Nearly one in six kids on GLP-1 drugs developed a nutrition deficiency within a year, study finds

Nearly one in six children treated with a GLP-1 drug for weight or diabetes management developed a diagnosed nutritional deficiency within their first year on the medication, according to a study out of Ann & Robert H. Lurie Children’s Hospital of Chicago. Researchers tracked 2,031 patients between the ages of 10 and 17 using national insurance claims data and found that 16.8% of them, roughly one in six, were flagged with at least one nutrient shortfall. The finding arrives as prescriptions for the drug class, which includes Victoza, Saxenda, Trulicity and Ozempic, have climbed among adolescents since regulators began clearing individual medications for pediatric obesity treatment.

A Claims Database Spanning 2,031 Young Patients

The study drew on national administrative insurance claims covering more than 100 million patients between 2017 and 2022, narrowing to the 2,031 adolescents who started a GLP-1 receptor agonist, stayed continuously enrolled, and had no nutrition-related diagnosis on record before treatment began. Liraglutide, sold under the brand names Victoza and Saxenda, accounted for 78.6% of those prescriptions. Dulaglutide, marketed as Trulicity, made up another 10.4%, and semaglutide, the ingredient behind Ozempic and Wegovy, covered the remaining 9.1%. That split tracks almost exactly with how long each drug has held a pediatric obesity indication, with the older medication still doing most of the prescribing even as the newer one draws the bulk of public attention.

Within a year of starting treatment, 16.8% of the children in the sample had been diagnosed with a nutritional deficiency or a related complication, senior author Justin Ryder and five coauthors reported in the journal Childhood Obesity, a figure also detailed in the underlying research summary distributed alongside the paper. Vitamin D deficiency was by far the most common single finding, turning up in 12.4% of patients, and nutritional anemia followed at 1.55%. Ryder holds a joint appointment as vice chair of research in Lurie Children’s Department of Surgery and as an associate professor of surgery and pediatrics at Northwestern University’s Feinberg School of Medicine.

Counseling Lags Behind the Prescription Pad

The same dataset showed a gap between diagnosis and follow-up support. Only 23.3% of the children received documented nutrition counseling within 180 days of starting the medication, and just 5% got that counseling within the first month, the period when appetite suppression from the drugs tends to be most pronounced. “Nutritional support needs to play a critical role once treatment with a GLP-1 medication is initiated,” Ryder said in comments distributed with the study.

Children who did receive documented nutrition support were somewhat more likely to end up with a formal deficiency diagnosis than those who did not, 23.2% versus 14.8%, a pattern the authors read as evidence that the condition goes undetected in unmonitored patients more often than it is caused by monitoring itself. Adolescence is a period when bone and organ systems are still developing, and the authors singled out vitamin D, iron and calcium as nutrients where a shortfall during these years can carry consequences that outlast the deficiency itself.

Two Drugs Cleared for Adolescents, Three Years Apart

Liraglutide became the first of the group approved specifically for teenagers when the Food and Drug Administration cleared Saxenda for patients ages 12 to 17 in 2020, provided they weighed more than 60 kilograms and met a body-mass-index threshold. Semaglutide followed two years later, when the agency approved Wegovy for adolescents 12 and older in December 2022 on the strength of a placebo-controlled trial. That timeline helps explain why liraglutide still accounts for the bulk of pediatric GLP-1 prescriptions in the Lurie Children’s data even though semaglutide, sold as Ozempic for diabetes and Wegovy for weight loss, gets far more attention in adult use.

An Association the Claims Data Cannot Settle

The study cannot show that the drugs directly caused the deficiencies it found. Appetite suppression, a narrower diet, or the underlying weight condition itself could each contribute, and the insurance claims used for the analysis never captured what the children actually ate, only the diagnosis codes their doctors later entered. Kerr, Ryder and their coauthors framed the pattern instead as a sign of gaps in routine care around a drug class that is still new to pediatrics, rather than proof of a direct physiological effect, and they noted that claims data of this kind will always undercount deficiencies that are never tested for in the first place.

That undercount matters because the drugs are not going away. Pediatric use of the class has expanded rapidly since liraglutide’s 2020 clearance, and the study’s authors work in a hospital system, Lurie Children’s, that has watched prescribing volume rise alongside it. Whether pediatricians begin ordering baseline vitamin D and iron panels before writing these prescriptions, or whether professional guidelines catch up with how quickly the drug class has spread among teenagers, the study does not say. For now, the counseling gap it documented, five percent of patients reached within a month, 23.3% within six, remains open.

This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.

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