A dramatic surge in obesity medication prescriptions among US adolescents has highlighted both progress and persistent barriers in pediatric weight management, according to new data from the CDC's Morbidity and Mortality Weekly Report. Between 2020 and 2023, prescriptions for obesity medications among adolescents aged 12 to 17 years increased by 301.7%, yet only 0.5% of adolescents with obesity received such prescriptions in 2023.
The analysis, based on IQVIA ambulatory electronic medical records data from 526,973 adolescents, reveals significant disparities in access and prescribing patterns that underscore the complexity of addressing pediatric obesity through pharmacological interventions.
Regulatory Approvals Drive Prescription Growth
The prescription surge can be traced to two landmark regulatory changes in 2022: the FDA approvals of phentermine-topiramate extended-release capsules (Qsymia) in June and semaglutide injection 2.4 mg (Wegovy) in December for adolescent use. These approvals expanded the pediatric obesity medication arsenal to four evidence-based options for patients aged 12 and older, joining orlistat injection 120 mg (Xenical), approved in 2003, and liraglutide injection 3 mg (Saxenda), approved in 2020.
The impact was immediate and substantial. Truveta Research data shows that the average rate of first-time semaglutide prescriptions among adolescents was 14.8 prescriptions per 100,000 adolescents in 2024, representing a 1.5-fold increase from 9.9 prescriptions per 100,000 in 2023. Among adolescents with obesity specifically, semaglutide prescription rates increased 88.2% from 2023 to 2024.
By 2023, semaglutide emerged as the most commonly prescribed obesity medication for adolescents, accounting for 57.1% of prescriptions, followed by phentermine or phentermine-topiramate (37.7%), liraglutide (11.9%), and orlistat or setmelanotide (3.3%).
Demographic Disparities Reveal Access Inequities
The CDC analysis revealed concerning disparities in prescribing patterns across demographic groups. In 2023, adolescents were more likely to receive obesity medications if they were female (adjusted prevalence rate 2.05; 95% CI, 1.69-2.49), aged 15 to 17 years (aPR 2.24; 95% CI, 1.83-2.74), and lived in the West (aPR 2.65; 95% CI, 1.68-4.19), South (aPR 2.35; 95% CI, 1.51-3.65), or Midwest (aPR 1.58; 95% CI, 1.03-2.43) regions.
Most concerning were racial disparities in prescribing. Despite Black or African American adolescents having higher rates of severe obesity compared with White or Asian adolescents (50.0% vs 39.0% vs 30.4%, respectively), they received obesity medications at the same or lower rates in 2023 (0.4% vs 0.5% vs 0.4%). These disparities persisted even after controlling for obesity class.
The majority of prescriptions (67.4%) went to adolescents aged 15 to 17 years, with 62.3% prescribed to females and 59.5% to White adolescents. More than half of those receiving prescriptions had severe obesity, classified as class 2 or 3 obesity (82.9%).
Multiple Barriers Limit Access
Several factors contribute to the low overall prescribing rates and demographic disparities. High out-of-pocket costs present a significant barrier, with semaglutide (Wegovy) costing $1,349 for a 28-day supply without insurance. Supply chain issues have also impacted access, with the FDA placing semaglutide on its shortage list in early 2022, only removing it in February 2025.
Insurance coverage remains inconsistent across the healthcare landscape. As recently as 2024, only 44% of US employers with 500 or more employees and 64% with more than 20,000 employees covered weight loss drugs. Complex prior authorization processes create additional hurdles for both providers and patients seeking treatment.
Provider knowledge gaps represent another significant barrier. A 2024 survey found that 34% of pediatricians were unwilling to prescribe obesity medications, while 24% weren't even aware that prescribing guidance was available from the American Academy of Pediatrics.
Clinical Guidelines Emphasize Comprehensive Approach
The 2023 American Academy of Pediatrics guidance on evaluating and treating children and adolescents with obesity contributed to the prescription increase by providing clear recommendations for medication use. However, the guidance emphasizes that medications must complement lifestyle interventions rather than replace them.
"All adolescents with obesity, including those who receive obesity medications, should receive evidence-based health behavior and lifestyle interventions," the CDC report authors wrote, "which can help them and their families build skills that promote healthier nutrition, physical activity, and related behaviors."
This comprehensive approach reflects growing recognition that pharmacological interventions alone are insufficient for addressing the complex nature of pediatric obesity.
Safety Considerations in Adolescent Populations
While the medications show promise for weight management, safety considerations remain paramount in adolescent populations. Common adverse reactions observed in adolescents include headache, abdominal pain, nausea, vomiting, and diarrhea, mirroring those reported in adult populations.
Mental health effects warrant particular attention. While some studies suggest potential benefits—including a 33% reduction in suicidal ideation or attempts over 12 months among teenagers with obesity treated with semaglutide—evidence on suicidality risk remains mixed. The long-term consequences of GLP-1 receptor agonist use in adolescents remain under-researched, highlighting the need for continued monitoring and future safety studies.
Addressing the Treatment Gap
The CDC calls for continued monitoring of medication use and safety to inform treatment guidance development. However, immediate actions could help close existing gaps in care. Prior authorization reforms could streamline access, while partnerships with professional organizations like the American Academy of Pediatrics could improve provider education on prescribing protocols.
Integrating obesity medications into comprehensive healthy weight programs that include lifestyle interventions could improve outcomes while addressing the holistic nature of obesity treatment. Such programs would align with clinical guidelines emphasizing that medications should augment, not replace, behavioral and lifestyle modifications.
The findings serve as a call to action for healthcare leaders to address cost barriers, unconscious bias, and fragmentation in pediatric obesity care. With adolescents having obesity facing greater likelihood of adult obesity and associated comorbidities including hypertension and type 2 diabetes, improving access to evidence-based treatments could yield significant long-term health benefits while reducing the hundreds of billions in obesity-related costs that burden the US healthcare system annually.
