# Perceptions of GLP-1 RA Use for Children With Obesity Among Caregivers With Food Insecurity: A Qualitative Study

## TL;DR

This study examines how caregivers facing food insecurity make decisions about using GLP-1 RA medications for their children's obesity and metabolic disease.

## Contribution

The study identifies three key themes influencing caregivers' decisions about GLP-1 RA use in food-insecure settings.

## Key findings

- Caregivers' prior experiences with lifestyle changes influenced their perceptions of GLP-1 RA use.
- Trust in the safety and efficacy of GLP-1 RAs was a major factor in decision-making.
- Personal values about caring for children shaped caregivers' treatment preferences.

## Abstract

This qualitative study explores perceptions among caregivers who have food insecurity about use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for children with obesity and metabolic disease.

What factors shape how caregivers experiencing food insecurity perceive the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for children with obesity and metabolic disease?

In this qualitative study including 20 caregivers, 3 common themes influencing decision-making about GLP-1 RA use for children emerged: quality of prior experiences with lifestyle change, trust in the safety and efficacy of medication, and personal beliefs about caring for children.

These findings suggest 3 key entry points for shared decision-making about GLP-1 RA initiation in food-insecure settings: exploring prior barriers to achieving lifestyle change, building understanding around all treatment options, and aligning care with family values.

With the approval of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for pediatric obesity, families are increasingly considering pharmaceutical treatment alongside lifestyle optimization for their children, although how caregivers will make these decisions remains unexplored. This is especially important in contexts where food insecurity may limit the feasibility of lifestyle change and adjunct therapy could improve outcomes.

To explore how caregivers make decisions regarding the inclusion of GLP-1 RAs for pediatric obesity treatment in the context of food insecurity.

In this qualitative study, eligible participants were caregivers (aged ≥18 years) of children (aged <18 years) with obesity and metabolic dysfunction–associated steatotic liver disease who screened positive for moderate-severe food insecurity between July 1, 2022, and October 31, 2023. Caregivers were recruited from pediatric gastroenterology clinics of a regional academic health care system. Semistructured interviews via telephone or video were offered in participants’ preferred language between December 1, 2023, and April 30, 2024.

The main outcome was factors influencing caregiver decisions regarding medication use for their child’s metabolic disease. Interview transcripts were translated to English as needed, then thematically analyzed inductively by 2 research investigators to identify themes within an array of caregivers’ decision-making processes.

Of 37 eligible caregivers, 21 completed interviews, 20 of which were included in the analysis. Of the 20 caregiver participants (19 [95%] mothers; mean [SD] age, 40.5 [6.1] years), 18 (90%) were born outside the US, 13 (65%) had not completed high school, and 15 (75%) used a language other than English in clinical settings. Of the 20 child patients, 18 (90%) were male, and mean (SD) age at interview was 12.9 (2.9) years. All caregivers had received lifestyle-related recommendations from their child’s physicians and had been referred to dietetics; 10 (50%) had met with a dietitian. Twelve (60%) desired adjunct pharmacotherapy for their child. Three common themes influenced caregiver decision-making about GLP-1 RA use: (1) prior experience with lifestyle change, (2) trust in the safety and efficacy of GLP-1 RAs, and (3) values regarding optimal care for children. An updated conceptual framework was applied to illustrate caregivers’ decision-making.

In this qualitative study, children’s caregivers experiencing food insecurity expressed interest in both lifestyle-only and medication-inclusive approaches, with decisions shaped by lived experience, perceptions of safety, and values. Shared decision-making conversations in clinical settings that acknowledge these influences—and address barriers to both treatment options—could foster more family-centered, equitable, and effective pediatric obesity care.