Babak J. Orandi, a transplant surgeon at NYU Langone, is concerned about the young people who do not show up in his clinic until adulthood. His patients in their 30s and 40s have organ failure that can be traced back to weight problems from their youth. Orandi hopes to break that chain before it starts.
A new study from his research team shows a 310-fold rise in GLP-1 receptor agonist prescriptions for children ages 8-11 with obesity since 2019. The figure is striking. Yet the portion of kids who were given the drug is still very small.
The Numbers Behind the Alarm
Orandi’s study covered over 3.5 million children aged 8 to 11 who had obesity. Just 0.6% of them got a GLP-1 prescription. Most children with serious obesity and related health problems never got one.
His central point rests on a small figure. It is not a caution about a child requiring a liver transplant. Instead, it warns that the system itself has failed to assist children who plainly need help.
A closer look at the numbers reveals a more complex story. Of those children who received the prescription, 94% carried severe obesity. These young people were already suffering from adult conditions, including sleep apnea, prediabetes, hypertension, metabolic dysfunction-associated steatotic liver disease (previously “fatty liver disease”), and hyperlipidemia.
Why Transplant Surgeons Study Obesity
Orandi’s patients are getting younger. Many are in their 30s and 40s, adults whose organ failure can be traced back to childhood obesity. And obesity itself can be a barrier to transplant, compounding the crisis it created.
His clinical practice led him into both obesity medicine and health services research. Adolescents with severe obesity face up to nine times the odds of developing chronic kidney disease in young adulthood, regardless of whether they have diabetes or hypertension. Childhood fatty liver disease raises mortality risk 40-fold and has become the fastest-growing reason for liver transplants among young adults.
His aim was to reach patients before they require a transplant, which led him to seek extra training in obesity medicine.
The Public Reaction to GLP-1s
The American Academy of Pediatrics published obesity management guidelines that included recommendations about GLP-1s in 2023, and the public response was immediate and strong. Orandi recognizes the unease. People find the notion of a child receiving an injection for weight loss troubling, touching upon a deep wish to keep children innocent and unburdened by adult cares.
The numbers reveal a far more complex situation than a simple narrative would suggest. Medication for obesity is not given to most children with the condition; it is reserved for a subset with severe obesity and serious health problems.
“The prescription is not the beginning of medicalization; it is the response to childhood medicalization already underway.”
The quotation sums up his core point: children with obesity complications have already had their childhood turned into a medical issue — not because of a doctor’s decision, but because of the environment that caused their illness. Left alone, their path moves toward an adulthood that is just as thoroughly medicalized.
What the Data Actually Show
The 310-fold increase is striking. But the actual prescribing rate is small. Among millions of children with obesity, only a few thousand got the medication.
A number of medications belonging to the GLP-1 class have won approval for treating obesity in people aged 12 and above. No such drug has yet been cleared for use in younger children. If the FDA were to approve a GLP-1 drug for that younger group, it could extend insurance coverage further and work toward closing the access gaps that Orandi’s research identified.
There is also room for wider, more liberal use in less serious cases, though that would not be justified until there is long-term information about how these medications affect growth and puberty. That is a genuine worry. However, the current evidence shows that doctors are not prescribing GLP-1s carelessly.
Systems Built for Obesity
Several forces combined to bring us to this point. Kids spend their early years in places where moving around is discouraged, surrounded by heavily processed foods pushed at them through marketing, and living with parents weighed down by rising costs, food shortages, and a lack of free time. We’ve constructed a world that generates obesity with striking efficiency.
Three policies stand at the center of Orandi’s argument for broader reform. He names them as the path toward the kind of lasting change he seeks.
| Policy | Effect |
|---|---|
| Tax sugar-sweetened beverages | Projected to save more in health care costs than its cost to implement |
| End tax deductions for advertising unhealthy food to children | Projected to save more in health care costs than its cost to implement |
| Improve school nutrition standards | Projected to save more in health care costs than its cost to implement |
All three policies have been projected to generate savings in health care costs that exceed their cost to put into effect.
The choice between fixing the food system and treating children is not what he is proposing. He describes it as a false binary that leads to therapeutic nihilism. Instead, he argues both efforts must occur at the same time.
Moving Upstream
Orandi chose to become an obesity medicine physician so that he could work upstream of the end-stage organ disease process. His goal is to encounter his patients at the start of their health journey instead of waiting until the final chapter.
He admits the danger of turning childhood into a medical condition. Yet he contends that the young people suffering from obesity’s consequences have already been made into patients by the world around them. The remedy follows from that situation, rather than creating it.
He presents the two goals as working together, not against each other. Caring for children already affected by obesity while altering the systems that caused it is how we stop more young adults from being added to the transplant waiting list.
The Bottom Line
In one respect, the numbers about GLP-1 drugs are comforting: physicians are not prescribing these medicines to a large number of young people. Yet in another respect, the picture is troubling: far too many children who suffer from serious obesity are not receiving the treatment they require.
Orandi makes the case for working on two fronts at once: fixing the systems that create obesity and providing evidence-based treatment to children who already suffer from it. His position is clear: do not deny these children care. Instead, he argues, give them what they need while demanding change.
This is a careful stance. It honors parental worries while placing trust in the evidence. It notes the dangers of medicalizing youth without overlooking the damage that has already occurred.
Young adults fill the transplant waiting list with a condition that could have been avoided. Orandi hopes to halt the list’s expansion entirely. His research reveals where the trend stands today.
Source material: “Opinion: I studied GLP-1 use in children. The results are reassuring,” STAT.
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