GLP-1 receptor agonists in pediatric obesity

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of obesity in adults and are now gaining attention in pediatric populations facing a dramatic rise of obesity prevalence and related comorbidities. In addition to weight loss, their role extends to cardiometabolic effects and improvements of kidney function. Liraglutide and semaglutide have demonstrated clinically meaningful efficacy in adolescents, leading to FDA and EMA approvals for patients ≥12 years. Ongoing trials are being conducted to combine GLP-1 analogues with other effective molecules or with bariatric surgery. Current evidence on safety most frequently highlights gastrointestinal adverse events, with no consistent impact on growth or pubertal development reported to date. Psychosocial dimensions, including stigma, mental health risks, and potential disordered eating, together with economic barriers and disparities in access, require careful consideration and efforts to be overcome. Implementing intensive lifestyle interventions is mandatory, including nutritional education, physical activity promotion, and family-based behavioral strategies, to support long-term weight management and address the broader determinants of health. Preliminary studies suggest complementary roles for GLP-1RAs alongside metabolic bariatric surgery in selected high-risk patients. Long-term data on safety and multidisciplinary approaches are required to define the optimal integration of pharmacotherapy into comprehensive, family-centered pediatric obesity care models.