Beyond Body Image: Medicalizing Teen Obesity with GLP-1s

GLP-1 receptor agonists, medications initially developed for diabetes, are now at the forefront of treating obesity, including in adolescents. As the United States contends with a persistent and growing obesity epidemic, these medications offer substantial therapeutic potential alongside complex medical and ethical challenges that will shape the future of healthcare, equity, and youth well-being.

Despite this medical advancement, the nation faces a rapidly worsening crisis: childhood and adolescent obesity rates have climbed from 8% to 20% over the last 30 years. As of 2017, more than 14.7 million U.S. youth aged 2–19 years old were diagnosed with obesity. These figures reflect a broader public health challenge, as over 42% of U.S. adults have obesity, with one in eleven experiencing severe obesity.

The Medical Catalyst

GLP-1s represent a pivotal development, illuminating a potential future where the chronic struggle of obesity can be managed starting at a young age. In 2020, Liraglutide (marketed as Saxenda) became the first GLP-1 receptor agonist approved by the FDA for adolescents aged 12 and over diagnosed with obesity. The medication was explicitly approved as a complement to lifestyle changes, including increased physical activity and diet modifications. Liraglutide had also been approved the prior year for managing type 2 diabetes in adolescents.

This regulatory action marked the beginning of a significant shift in pediatric obesity treatment. In 2022, Semaglutide (Wegovy) secured approval, and by 2023, the American Academy of Pediatrics officially endorsed the use of GLP-1 agonists for pediatric obesity. However, a key caveat remains: the medications must be used as an adjunct to behavioral and diet-based lifestyle changes, not as standalone treatments. Given that adolescents are in critical stages of physical and emotional development, it is essential that these pharmacological tools are paired with lasting, sustainable behavioral changes.

Dr. Vibha Singhal, Director of Pediatric Obesity at UCLA, notes that while minor side effects such as gastrointestinal (GI) symptoms, nausea, and fatigue can occur, the broader clinical impact for young patients is often profound. These medications can help young patients not only improve their physical health but also gain confidence and reduce the long-term risk for chronic conditions associated with obesity.

Given the relatively recent introduction of these medications, the long-term effects remain largely unknown. Current research is limited to one- to two-year follow-ups, which suggest promising outcomes when GLP-1s are paired with consistent lifestyle modifications.

Dr. Singhal emphasizes that obesity is a “progressive chronic condition,” requiring ongoing treatment. When the medication is stopped, weight regain typically occurs. Therefore, similar to conditions like diabetes or hypothyroidism, Singhal suggests lifelong management is currently necessary. Researchers are actively exploring whether future iterations or combinations of therapies could ultimately reduce the need for such continuous use.

Ethical Concerns: Mental Health and Access

One prominent ethical concern prompted by the use of GLP-1 medications among adolescents centers on mental health and body image. Adolescence is a formative period for self-esteem, and while the medications offer therapeutic benefits, there is a distinct risk of reinforcing a medicalized view of body image. The clinical goal must not be "thinness," but health, empowerment, and sustainable well-being. Defining the terms of "health" and "success" in this context is crucial for ensuring positive developmental outcomes.

Equity and accessibility also loom large, raising serious concerns about the unequal distribution of these costly medications. GLP-1 agonist medications are expensive, and combined with the necessity for long-term use, these expenses accumulate rapidly. Insurance coverage remains inconsistent and unpredictable, particularly for marginalized communities, often resulting in prohibitively high out-of-pocket costs. Furthermore, the expanded use of drugs originally approved for diabetes introduces new complexities, including the potential for unsafe off-label usage or black market alternatives that could expose young users to unsafe or counterfeit products.

Bridging Innovation and Systemic Policy

The cost of inaction is severe: pediatric obesity alone costs the U.S. healthcare system approximately $1.3 billion per year. Individual medical costs are $116 higher annually for those with moderate obesity and over $300 more for severe obesity compared to children with a healthy body mass index (BMI). GLP-1s represent an important biomedical achievement, but they are not a panacea or a standalone solution.

The deeper challenge and opportunity lie in bridging biomedical innovation with public health values. The U.S. requires a holistic, youth-centered approach to obesity that systematically prioritizes prevention, mental health, equitable access, and comprehensive education. Addressing the epidemic effectively demands a collective effort to reform environments dominated by digital consumption and ultra-processed foods, thereby restoring structural support for community, movement, and well-being. Medication is necessary, but its integration must occur within a larger framework that addresses the social and environmental determinants of health.