Across the span of a few years, a quiet gap opened in how American society cares for its youngest people struggling with severe weight. Medicines that once seemed out of reach arrived for teenagers, and an older surgical path that had been proven safe and effective continued to wane, yet the great majority of adolescents who met the medical criteria for treatment were left with neither. Researchers at Lurie Children's Hospital in Chicago, tracing electronic records of more than 1.4 million eligible teens through 2025, have made visible a truth that new possibilities alone cannot cure: a cure t
Most Eligible U.S. Teens Receive Neither GLP-1 Drugs Nor Bariatric Surgery, Lurie Study Finds
More than 1.29 million eligible adolescents with obesity received neither recommended treatment, leaving them without evidence-based care.
Nine out of 10 eligible teens received neither treatment.
Mark
The headline number is 90.4 percent receiving neither treatment. How was that group defined?
Mimi
They were teens in electronic health records, more than 1.4 million of them, who met guideline-based eligibility for metabolic and bariatric surgery between 2017 and 2025. By late 2025, over 1.29 million had received neither surgery nor a GLP-1.
Luke
Worth noting that the 90.4 percent is a snapshot at the fourth quarter of 2025. The 4.6 percent with a GLP-1 prescription and under 1 percent with surgery cover the whole period.
Mark
So surgery fell while drug prescribing soared. Is that cause and effect?
Mimi
Dr. Rode says the 29 percent drop in surgery coincided with semaglutide's approval for teens 12 and older in late 2022. That timing is the link he draws.
Luke
Coincided is the key word. The study shows timing, not that families chose drugs instead of surgery. And the 35-fold rise in prescribing started from a very low base of 301 per 100,000.
Mark
What about the insurance gap?
Mimi
Privately insured teens were prescribed GLP-1s at 2.4 times the rate of uninsured or self-pay patients by late 2025. Surgery rates were similar across insurance groups.
Luke
Dr. Rode says the findings raise concern about widening inequities. That's a concern, not a demonstrated widening, since the data show a snapshot of difference, not a trend in the gap.
Mark
And why are so many untreated?
Mimi
The authors say they don't know. Dr. Rode says the data indicate those who qualify likely lack access, and he calls for research into the reasons.
Luke
Right, "likely" is doing work there. Access is the hypothesis, not a finding.
El Pulso
- More than 1.29 million eligible American teens received neither a GLP-1 prescription nor weight-loss surgery by late 2025, a silent majority left untreated.
- GLP-1 prescribing surged 35-fold while bariatric surgery fell about 29% after semaglutide's adolescent approval, reshaping care in a single stroke.
- Privately insured teens received GLP-1 drugs at 2.4 times the rate of uninsured peers, raising fears that new medicines could deepen existing inequities.
- Researchers are pressing for answers to why access remains so scarce, and whether GLP-1s might work alongside surgery rather than replace it.
Across the span of a few years, a quiet gap opened in how American society cares for its youngest people struggling with severe weight. Medicines that once seemed out of reach arrived for teenagers, and an older surgical path that had been proven safe and effective continued to wane, yet the great majority of adolescents who met the medical criteria for treatment were left with neither. Researchers at Lurie Children's Hospital in Chicago, tracing electronic records of more than 1.4 million eligible teens through 2025, have made visible a truth that new possibilities alone cannot cure: a cure that exists on paper does not always reach the person who needs it.
By the end of 2025, more than 1.29 million American teenagers who qualified for weight-loss treatment had received nothing at all. Neither a surgical operation nor a prescription for one of the newer GLP-1 drugs had reached them. That figure, 90.4 percent of the group studied, is the central finding of a study from Ann & Robert H. Lurie Children's Hospital of Chicago, published in JAMA Pediatrics.
The team, led by first author John B. Rode, MD, MS, set out to understand how two developments in adolescent obesity care relate to one another. One is long-term evidence that bariatric surgery is safe and effective for teenagers. The other is the FDA's approval of GLP-1 medications for this age group. Justin Ryder, PhD, served as senior author. The researchers examined electronic health records for over 1.4 million U.S. adolescents who met guideline-based criteria between 2017 and 2025.
GLP-1 prescribing climbed dramatically, rising thirty-five-fold, and was highest among teens with the most severe obesity. Surgery moved in the opposite direction, peaking around 2022 and then falling roughly 29 percent. Dr. Rode noted that the decline coincided with semaglutide's approval for adolescents in late 2022.
Yet the rise of one treatment and the fall of the other concealed how few teens received either. Across the whole period, less than 1 percent underwent surgery, and 4.6 percent received at least one GLP-1 prescription. Insurance status revealed a stark gap: privately insured teens were prescribed GLP-1s at 2.4 times the rate of uninsured patients. Dr. Rode expressed concern that these newer medications could be widening existing inequities in care.
The study cannot explain why so many eligible teens go untreated, and the authors consider that the most urgent question still open. Dr. Rode called for research into how GLP-1s might reshape obesity care, including a possible complementary role alongside surgery, and into the barriers that keep evidence-based treatment out of reach.
By the last quarter of 2025, more than 1.29 million American teenagers who qualified for weight-loss surgery had received no treatment for obesity at all: no operation, and no prescription for one of the new GLP-1 drugs. That figure, 90.4 percent of the group studied, is the central finding of research from Ann & Robert H. Lurie Children's Hospital of Chicago, published in JAMA Pediatrics.
The team, led by first author John B. Rode, MD, MS, a fourth-year resident physician at Lurie Children's, set out to examine how two developments in adolescent obesity care relate to each other. One is long-term evidence that bariatric surgery is safe and effective in teenagers. The other is FDA approval of GLP-1 medications for this age group. Justin Ryder, PhD, was senior author. He is Vice Chair of Research in the Department of Surgery at Lurie Children's and an Associate Professor of Surgery and Pediatrics at Northwestern University Feinberg School of Medicine.
The investigators analyzed electronic health records for more than 1.4 million U.S. adolescents who met guideline-based eligibility criteria for metabolic and bariatric surgery between 2017 and 2025. Use of GLP-1 drugs, including semaglutide and liraglutide, rose dramatically over that period. Overall prescribing climbed from 301 prescriptions 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.
Surgery moved the other way. Bariatric procedures among eligible adolescents rose steadily from 2017 through 2022, peaking at 189 per 100,000 eligible teens. After that, they fell about 29 percent through the end of 2025. Dr. Rode noted that the decline coincided with the FDA's approval of semaglutide for adolescents aged 12 and older with obesity, which came in late 2022.
Yet the rise of one treatment and the fall of the other mask how few teens received either. Across the whole study period, less than 1 percent of the 1.4 million eligible adolescents underwent surgery, and 4.6 percent received at least one GLP-1 prescription. "Nine out of 10 adolescents who qualified for bariatric surgery received neither treatment" over the span from 2017 to 2025, Dr. Rode said. He added that, although safe and effective treatments now exist, the data suggest those who qualify likely lack access to them.
Insurance status showed a gap. By late 2025, privately insured adolescents were being prescribed GLP-1 drugs at 2.4 times the rate of uninsured or self-pay patients, and at modestly higher rates than publicly insured patients. Bariatric surgery rates, by contrast, were similar across insurance groups. Dr. Rode said the findings raise concern that the newer medications could be widening existing inequities in care.
The study does not explain why so many eligible teens go untreated, and the authors say that is the most important question left. Dr. Rode called for further research on how GLP-1s may reshape obesity care, including a possible complementary role alongside surgery, and on the reasons behind the lack of access to evidence-based treatment, so that patients get the care they need. The work was supported by the National Cancer Institute under award T32CA247801.
Citas Notables
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.— John B. Rode, MD, MS, first author, Lurie Children's
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