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GLP-1 drugs have rapidly taken over obesity treatment for adolescents and young adults, while bariatric surgery has fallen sharply. A retrospective study of over 200,000 patients aged 13–25 found GLP-1-only use jumped from 88.2% to 96.1% between 2022 and 2026, while surgery dropped from 11.6% to just 3.7%. Experts warn that evidence-based guidance for sequencing these therapies in youth is still urgently needed.
GLP-1 receptor agonists have taken the obesity treatment world by storm — and a new large-scale study confirms that trend is hitting the pediatric space hard. A retrospective analysis of 204,148 adolescents and young adults (ages 13–25) treated for obesity between May 2022 and January 2026 found a dramatic shift away from metabolic and bariatric surgery (MBS) toward GLP-1 drugs, published in JAMA Pediatrics.
Researchers used Epic Cosmos — an EHR database covering over 300 million U.S. patients — to track treatment patterns. The shift was stark: GLP-1-only use climbed from 88.2% to 96.1%, while surgery fell from 11.6% to 3.7%. Combination therapy (GLP-1 + surgery) remained rare at just 0.2%, and among those who received both, 72.3% started GLP-1s before surgery. Lead researcher Dr. Sarah Messiah noted that while surgery has the strongest long-term evidence base, fears of the OR, insurance gaps for GLP-1s in adolescents, and patient preference are all driving the shift.
By the Numbers:
Why it matters: With GLP-1 approvals expanding into the pediatric space and real-world use already outpacing clinical guidance, clinicians are making sequencing decisions without a roadmap. This study is a wake-up call for the field to develop evidence-based protocols for combining or sequencing GLP-1s and surgery in young patients — before practice gets too far ahead of the science.
