Pediatric Obesity and GLP-1 Agonist Therapy: Clinical Outcomes of Semaglutide (Wegovy) in Adolescents Aged 12+ with Severe Obesity and Metabolic Comorbidities

Abstract

Background: Adolescent obesity represents one of the most pressing public health challenges of the current era. Rates of severe obesity in individuals aged 12 to 17 have increased substantially over the past two decades, with associated metabolic comorbidities including insulin resistance, type 2 diabetes, dyslipidemia, and hypertension presenting at younger ages than previously observed. Pharmacological intervention has historically been limited in this population, but the approval of semaglutide 2.4 mg (Wegovy) for adolescents aged 12 and older by the FDA in 2022 marked a significant expansion in available treatment options.

Objective: This review examines the clinical evidence for semaglutide use in adolescents with severe obesity and metabolic comorbidities, with particular attention to the STEP TEENS trial, safety considerations specific to the pediatric population, and implications for clinical practice in pediatric obesity management. Methods: A narrative review of published clinical trial data, regulatory submissions, and relevant clinical guidelines was conducted. Primary sources included the STEP TEENS randomized controlled trial, FDA prescribing information for semaglutide 2.4 mg in adolescents, and supporting literature on GLP-1 receptor agonist mechanisms in pediatric populations.

Results: The STEP TEENS trial demonstrated that semaglutide 2.4 mg produced a mean reduction in BMI of 16.1% compared to 0.6% in the placebo group at 68 weeks. Approximately 45% of participants achieved a BMI reduction of at least 20%. Improvements were observed across metabolic markers including waist circumference, HbA1c, fasting glucose, and lipid profiles. The side effect profile was consistent with that seen in adult populations, with nausea and vomiting being the most frequently reported adverse events during dose escalation.

Conclusion: Semaglutide represents a clinically meaningful pharmacological option for adolescents aged 12 and older with severe obesity and metabolic comorbidities. Early intervention with effective pharmacotherapy may alter the trajectory of metabolic disease in this population. Ongoing monitoring and individualized clinical management remain essential, and longer-term outcome data in adolescent populations is needed.