatment persistence partly to Iceland’s universal reimbursement policy, and caution that generalizing to countries without universal coverage is uncertain [15].

That last point is the American problem in a sentence. Coverage for adolescent obesity medication in the US is inconsistent, and whether a family can afford to continue is often the decisive variable.

Questions worth asking your child’s clinician

• Which specific drug, and is this use on-label for my child’s age and diagnosis?
• What behavioral and nutritional program comes with it, and how many hours of contact does it actually involve? [8]
• How will muscle, strength and physical function be tracked, not just BMI? [11]
• What is the plan for protein intake and resistance activity? [11]
• What is the plan if we need to stop, and what should we expect then? [8]
• How will mood be screened before and during treatment? [10]
• What will this cost, and what happens if coverage changes? [15]

Sources

1. WEGOVY (semaglutide) US Prescribing Information. Novo Nordisk. https://www.novo-pi.com/wegovy.pdf
2. Saxenda (liraglutide) injection, US prescribing information (pediatric patients aged 12 years and older with obesity). Novo Nordisk. https://www.novo-pi.com/saxenda.pdf
3. MOUNJARO (tirzepatide) US Prescribing Information. Eli Lilly. https://uspl.lilly.com/mounjaro/mounjaro.html
4. ZEPBOUND (tirzepatide) US Prescribing Information. Eli Lilly. https://uspl.lilly.com/zepbound/zepbound.html
5. Kelly AS, Auerbach P, Barrientos-Perez M, et al. A Randomized, Controlled Trial of Liraglutide for Adolescents with Obesity (SCALE TEENS). N Engl J Med. 2020 May 28;382(22):2117-2128. https://doi.org/10.1056/NEJMoa1916038
6. Hannon TS, Chao LC, Barrientos-Pérez M, et al. Efficacy and safety of tirzepatide in children and adolescents with type 2 diabetes (SURPASS-PEDS). The Lancet. 2025 Oct 4. https://doi.org/10.1016/S0140-6736(25)01774-X
7. Fox CK, Barrientos-Pérez M, Bomberg EM, et al. Liraglutide for Children 6 to <12 Years of Age with Obesity - A Randomized Trial. N Engl J Med. 2025 Feb 6. https://doi.org/10.1056/NEJMoa2407379
8. Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity (Key Action Statement 12 and the consensus recommendation on ages 8 through 11). Pediatrics. 2023 Feb;151(2):e2022060640. https://publications.aap.org/pediatrics/article/151/2/e2022060640/190443/Clinical-Practice-Guideline-for-the-Evaluation-and
9. American Diabetes Association. 14. Children and Adolescents: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Suppl 1). https://doi.org/10.2337/dc26-S014
10. Said J, Liegl M, Pan AY, Dabrowski E. GLP-1 receptor agonist use and mental health outcomes in adolescents with obesity: a retrospective review. J Pediatr Endocrinol Metab. 2026 Sep 14. https://doi.org/10.1515/jpem-2026-0227
11. Smith WA, Kim A, Khalil TJ, Giovinazzo C, Burton ET. Protecting Musculoskeletal Development and Physical Function in Adolescents on GLP-1 Therapy. Child Obes. 2026 Aug 3. https://doi.org/10.1177/21532176261475103
12. Haider MA, Javed H. GLP-1 Receptor Agonists in Adolescents: Emerging Endocrine, Reproductive, and Psychosocial Concerns. J Pediatr Adolesc Gynecol. 2026 Jun 28. https://doi.org/10.1016/j.jpag.2026.06.017
13. Pharmacotherapy in childhood obesity: Key points from the 2023 AAP clinical practice guideline. PubMed. https://pubmed.ncbi.nlm.nih.gov/41794571/
14. Valdez Y, Segev N, Parimi N, et al. Real-world effectiveness of tirzepatide among youth with type 2 diabetes and/or obesity: a multicenter analysis. J Pediatr Endocrinol Metab. 2026 Aug 12. https://doi.org/10.1515/jpem-2026-0335
15. Thorsteinsdottir S, Jonsdottir B, Olafsdottir AS, et al. Real-World Use of Subsidised Semaglutide in Icelandic Children With Obesity: A Nationwide Retrospective Cohort Study. Pediatr Obes. 2026 Aug. https://doi.org/10.1111/ijpo.70139
16. SURMOUNT-ADOLESCENTS-2, NCT06439277. ClinicalTrials.gov. https://clinicaltrials.gov/study/NCT06439277
17. SURMOUNT-ADOLESCENTS, NCT06075667. ClinicalTrials.gov. https://clinicaltrials.gov/study/NCT06075667