Severe cases account for 94% of GLP-1 prescriptions to obese children aged 8 to 11

According to the author's account of the study in STAT, the 0.6% share comes to about 21,000 children ^[1]. The op-ed does not give the 2019 count, so the starting point of the 310-fold multiple is unknown ^[4]. A prescription count also measures orders written. A child who stops the drug after a month counts the same as one who stays on it. For scale, the author notes that 20% of US children have obesity ^[12].

The result the author calls reassuring is where those prescriptions went. With 94% going to children with severe obesity ^[10], the remaining 6% is roughly 1,300 children ^[2]. No GLP-1 drug is approved below age 12, so every one of these prescriptions was written off-label ^[3].

Those figures describe how prescribers behave. They show pediatricians keeping the drugs for the sickest children. Safety is a separate question, and the author leaves it open. Broader use in less severe cases, the author wrote, "is not justified without long-term data on how these medications impact growth and puberty" ^[7].

The case for treating early rests on what untreated obesity does later. The author, a transplant surgeon, writes that many patients now in their 30s and 40s have organ failure that traces back to childhood obesity ^[1]. Adolescents with severe obesity are up to nine times more likely to develop chronic kidney disease in young adulthood, even without diabetes or hypertension ^[2]. Childhood fatty liver disease raises mortality risk 40-fold and is the fastest-growing cause of liver transplants in young adults ^[3]. Both are relative risks. They show that severe childhood obesity predicts adult organ disease. Whether a GLP-1 started at age nine changes that course is another question. A study that could answer it would have to follow children from age 8 to 11 into their 30s, about two decades ^[4].

I think the prescribing data support a narrower claim than the word "reassuring" suggests. Clinicians are concentrating these drugs on children who already have obesity's complications, and for those children the argument for treatment rests on disease that is already present. "This number is too low," the author wrote of the 0.6% share ^[9]. Calling the drugs safe for 8-year-olds would go further, and the author's own caveat on growth and puberty stops short of that ^[7].

The author also argues for policy alongside prescriptions: taxing sugar-sweetened beverages, ending tax deductions for advertising unhealthy food to children, and improving school nutrition standards ^[13]. The author writes that those three measures have been projected to save more in health care costs than they cost to implement ^[13].