Prescribing of GLP-1 Receptor Agonists for Adolescents with Obesity and Associated Disparities

Abstract This retrospective cohort study examined national prescribing patterns of glucagon like peptide 1 receptor agonists (GLP1RAs) for U.S. adolescents with obesity using electronic health record data from over 2 million patients aged 12 to 17 years between 2021 and 2025. Among eligible adolescents, only 0.9 received a GLP1RA prescription, though use increased after semaglutide approval in December 2022, with semaglutide rapidly surpassing liraglutide and off-label tirzepatide use rising by 2025. Prescribing was strongly associated with clinical and sociodemographic factors: adolescents with severe obesity were more likely to be prescribed, while males, Hispanic/Latino and non Hispanic Black youth, non English/Spanish speakers, those living in rural or socioeconomically disadvantaged areas, and those with Medicaid or self pay coverage were significantly less likely to receive prescriptions. These findings highlight growing uptake of GLP1RAs but reveal substantial disparities in access, suggesting insurance barriers and structural inequities may limit availability for groups disproportionately affected by obesity. Competing Interest Statement Dr. Ross currently receives research support through Yale University from Johnson and Johnson to develop methods of clinical trial data sharing, from the Food and Drug Administration for the Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation (CERSI) program (U01FD005938), from the Greenwall Foundation, and from Arnold Ventures. Dr. Krumholz, in the past three years, has received options for Element Science and Identifeye and payments from F-Prime for advisory roles. He was a co-founder of and held equity in Hugo Health. He is a co-founder of and holds equity in Refactor Health and ENSIGHT-AI. He is a co-founder of medRxiv and is on the Board of openRxiv (non-paid, volunteer). He is associated with research contracts through Yale University from Janssen, Kenvue, Novartis, and Pfizer. Dr. Lu reported receiving grants from NHLBI, PCORI, Novartis, and Sentara Research Foundation outside the submitted work. No other disclosures were reported. Funding Statement Dr Sharifi is supported by the National Institute on Minority Health and Health Disparities under award R01MD014853 and by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award R01HL151603. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Conflicts of Interest Disclosure Dr. Ross currently receives research support through Yale University from Johnson and Johnson to develop methods of clinical trial data sharing, from the Food and Drug Administration for the Yale-Mayo Clinic Center for Excellence in Regulatory Science and Innovation (CERSI) program (U01FD005938), from the Greenwall Foundation, and from Arnold Ventures. Dr. Krumholz, in the past three years, has received options for Element Science and Identifeye and payments from F-Prime for advisory roles. He was a co-founder of and held equity in Hugo Health. He is a co-founder of and holds equity in Refactor Health and ENSIGHT-AI. He is a co-founder of medRxiv and is on the Board of openRxiv (non-paid, volunteer). He is associated with research contracts through Yale University from Janssen, Kenvue, Novartis, and Pfizer. Dr. Lu reported receiving grants from NHLBI, PCORI, Novartis, and Sentara Research Foundation outside the submitted work. No other disclosures were reported. Funding/Support Dr Sharifi’s research is supported by the National Institute on Minority Health and Health Disparities under award R01MD014853 and by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award R01HL151603. Role of the Funder/Sponsor The funders had no role in the design and conduct of this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Data Availability All data produced in the present study are available upon reasonable request to the authors