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July 20, 2026 – Adolescents and young adults in the U.S. are increasingly using popular GLP-1 weight-loss drugs alone or in conjunction with metabolic and bariatric surgery (MBS) to manage obesity, according to a study by UT Southwestern Medical Center researchers published in JAMA Pediatrics
Severe obesity among adolescents and young adults has increased substantially over the past two decades, currently affecting about 9% of people between ages 12 and 18. Among adults, the rate of severe obesity increased from 5% to 10%
To assess how the availability of glucagon-like peptide-1 receptor agonists (GLP-1RAs) has shifted clinical approaches to obesity management within that population, researchers analyzed records from more than 204,000 13- to 25-year-olds treated for obesity between May 2022 and January 2026 in Epic Cosmos, a U.S.-based electronic health record database
Sarah Messiah, Ph.D., M.P.H., is Professor of Epidemiology and Associate Dean for Research in the Peter O’Donnell Jr. School of Public Health at UT Southwestern. She is also a Professor of Pediatrics and Director of the UTSW Child and Adolescent Population Health Program.
“This research is the first national-scale Epic Cosmos analysis, to our knowledge, to characterize real-world use of combined GLP-1RA therapy and MBS among adolescents and young adults with obesity,” said lead author Sarah Messiah, Ph.D., M.P.H., Professor of Epidemiology and Associate Dean for Research in the Peter O’Donnell Jr. School of Public Health at UT Southwestern
In 2025, Dr. Messiah’s team published another study using a different database that found weight-loss surgery rates had increased 15% among adolescents and young adults in the U.S. between 2021 and 2023. However, subsequent approval of certain GLP-1RAs for adolescents in December 2022 coincided with changing treatment patterns
The UTSW research revealed that exclusive GLP-1RA use among those treated for obesity in this age group rose from 88.2% between May and November in 2022 to 96.1% between June 2025 and January 2026. At the same time, MBS rates decreased from 11.6% to 3.7%. The study also found that combining surgery and GLP-1RAs in adolescents and young adults held steady at 0.2% during both periods
“Our team’s study captures an inflection point in pediatric obesity treatment,” said Dr. Messiah, who is also a Professor of Pediatrics and Director of the UTSW Child and Adolescent Population Health Program. “While only a small proportion of adolescents and young adults currently receive both therapies, combination treatment was virtually nonexistent before GLP-1 medications became widely available. We’re now seeing clinicians integrate these therapies in different ways as obesity care continues to evolve.”
These findings point to the need to establish evidence-based clinical protocols in this rapidly evolving area of medicine
“The study advances the field by showing that obesity treatment sequencing strategies are already emerging in routine clinical care, even though evidence-based guidance for how to combine or sequence these therapies in youth remains limited,” Dr. Messiah said. “These findings highlight the urgent need for evidence-based guidance for when GLP-1RAs should be used relative to bariatric surgery in adolescents and young adults, including whether medications are most effective before surgery, after surgery, or as part of combination therapy.”
Other UTSW researchers who contributed to this study are senior author Sarah Barlow, M.D., M.P.H., Professor of Pediatrics; Yaser ElNakieb, Ph.D., Senior Data Scientist; Jackson Francis, M.P.H., Population Science Project Coordinator; M. Sunil Mathew, M.S., Senior Population Science Data Manager; Luyu “Amber” Xie, Ph.D., Pharm.D., Assistant Professor of Health Data Science and Biostatistics in the O’Donnell School of Public Health and co-Director of the Biostatistics and Data Science Core; Bethany Cartwright, M.D., Ph.D., Assistant Professor of Pediatrics; Faisal Qureshi, M.D., M.B.A., Professor of Surgery in the Division of Pediatric Surgery; Jaime Almandoz, M.D., M.B.A., Professor of Internal Medicine in the Division of Endocrinology and Medical Director of UTSW’s Weight Wellness Program; and Deepali Ernest, Ph.D., M.P.H., and Subin Jang, Ph.D., M.P.H., postdoctoral researchers.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 28 members of the National Academy of Sciences, 26 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of nearly 3,400 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians in more than 80 specialties care for more than 143,000 hospitalized patients, attend to more than 470,000 emergency room cases, and oversee nearly 5.3 million outpatient visits a year.
