Abstract Objective To critically discuss evidence from randomised clinical trials investigating efficacy of glucagon like peptide 1 receptor agonists in paediatric population and highlight important gap in knowledge while anticipating planned sponsored and investigator-initiated study. Methods Expert’s non-systematic revision of the literature and opinion. Results and conclusion Intensive health behaviour and lifestyle treatment (IHBLT) remains the foundation of care; however, obesity management medications (OMMs), i.e. glucagon-like peptide-1 receptor agonists (GLP-1 RAs), are increasingly integrated into management strategies for selected youth with moderate to severe obesity. While reductions in BMI z-score have been found as clinically meaningful thresholds associated with cardiometabolic improvement, efficacy assessment must extend beyond weight-centric metrics to include amelioration of comorbidities, mental health outcomes, quality of life, and social functioning. Current limitations include short trial duration, heterogeneity in outcomes, absence of head-to-head comparisons, and limited long-term safety data, particularly regarding growth, pubertal progression, bone health, and neurocognitive development. Ongoing sponsored and investigator-initiated studies are expected to fill important gap in knowledge informing safety in younger children, and exploring differential responses in specific phenotypes, including youth with polycystic ovary syndrome or metabolic-associated steatotic liver disease. Adherence and long-term engagement are critical challenges in adolescent populations, underscoring the need for patient-centred care, shared decision-making, and structured frameworks such as the 5As approach. Robust paediatric-specific evidence is required to guide prioritization, treatment algorithms, and personalization of OMM therapy. A balanced, holistic, and evidence-based approach is required to optimize outcomes and reduce lifelong obesity-related morbidity.
Equitani et al. (Tue,) studied this question.