What Happened
A Northwestern Medicine study published Nov. 2 in JAMA Pediatrics reports that 90.4% of U.S. adolescents who met guideline-based criteria for metabolic and bariatric surgery had received neither surgery nor a GLP-1 prescription by the fourth quarter of 2025. Investigators analyzed electronic health records for more than 1.4 million adolescents between 2017 and 2025.
The trend lines move in opposite directions. Surgery use climbed steadily from 2017, peaking at 189 procedures per 100,000 eligible teens in 2022, then fell about 29% through the end of 2025 — a decline the authors associate with FDA's late-2022 approval of semaglutide for adolescents aged 12 and older with obesity. Over the full study period, fewer than 1% of eligible adolescents underwent surgery, while 4.6% received at least one GLP-1 prescription.
"Nine out of ten adolescents who qualified for bariatric surgery received neither treatment throughout the whole study period," said John B. Rode, the study's lead author. "Even though we've developed safe and effective treatments for obesity in adolescents, the data indicate that those who qualify likely don't have access to these treatments."
Who Is Affected
Prescribing tracked insurance status. By late 2025, privately insured adolescents received GLP-1 prescriptions at 2.4 times the rate of uninsured or self-pay patients, and modestly higher than publicly insured patients. Surgery rates were similar across insurance groups — a contrast the authors read as evidence that the medication pathway, not the surgical one, is where coverage gaps bite.
Timeline
- 2017–2022: Bariatric surgery use among eligible adolescents rises to a peak of 189 procedures per 100,000
- Late 2022: FDA approves semaglutide for adolescents 12 and older with obesity
- 2023–2025: GLP-1 prescribing reaches 10,676 per 100,000, a 35-fold increase from 301 per 100,000 in early 2017; surgery falls roughly 29%
- Q4 2025: 1.29 million eligible adolescents — 90.4% of the study population — have received neither treatment
- Nov. 2, 2026: Findings published in JAMA Pediatrics
What This Means for Researchers
The study measures uptake, not outcomes, and it cannot say why a given adolescent went untreated. Two explanations dominate: genuine barriers — cost, prior authorization, thin pediatric obesity specialist capacity — and clinical inertia, where eligibility criteria are not acted on in routine visits.
There is a third possibility the dataset can barely see. Because the analysis draws on health-system records, GLP-1 prescriptions filled outside the network, and any unapproved product obtained through telehealth or gray-market channels, would not register. The 4.6% treatment figure is therefore a floor for real-world exposure, not a ceiling. That matters for pediatric safety surveillance: if families are bypassing the formal system, the adverse events will surface somewhere other than the clinic.
The open question is whether GLP-1s are substituting for surgery, delaying it, or being started and then abandoned.
How to Verify Your Peptides
For families considering an unapproved GLP-1 — retatrutide and cagrilintide cannot lawfully be used in compounding — third-party testing is the only check that matters. Our guides on how testing works and identity, purity, and fill weight explain what a certificate of analysis should contain, and why an HPLC purity number without mass-spec identity confirmation is not sufficient.
Safe Alternatives
In this age group the evidence-backed options are the two FDA-approved GLP-1s plus metabolic and bariatric surgery, which carries the longer adolescent safety record. Background on each compound is in our peptide library — see semaglutide and liraglutide — and any vendor claiming to supply a pediatric-appropriate product should be checked against our vendor directory.
Sources
- Peer-reviewed study, JAMA Pediatrics, Nov. 2, 2026
- Regulatory approval records, U.S. Food and Drug Administration
- Academic medical center research announcements