New Global Review Reveals Key Early-Life Factors Driving Childhood Obesity

A growing body of research has long suggested that the first years of life shape long-term health outcomes. Now, a major new analysis has brought unprecedented clarity to the early-life factors most strongly linked to childhood obesity — and what parents, healthcare providers, and policymakers can do to intervene earlier and more effectively.

According to the review,

A comprehensive new review of 177 global studies has pinpointed the strongest maternal and infant factors linked to childhood obesity in the first 1,000 days of life, offering insights to guide early prevention strategies.

A landmark global analysis

The review, “A major new systematic review, published this month by Obesity Reviews [the link is ours], has identified the most consistent maternal, paternal and infant factors linked to childhood obesity in the first 1,000 days of life.” Conducted by an international team from the Early Nutrition and Long-Term Health Task Force at ILSI Europe, the project represents the most extensive effort to date to map early-life influences on obesity risk.

As the report summarizes,

The researchers screened more than 17,000 publications and analysed 177 studies — including data from over 1.8 million children across 37 predominantly high-income countries. The average childhood obesity prevalence reported across these studies was 11 percent.

Ultimately, “In total, the team identified 23 risk factors consistently associated with a higher likelihood of childhood obesity.”

The strongest early-life risk factors

The findings underscore how maternal health, fetal development, and infant growth patterns collectively shape obesity risk. According to the review, the most influential factors include maternal health, and birth and infancy. In particular, “Higher maternal pre-pregnancy weight, excessive gestational weight gain and smoking during pregnancy.” And “Higher birthweight, being large for gestational age, lack of breastfeeding and rapid infant weight gain” for birth and infancy.

Critical knowledge gaps still remain

Despite the massive scope of the study, researchers warn that significant blind spots remain. As the report notes,

Despite the breadth of available evidence, the authors report several notable research gaps. These include limited study of paternal factors and the preconception period, as well as a lack of research using non-invasive biomarkers. The review also calls for more standardised data collection to support large-scale meta-analyses and more accurate models for predicting childhood obesity risk.

Closing these gaps, the authors say, will be essential for developing more accurate, personalized early-life obesity risk assessments.

Opportunities for earlier and more effective prevention

Research proves that multi-faceted intervention on an earlier side helps prevent childhood obesity. One of the central messages of the review is that intervention must begin before birth, and ideally even earlier. Chair of the expert group, Dr. Romy Gaillard, emphasized the importance of using the first 1,000 days as a window for prevention:

Parents-to-be or parents of newborns are in frequent contact with healthcare workers, and are often motivated to make lifestyle changes that benefit both their own health and the health of their children. Our systematic review provides the most comprehensive overview of family-based risk factors for childhood obesity from preconception to two years of age.

She also notes that improved predictive tools may transform how obesity prevention is delivered:

She added that improved early-life risk assessment, supported by advanced modelling, could help target prevention strategies more effectively.

This landmark review offers the clearest picture yet of how early-life environments shape obesity risk — and how early, targeted interventions may hold the key to reversing global childhood obesity trends. With evidence spanning millions of children and dozens of countries, the message is unmistakable: Supporting families before and after birth is not just beneficial — it is essential.

Your responses and feedback are welcome!

Source: “Risk Factors in the First 1000 Days of Life Associated With Childhood Obesity: A Systematic Review and Risk Factor Quality Assessment,” Obesity Reviews, 11/19/25
Source: “New systematic review reveals strongest early-life risk factors for childhood obesity,” New Food, 11/24/25
Source: “Multi-component school intervention reduces obesity and improves health behaviors in children: a cluster-randomized controlled trial,” Nature.com, 11/18/25
Image by Vanessa Loring/Pexels

The Fast-Changing GLP-1 Landscape and Employee Coverage

GLP-1 medications continue to dominate conversations in the world of employer-sponsored health benefits, and it’s not hard to see why. These drugs have already reshaped care for millions of people living with type 2 diabetes and obesity, delivering meaningful improvements in weight (including in children), cardiovascular health, and overall quality of life. And their reach is expanding fast.

Beyond their well-established role in diabetes and obesity treatment, GLP-1s are now being researched for a wide range of additional conditions — everything from osteoarthritis and Alzheimer’s disease to diabetic complications — and even addiction. As scientific interest grows, so do the complexities employers face in managing pharmacy benefits, projecting future costs, and determining what coverage makes sense. This, of course, directly affects the employees and their families, including their kids.

Let’s take a quick look at the latest developments in the GLP-1 market and what they could mean for employer health programs in the months and years ahead.

Oral GLP-1s are poised to change the market

One of the most anticipated shifts in the weight-loss drug space is the arrival of oral GLP-1 therapies. Oral semaglutide — built on the same active ingredient used in Ozempic, Wegovy, and Rybelsus — is expected to receive approval soon for obesity treatment and for reducing cardiovascular risk in people with obesity. If authorized, it will become the first oral GLP-1 specifically approved for weight management.

Another contender, Lilly’s orforglipron, is expected to receive approval in 2026. Clinical trials show promising results: patients lost roughly 7.8% to 12.4% of their body weight over 72 weeks, only slightly below the outcomes typically seen with injectables.

Because many people prefer pills over injections, oral GLP-1s may boost both uptake and adherence. That likely means increased utilization and higher claims volume. What about pricing? Despite lower manufacturing costs, oral GLP-1s are unlikely to be much cheaper than injectables, and some may even carry a premium due to convenience and strong clinical outcomes.

Generics and new pricing pressures

Cost relief may finally be on the horizon, albeit slowly. Generic versions of Victoza (for diabetes) are already available, and the first generic alternative to Saxenda (for weight loss) has been approved. More generics for Saxenda are expected by March 2026, which should drive prices down.

However, employers won’t see generic versions of the most in-demand injectables (like Ozempic) until at least 2031. Another form of price pressure is emerging: semaglutide products (Ozempic, Wegovy, Rybelsus) appear on Medicare’s 2027 drug price negotiation list. New “Maximum Fair Prices” will be announced in November, and while manufacturers aren’t required to extend discounts to commercial plans, some ripple effects are possible.

What does it mean? Generics won’t dramatically reduce GLP-1 spending in the short term. Medicare negotiations may influence commercial pricing, but the extent is impossible to predict. And employers that currently exclude weight-loss drugs might consider a future “generic-only” benefit once Saxenda generics are plentiful and affordable.

Direct-to-consumer (DTC) models are shaking up pricing

The GLP-1 boom has sparked a wave of direct-to-consumer (DTC) offerings that drastically undercut typical retail prices. Lilly Direct (for Zepbound) and NovoCare (for Wegovy) give patients simplified access and steeply discounted rates. Novo Nordisk even partnered with Costco (yes, Costco) to offer Wegovy at its DTC price through Costco pharmacies. Employers that exclude weight-loss GLP-1s are exploring how to guide employees toward low-cost DTC options without adding these drugs to the plan.

Is this the next “Wonder Drug” class?

GLP-1 therapies continue to earn FDA approvals for conditions beyond diabetes and weight management. Recent developments include Wegovy being approved to treat metabolic-associated steatohepatitis (MASH), and Zepbound being approved for obstructive sleep apnea in people with obesity.

Meanwhile, ongoing trials are evaluating potential use in osteoarthritis, diabetic complications, Alzheimer’s, and addiction — studies that could dramatically widen the patient population in future years.

What does this mean for employer plans?

Employers that already cover GLP-1s for weight loss likely won’t see a large increase in utilization, since the affected populations overlap significantly. Employers that don’t cover weight-loss GLP-1s must make strategic decisions about new indications and potential cost implications, as rebates are typically unavailable unless all FDA-approved indications are covered.

It’s also worth noting that cost-benefit profiles vary widely by condition. In some areas, like MASH, GLP-1s may be cheaper than alternative treatments. In others, such as sleep apnea, they may cost more than existing non-drug therapies.

The weight-loss drug pipeline is exploding

GLP-1s may be leading the market now, but they’re far from the only players. More than 170 weight-loss drug candidates are moving through development pipelines across 82 manufacturers. Many follow GLP-1 pathways, but others target entirely different biological mechanisms, some of which may reduce common side effects like nausea.

One standout is Amgen’s MariTide, a monthly injectable that has shown an impressive 20% average weight loss in one year of clinical trials. Its monthly dosing may appeal to patients looking for convenience over weekly injections.

GLP-1 therapies and the broader weight-loss drug category are moving faster than almost any other segment of pharmacy benefits. For employers, that means the long-term strategy must remain flexible and data-driven as employees may increasingly request coverage for themselves and whoever else is included in their health plan.

Your responses and feedback are welcome!

Source: “Top Five Developments in GLP-1s, Weight-Loss Drugs,” CBIA.com, 11/12/25
Source: “Ozempic at Costco? Discount Giant Expands Into $100 Billion Weight-Loss Drug Market,” Yahoo.com, 10/19/25
Image by JESHOOTS.com/Pexels

GLP-1 Drugs and Youth: Why More Research Is Needed Before Expanding Use

In just a few years, medications like Ozempic and Wegovy have gone from niche diabetes treatments to global sensations. On social media alone, the hashtag #Ozempic skyrocketed from 2 million views in 2021 to over 1.2 billion by 2023, fueling massive demand and positioning GLP-1 drugs among the fastest-growing prescriptions of the century.

While originally intended for people with type 2 diabetes, these medications are now being hailed as revolutionary tools for weight loss. Their success has inspired both clinical innovation and public fascination, but it’s also raising difficult questions, especially as their use spreads to younger populations.

What are GLP-1 drugs?

GLP-1 drugs mimic natural gut hormones called glucagon-like peptide-1 analogs, which help regulate blood sugar and appetite. Older versions, such as exenatide and dulaglutide, have existed for decades, but newer formulations like semaglutide (Ozempic/Wegovy) are far more potent. They’re now considered a central part of modern obesity and diabetes care.

However, the rise of GLP-1 prescriptions isn’t limited to adults. In the United States, use among children and teens has surged nearly 600% in the past five years, driven by rising obesity rates and FDA approval for adolescents 12 and older. Yet despite this rapid growth, international data remain sparse, and pediatric guidelines lag far behind adult research.

How GLP-1s fit into pediatric weight management

According to the Global Obesity Observatory, the U.S. ranks among the top 10 countries for obesity rates. Traditionally, treatment for childhood obesity has focused on nutrition, physical activity, and behavioral change. But that approach is evolving.

In 2023, the American Academy of Pediatrics (AAP) updated its clinical guidelines, recommending that pediatricians consider weight loss medications for patients aged 12 and older with obesity (defined as a body mass index (BMI) in the 95th percentile or above). The AAP also suggests bariatric surgery for teens 13 and up who face severe obesity and related health complications.

Still, the AAP stresses that medication should not be the first step. Lifestyle and behavioral interventions — especially those involving family participation — remain the foundation of care. These programs focus on building sustainable habits around eating, exercise and emotional well-being, often requiring consistent, long-term engagement.

GLP-1 use around the world

While the United States has embraced GLP-1 medications more rapidly than most nations, the global picture looks very different. In the U.K., GLP-1s are only approved for people with a BMI over 30, and patients must reapply for treatment every two years. In the Netherlands, approval starts at a BMI over 35. In the U.S., insurance often covers the medication for just one year, even though it’s meant for long-term use.

Some countries, such as India and Canada, have begun crafting pediatric guidelines. The Indian Academy of Pediatrics permits GLP-1 use for adolescents 12 and older with severe obesity (BMI ≥ 40) or life-threatening complications. Similarly, the Canadian Medical Association Journal recommends combining GLP-1 therapy with behavioral and psychological interventions.

Yet, despite these developments, international research on pediatric use remains limited. Most studies focus on adults, leaving many unanswered questions about long-term safety, effectiveness, and psychological impact for children and teens.

Balancing benefits and concerns

GLP-1 drugs offer a promising new tool in the fight against childhood obesity, but they also introduce complex challenges. For one, starting these medications at a young age could mean lifelong use, with uncertain implications for physical and emotional development. Adolescents may not fully grasp the commitment or side effects that come with chronic medication use.

There’s also the question of mental health and body image. Adolescence is a sensitive time, and focusing heavily on weight can affect self-esteem, peer relationships, and social participation. For many families, the goal isn’t just weight loss — it’s helping children build confidence and lifelong healthy habits.

Finally, researchers simply don’t know enough about how GLP-1s affect children over the long term. Clinical trials in adults show promising results, but pediatric data trails far behind. Without clearer evidence, experts caution against over-reliance on these drugs before understanding their full impact. Until science catches up, one thing remains clear: when it comes to kids and GLP-1s, careful consideration is just as vital as clinical innovation.

Your responses and feedback are welcome!

Source: “How Ozempic and GLP-1s Are Changing Childhood and Teen Weight Management,” Think Global Health, 10/31/25
Source: “The Ozempic Era,” Medical University of South Carolina, 8/29/24
Image by Markus Winkler/Pexels

Managing Obesity With Long-Term Care

The European Association for the Study of Obesity (EASO) has introduced a new clinical management algorithm that reinforces a key message echoed across the medical community: obesity is a chronic, relapsing disease requiring long-term, sustained care.

Moving away from short-term, weight-focused approaches, the new EASO guidelines present a comprehensive, evidence-based framework centered on personalized, multi-faceted treatment strategies. The algorithm marks a major step forward in how obesity should be addressed across clinical settings — not as a temporary condition, but as a complex disease that demands continuous management, just like diabetes or hypertension.

A comprehensive, individualized approach

At the foundation of EASO’s new model lies a triad of core lifestyle interventions: nutrition, physical activity, and behavioral therapy. While these remain essential, the guidelines acknowledge that lifestyle changes alone are often insufficient for achieving and sustaining meaningful weight loss in many patients.

To close this gap, the algorithm integrates obesity management medications (OMMs) and, where clinically appropriate, metabolic bariatric surgery. The framework encourages healthcare providers to tailor interventions based on each patient’s specific health profile, comorbidities, and response to treatment.

Evidence-based pharmacologic recommendations

The EASO algorithm reviews a spectrum of approved OMMs, including orlistat, naltrexone/bupropion, liraglutide, semaglutide, and tirzepatide. Among these, The GLP-1 receptor agonists semaglutide and tirzepatide are identified as preferred first-line options when substantial weight reduction is required.

Key clinical highlights

Semaglutide is highlighted as a cornerstone therapy for a broad range of patients. It produces over 10% total body weight loss on average and offers proven benefits, including a reduction in all-cause mortality and Type 2 diabetes remission.

Tirzepatide, a dual GIP/GLP-1 receptor agonist, is recommended for patients with liver disease or obstructive sleep apnea, and as a co-first-line option for certain metabolic conditions.

Here are some condition-specific recommendations highlighted in Healthcare Radius:

Cardiovascular disease: Semaglutide was the only recommended OMM due to its proven ability to reduce Major Adverse Cardiovascular Events (MACE).

Heart failure: Both semaglutide and tirzepatide should be considered as first-line treatments.

Knee osteoarthritis: Semaglutide should be considered as the first-line treatment as it reduces pain associated with this condition.

Type 2 diabetes or prediabetes: Semaglutide and tirzepatide are first-choice medications, and liraglutide and naltrexone–bupropion are second-line treatments.

Perhaps the most significant takeaway from the EASO update is its emphasis on continuity of care. Clinical data show that discontinuing pharmacotherapy often results in weight regain, reinforcing the need for ongoing management.

This represents a crucial shift in mindset: Obesity treatment should mirror the long-term care models used for other chronic diseases, combining sustained pharmacologic therapy with lifestyle and behavioral support to improve health outcomes and quality of life.

New evidence: GLP-1 receptor agonists effective for pediatric obesity

While much of the EASO algorithm focuses on adults, emerging research highlights the growing importance of early intervention. A recent meta-analysis published in Pediatric Research by Romariz et al. found that GLP-1 receptor agonists — a class that includes liraglutide and semaglutide — are also effective in managing obesity in children.

Study findings

The meta-analysis included 11 randomized controlled trials with 1,024 participants aged 6-19. Results showed that GLP-1 agonists significantly reduced body weight, BMI, and waist circumference. Importantly, the study demonstrated clinically meaningful reductions in BMI even among children under 12 years old, a critical finding given the limited treatment options for younger patients.

Implications for pediatric care

The European Medicines Agency (EMA) recently recommended authorizing liraglutide for weight loss in children under 12, following a year-long trial in 82 participants showing significant BMI reductions.

The Romariz et al. study provides additional support for this move, confirming that GLP-1 receptor agonists are effective regardless of diabetes status or specific drug used. Early pharmacologic intervention may help improve long-term health outcomes and reduce future cardiovascular risk by addressing obesity before it progresses into adulthood.

A step toward population health improvement

By identifying effective pharmacologic tools for managing obesity across all age groups, these developments have the potential to transform public health. Treating obesity early, especially in children, can dramatically lower the lifetime burden of cardiovascular disease, diabetes, and other obesity-related conditions, ultimately reducing healthcare costs and improving overall quality of life.

Your responses and feedback are welcome!

Source: “EASO releases new obesity care model focused on long-term results,” Healthcare Radius, 10/13/25
Source: “Semaglutide, Tirzepatide Named First-Line Drugs for Obesity,” Medscape, 10/9/25
Source: “Weighing up the options: childhood intervention to tackle obesity,” Nature.com, 10/9/25
Image by Pavel Danilyuk/Pexels

Childhood Obesity in Europe: Could GLP-1 Drugs Play a Role?

As we’ve been saying over and over, across many different subjects on this blog and stretching for years, childhood obesity is rising at an alarming rate (sadly, not exactly news anymore). And not only in the U.S. It’s also happening across Europe and Central Asia. The World Obesity Federation predicts that between 2020 and 2035, obesity among boys will climb by 61%, while rates among girls are expected to soar by 75%.

Faced with this surge, health experts are asking a difficult question: What is the best way to treat this chronic disease in children? Could GLP-1 medications play a role?

Again, on this blog, we’ve been covering them in terms of research and policymaking, whether they are safe for children to use (and if yes, from what age?), whether there are any promising, successfully used alternatives, and how those aren’t enough but must come as part of the package, combined with lifestyle changes and families working together.

All that said, our content is almost exclusively focused on the U.S. But what’s the approach to rising obesity rates in other parts of the globe, in Europe in particular?

Turns out, it’s pretty much on the same page, though perhaps with a more cautious attitude. And while this might not necessarily constitute earth-shattering news, it shows that we as a global community can work together, or at least try to, if not to eradicate childhood obesity altogether, then at least to alleviate the issue using the same tools.

And those include GLP-1 medications. Sophie Cousins, MIPH, a global health journalist who has reported from more than 20 countries, dives into the subject for Medscape.

The rise of GLP-1 medications

Over the past few years, GLP-1 receptor agonists have gained global attention as effective treatments for obesity. As has been established and backed by research, these drugs act on the brain and the gut to curb appetite, slow digestion, and increase feelings of fullness.

In parts of Europe, medications such as liraglutide (Saxenda), semaglutide (Wegovy), and orlistat (Xenical) are already approved for use in adolescents aged 12 and older. But change may be on the horizon. Novo Nordisk has applied for regulatory approval of liraglutide in children as young as six years old in both Europe and the United States.

Early trial results are promising but mixed. In a phase 3 study, children aged 6 to 12 years who received 3 mg liraglutide plus behavioral therapy for 56 weeks saw a 5.8% BMI reduction, compared with a 1.6% increase in the placebo group. However, 80% of the children on liraglutide experienced gastrointestinal side effects.

These results raise a pressing question: Should children be treated with powerful weight-loss drugs, or should medical professionals and society focus more heavily on prevention?

Concerns over safety and equity

Some experts remain skeptical. Malta, for instance, has one of Europe’s highest rates of childhood obesity, driven largely by poor diet, inactivity, and socioeconomic factors. Renald Blundell, Ph.D., of the University of Malta, is deeply concerned about long-term safety.

He worries about the effects of GLP-1 medications on “growth, puberty, fertility, mental health, and lifelong health.” He stresses the need to monitor for issues such as anxiety and depression.

Dr. Blundell said:

Drugs don’t fix the unhealthy food environment, car dependency, poverty, or school systems that drive obesity. If relied on as the main solution, they risk overlooking prevention.

Still, he acknowledged their potential for children already struggling with severe obesity:

For children already suffering from severe obesity and related illnesses, medication can be life-changing and may give them a better chance to engage with lifestyle changes.

Blundell does not, however, support widespread use in children under 12:

We don’t yet know their long-term safety in young children. There are ethical concerns about medicalizing children, and their high costs and limited access to specialist care could cause inequities.

His conclusion was clear:

The bottom line is that GLP-1 drugs may be appropriate as an adjunct treatment for some children with severe obesity, but their use in 6- to 11-year-olds should be limited, cautious, and tightly monitored. The bigger priority is to change the environment, policies, and support systems so fewer children develop obesity in the first place.

Food policy and the bigger picture

Christina Vogel, Ph.D., a nutritionist and professor of food policy at City St George’s, University of London, echoed similar concerns. She said:

I don’t believe we have sufficient evidence to be able to confidently say they are good to use among children. Children’s bodies are growing, and we don’t know the long-term physical effects.

Vogel emphasized the responsibility of both governments and the pharmaceutical industry to protect children:

We need to get the school food environment right. We need to protect them against heavy marketing of high in fat, sugar, and salt. And we need to promote the availability, accessibility, and appeal of fruit, vegetables, and whole grains.

She also questioned whether children on these drugs might still eat poorly:

Will children continue to eat unhealthy foods because marketing hasn’t disappeared? Could children on these drugs face a higher risk for malnutrition and have more vitamin deficiencies?

Support for cautious use

Some specialists see GLP-1 drugs as a breakthrough, if used carefully. Julian Gomahr, M.D., of Paracelsus Medical University in Salzburg, Austria, noted that treating obesity was “frustrating” before these medications. He said:

We finally have effective medications available that can truly make a difference in treatment — especially when metabolic comorbidities are already present early on and lifestyle interventions have been exhausted. It is crucial that children are treated by an experienced team, particularly during the initial phase of pharmacological therapy.

He also argued that these drugs could reduce long-term healthcare costs but stressed that access must be equitable. He urged policymakers to fund both medications and interdisciplinary obesity centers to ensure children receive the care they need.

No silver bullet

Other experts emphasize that medication is only part of the picture. Annemarie Bennett, Ph.D., of Trinity College Dublin, made it clear: “There is no silver bullet for weight management in childhood.”

If GLP-1 drugs are prescribed, she argued, they should be integrated into a broader plan, such as “food-based and exercise supports, therapies such as cognitive-behavioral therapy, dialectical behavioral therapy, and family therapy may be considered.” We agree!

She explained that overeating often stems from distress and difficult circumstances, such as “difficult relationships at home or in school, experiencing inappropriate methods of discipline, or bereavement.” Addressing these root causes remains critical. This is also something we’ve been discussing on Childhood Obesity News for years (and will continue to do so): displacement.

The road ahead

Regulatory decisions on expanding the use of GLP-1 medications to children under 12, as well as the arrival of daily weight-loss pills in the coming years, could reshape treatment.

But for now, the debate continues: how to balance access to promising new drugs with prevention, therapy, and long-term strategies to protect children’s health.

Your responses and feedback are welcome!

Source: “Should Children Be Prescribed Anti-Obesity Drugs?,” Medscape, 9/26/25
Source: “Liraglutide for Children 6 to <12 Years of Age with Obesity — A Randomized Trial,” The New England Journal of Medicine, 9/10/24
Image by Yan Krukau/Pexels