Efficacy and safety of GLP-1 receptor agonists for adolescents and children with obesity: a meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the efficacy and safety of glucagon-like peptide-1 (GLP-1) receptor agonists in the treatment of obesity among children and adolescents. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared GLP-1 receptor agonists with placebo in children and adolescents with obesity. Literature retrieval, study selection, and data extraction were performed according to the PRISMA guidelines. Pooled mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using RevMan 5.3 software. RESULTS: Fourteen RCTs comprising 1349 participants were included, with 810 patients assigned to GLP-1 receptor agonist treatment (liraglutide [ = 317], exenatide [ = 125], semaglutide [ = 265], dulaglutide [ = 103]) and 539 to placebo. Compared with placebo, GLP-1 receptor agonists significantly reduced body weight (MD = -4.50; 95% CI: -6.40 to -2.60;  < 0.0001), body mass index (BMI) (MD = -1.65; 95% CI: -2.05 to -1.26;  < 0.00001), hemoglobin A1c (HbA1c) (MD = -0.34%; 95% CI: -0.63 to -0.05;  = 0.02), and fasting blood glucose (MD = -0.21; 95% CI: -0.41 to -0.01;  = 0.04). The overall incidence of adverse events was similar between groups, with no significant difference in serious adverse events. However, gastrointestinal adverse events were more frequent in the GLP-1 receptor agonist group. CONCLUSIONS: GLP-1 receptor agonists are effective in reducing weight and improving glycemic parameters in children and adolescents with obesity, with an acceptable safety profile. Variations in efficacy may exist among different agents within the drug class. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12902-026-02248-4.