Liraglutide and semaglutide have achieved FDA and EMA approval for adolescents aged 12 and older, demonstrating clinically meaningful reductions in BMI and body weight alongside cardiometabolic and renal benefits. Critically, current safety data show no consistent disruption to growth trajectories or pubertal development, with gastrointestinal adverse events remaining the dominant side effect profile — mirroring patterns observed in adult trials.
The approval of GLP-1 receptor agonists for adolescents marks a genuine inflection point in pediatric obesity medicine, a field that has historically relied almost entirely on lifestyle interventions with modest long-term success rates. Adult GLP-1RA trials like STEP and SUSTAIN established the mechanistic and efficacy foundation; pediatric extrapolation, while logical, carries inherent uncertainties around a developing neuroendocrine axis, bone density, and gut microbiome maturation — none of which are fully characterized here. The absence of reported pubertal disruption is reassuring but should not be mistaken for a clean safety bill: trial durations in adolescents have been short, cohorts small, and follow-up insufficient to detect subtle developmental effects. The authors rightly flag psychosocial risks — disordered eating patterns may be amplified rather than resolved by pharmacological appetite suppression in vulnerable adolescents. Practically, these agents should be positioned as adjuncts to intensive family-centered lifestyle programs, not replacements. This review is confirmatory and clinically useful, but the field urgently needs longer-term, adequately powered pediatric RCTs before widespread adoption is appropriate.