9 in 10 Teens Who Qualify for Weight Loss Surgery Receive Neither Surgery nor GLP-1s

Teens with obesity have more treatment options than ever, including weight loss surgery with long-term safety data and GLP-1 medications approved for adolescents. Yet a new study found that most eligible teens are receiving neither.

The study, led by researchers at Ann & Robert H. Lurie Children’s Hospital of Chicago and published in JAMA Pediatrics, found that about 9 in 10 adolescents who qualified for weight loss surgery received neither surgery nor a GLP-1 medication from 2017 through 2025.

Two major developments in teen obesity care

“The motivation behind our paper was to look at the relationship between two exciting developments in the treatment of obesity in adolescence,” said first author John B. Rode, M.D., M.S., a fourth-year resident physician at Lurie Children’s. “The first is long-term evidence for the safety and efficacy of bariatric surgery in adolescents, and the other is FDA approval of GLP-1s in this age group.”

The researchers analyzed electronic health records from more than 1.4 million U.S. adolescents who met guideline-based criteria for metabolic and bariatric surgery between 2017 and 2025.

Surgery declined as GLP-1 prescriptions soared

Bariatric surgery among eligible teens rose steadily from 2017 through 2022, reaching a peak of 189 procedures per 100,000 eligible adolescents. After that, rates began to fall.

“Our study found that while bariatric surgery use increased between 2017 and 2022, it subsequently decreased about 29 percent through the end of 2025,” Rode said. “This decline coincided with the FDA approval of semaglutide for adolescents aged 12 or older with obesity.”

Over the same period, GLP-1 prescriptions, including semaglutide and liraglutide, rose sharply. Prescribing rates climbed from 301 per 100,000 eligible adolescents in early 2017 to 10,676 per 100,000 by the end of 2025, a 35-fold increase. Rates were highest among teens with the most severe obesity.

Most eligible teens received neither treatment

Despite that growth, few eligible teens received either treatment. During the study period, less than 1% of the 1.4 million adolescents had bariatric surgery, and 4.6% received at least one GLP-1 prescription. By the end of 2025, more than 1.29 million eligible teens, or 90.4% of the study group, had received neither.

“Our findings suggest that 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,” Rode said.

Insurance gaps in access to GLP-1s

The researchers also found differences in access based on insurance. By late 2025, privately insured teens were prescribed GLP-1 medications at 2.4 times the rate of uninsured or self-pay patients, and at a modestly higher rate than teens with public insurance. Bariatric surgery rates, however, were similar across insurance groups.

According to Rode, the findings raise concerns that newer obesity medications could be widening existing inequities in care.

Understanding the barriers to care

Rode said more research is needed to understand how GLP-1 medications may change obesity care for teens, including how they might work alongside bariatric surgery. The biggest priority, he said, is understanding why so many eligible teens aren’t receiving treatment.

“Most importantly, further research is necessary to understand the reasons behind this lack of access to evidence-based treatments, to make sure that patients receive the care that they need,” Rode said.

For families of teens with obesity, the findings are a reminder that effective treatment options exist. Parents can talk with their child’s pediatrician about whether medication, surgery or other approaches might be appropriate.