A research brief published in Pediatrics on 4 September finds that GLP-1 prescribing to children aged 8 to 11 with obesity rose steeply between 2019 and 2026 while remaining uncommon: across 3,520,531 children in the dataset, 0.6% received a prescription. Every one of those prescriptions was off-label. The three drugs counted are labelled from age 12 (Wegovy injection, Saxenda) or for adults only (Zepbound). Prescriptions clustered in children who already had an obesity-related condition, and were less likely to reach children living in the most socially vulnerable areas.
What the study counted
The design is a retrospective cross-sectional study of repeated annual cohorts drawn from Epic Cosmos, the aggregated electronic-health-record dataset built from health systems running Epic. The window runs from 1 January 2019 to 17 June 2026, and the population is children aged 8 to 11 with obesity and without diabetes — 3,520,531 of them. Three drugs were counted: Saxenda (liraglutide), Wegovy (semaglutide) and Zepbound (tirzepatide).
The gradients are the most useful part, and the authors report them per 10,000 children. Eleven-year-olds were prescribed at 79.5 per 10,000 against 41.5 for eight-year-olds. Girls were at 75.9 against 42.8 for boys. Children in areas of low social vulnerability were at 76.1, against 49.2 in areas of high vulnerability. The widest single gap is clinical rather than demographic: children who already had an obesity-related condition were prescribed at 188.9 per 10,000, roughly three times the pooled rate of about 60 per 10,000 that 0.6% works out to. On the trend itself, the authors report prevalent prescribing rising from 0.03% in 2019 to 9.3% in 2026, which they describe as a 310-fold increase (P < .001).
The ceiling matters more than the multiplier
A 310-fold increase is a headline, but it starts from almost nothing — three children per 10,000 in 2019. The figure that describes the situation now is the ceiling: 0.6% across the study period, and 1.9% even in the subgroup carrying the most cardiometabolic risk. The authors read that as clinicians reserving these drugs for the children who are worst off, and the comorbidity number supports the reading.
The off-label point is worth stating plainly, because the abstract does not. We checked the three current labels on DailyMed. Wegovy injection is indicated for weight reduction in adults and patients aged 12 years and older with obesity (label revised June 2026). Saxenda is indicated in adults and patients aged 12 and older who weigh more than 60 kg and have obesity (revised June 2026). Zepbound is indicated in adults, and its label states that safety and effectiveness in pediatric patients have not been established (revised 28 August 2026). Prescribing any of the three to an eight-year-old is a clinician’s off-label judgement, not a labelled use — which is the background to everything else on our GLP-1 medications page.
The socioeconomic gradient runs opposite to need. Children in the most vulnerable areas were prescribed at roughly two-thirds the rate of those in the least vulnerable ones, in a population selected for already having obesity. That pattern is what coverage rules, prior authorization and out-of-pocket price produce, and it is the same friction we document on GLP-1 cost without insurance.
The full text sits behind a $36 paywall; we read the abstract on the publisher’s page and on PubMed, and did not buy the article. That matters, because two of the reported figures do not reconcile from the abstract alone. A pooled rate of 0.6%, with per-10,000 rates topping out at 188.9 — that is 1.9% — is hard to square with 9.3% in the final year, and 0.03% to 9.3% is exactly the 310-fold the authors cite, so the multiplier does not settle which number is off. It could be a partial-year denominator, a different base, or a typographical error. We cannot resolve it without the full text and will not guess. Two further limits are structural: Epic Cosmos captures prescriptions written inside participating systems, not fills, adherence or what a family paid; and a cross-sectional design says nothing about weight, growth or side effects in these children.
Sources: Babak J. Orandi, Suhani S. Patel, Mary Jo Messito, Michal A. Mankowski, Dorry L. Segev and Allan B. Massie, “Trends in GLP-1 Receptor Agonist Prescriptions for Children Ages 8 to 11 With Obesity: 2019–2026”, Pediatrics, published 4 September 2026 (abstract also on PubMed). Prescribing information via DailyMed: Wegovy, Saxenda and Zepbound.
