GLP-1 Receptor Agonists in Adolescents with Severe Obesity.

Abstract

This commentary examines the role of GLP-1 receptor agonists (GLP-1 RAs) in adolescents with severe obesity, focusing on the intersection between metabolic benefit and mental health vulnerability. Recent trials demonstrate significant reductions in BMI and improvement in cardiometabolic outcomes among adolescents treated with GLP-1's, leading to inclusion in contemporary paediatric obesity guidelines. However, concerns remain regarding long-term psychological and neurodevelopmental effects, particularly as many clinical trials exclude young people with psychiatric comorbidity. Adolescents with obesity frequently experience anxiety, depression, weight stigma, disordered eating, and Adverse Childhood Experiences (ACEs), all of which may influence treatment engagement and outcomes. This article highlights the need for careful multidisciplinary assessment prior to initiating pharmacotherapy. We argue that prescribing decisions should extend beyond BMI alone and incorporate psychological wellbeing, eating disorder risk, social context, and family capacity to ensure safe, equitable, and developmentally appropriate obesity care.