When it comes to treating childhood obesity, medical decisions rarely happen in a vacuum. For families facing food insecurity, choices about care are shaped not just by medical advice, but by lived experience, cultural values, and trust in the healthcare system.
A recent study published in JAMA Network Open explored how caregivers make decisions about using GLP-1 receptor agonists (GLP-1 RAs), a newer class of medications increasingly discussed as a treatment option for pediatric obesity. Researchers found that caregiver experiences, trust, and family values play a central role in whether medication is considered, accepted, or declined.
As outlined by Contemporary Pediatrics, their findings point to three key areas that matter most in shared decision-making: Understanding barriers to lifestyle change, building trust and knowledge about treatment options, and aligning care with family values.
Why this study matters
Lifestyle changes, such as healthier eating and increased physical activity, have long been the first recommendation for managing childhood obesity. But for many families, especially those with limited access to affordable, healthy foods, these changes can be difficult to maintain and may not lead to significant weight improvement.
GLP-1 medications have gained attention as a possible tool to help bridge that gap. These medications work by affecting appetite and blood sugar regulation, and they’ve shown promise in supporting weight loss. However, families experiencing food insecurity may have unique concerns, priorities, and barriers that influence whether this option feels right.
As the study authors noted:
As new pediatric clinical practices surrounding the use of GLP-1 RAs take shape, it is essential to incorporate the voices of families affected by food insecurity.
How the study was conducted
Researchers interviewed 20 caregivers of children with obesity who were also at moderate to high risk for household food insecurity. All children had already participated in at least two months of physician-recommended dietary changes.
The interviews lasted about 45 minutes and explored knowledge about treatment options, access to healthy foods, motivation and challenges related to lifestyle change, and beliefs about medication use in children.
Most caregivers faced significant structural challenges:
- 90% were born outside the U.S.
- 75% used a language other than English for medical care
- 70% had low health literacy
- 80% of children were insured through Medicaid
These factors are important because they influence how medical information is received, understood, and trusted.
Three themes that shaped decisions
One was past experiences with lifestyle changes. Caregivers who saw noticeable improvements from dietary and activity changes often felt proud and motivated to continue without medication. For these families, lifestyle change felt like the “right” and most natural path.
But for others, months — or even years — of effort brought little visible progress. In those cases, GLP-1 medications seemed like a hopeful next step.
At the same time, many caregivers described serious barriers to maintaining healthy routines, including:
- High cost of fresh foods
- Time-intensive meal planning
- Emotional stress around food and weight
- Family conflict and pressure during mealtimes
Some caregivers described using emotional appeals or strict approaches to motivate their children, which sometimes increased stress across the household.
Trust — or lack of it — also played a huge role. Many caregivers had safety concerns about GLP-1 medications, especially because they are relatively new and frequently discussed in the media. Questions about long-term effects and side effects were common.
Personal experiences mattered as well. One caregiver shared hesitancy due to a past negative experience with weight-related medication. Others were more open if they had seen medications help friends or family members. Trust was mainly shaped by personal or secondhand experiences, cultural beliefs about medication use in children, and clarity (or confusion) in how doctors explained options.
The third item was beliefs about what “good care” looked like. Caregivers differed in how they defined the best way to care for their child. Some prioritized physical health above all, believing lifestyle change was the most responsible and safest path. For them, medication felt like a last resort.
Others placed strong emphasis on their child’s emotional well-being and the overall stress on the family. These caregivers sometimes saw medication as a way to reduce conflict around food, ease emotional strain, and relieve financial and time pressures.
What this means for families and providers
The study highlights that decisions about GLP-1 medications aren’t just medical — they’re deeply personal.
Researchers concluded:
A shared decision-making model and clinical education tools that honor these complexities are essential for delivering care that is both effective and equitable and should be the focus of future research.
For healthcare providers, this means:
- Taking time to understand a family’s lived experience
- Asking about food access and daily challenges
- Exploring concerns about medication openly
- Respecting cultural and personal values
For families, it’s a reminder that:
- It’s okay to ask questions about safety and long-term effects
- Your experiences and priorities matter in treatment decisions
- There is no one-size-fits-all answer
So, the study clearly shows that for children with obesity in families facing food insecurity, treatment decisions are shaped by far more than a prescription pad. Past struggles, financial realities, emotional stress, cultural beliefs, and trust in medicine all come into play.
Your responses and feedback are welcome!
Source: “Themes identified for using GLP-1 RAs to manage obesity in food-insecure children,” Contemporary Pediatrics, 1/21/26
Source: “Perceptions of GLP-1 RA Use for Children With Obesity Among Caregivers With Food Insecurity,” JAMA Network, 1/7/26
Source: “We Need a New Approach to Prevent Obesity in Low-Income Minority Populations,” Pediatrics, 6/1/19
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