Beyond the Individual: Family-Level Impacts of Caregiver GLP-1 Use on Food Environments and Child Health Behaviors

Abstract

Parental behaviors shape children’s obesity risk, yet little is known about family-level implications of caregiver glucagon-like peptide-1 (GLP-1) use. This cross-sectional study surveyed caregivers who started GLP-1 medication for weight management within the past 6 months and lived with at least one child aged ≤18 years (n = 58). Guided by the Family Ecological Model, the survey assessed caregiver perceptions of family health behaviors since starting GLP-1 medication. Nearly half of caregivers reported offering healthier foods to children (46.6%) and increased focus on managing children’s nutrition and physical activity (50.0%). About one-quarter of caregivers reported healthier child eating (27.6%) and physical activity (24.1%). Most caregivers reported no change in child eating (67.2%) and physical activity (72.4%). Caregivers were more likely to report healthier foods offered following GLP-1 initiation when concern about a child’s weight had been raised by pediatrician (p = 0.02). Caregiver GLP-1 initiation may provide an opportunity to support family-centered obesity prevention.

Keywords

antiobesity medications family environment GLP-1 receptor agonists glucagon-like peptide-1 receptor agonists household food environment pediatric obesity

Introduction

Obesity affects one in five US children and is associated with adverse physical and psychosocial outcomes.^1–6 Childhood obesity predicts adult obesity and long-term chronic disease.^7,8 Children’s obesity risk is influenced by parental obesity through genetic and environmental pathways.^9,10 Parental participation in weight management treatment, including behavioral programs or bariatric surgery, has been linked to improvements in children’s behaviors and weight.^10–12 These findings underscore the importance of examining whether newer, widely prescribed obesity treatments, such as glucagon-like peptide-1 (GLP-1) medications, have similar spillover effects within the family environment. GLP-1 receptor agonists are increasingly prescribed for obesity treatment, including among parents initiating therapy.^13,14 Adults using GLP-1s commonly report reduced cravings, greater dietary structure, and healthier food environments,¹⁵ changes that may influence children through improved food availability and modeling. Consistent with the Family Ecological Model (FEM) for Childhood Obesity,¹⁶ changes in upstream parental behaviors may reshape the family environment and influence children’s eating and activity.¹⁶ However, little is known about how parental GLP-1 use affects family health behaviors, and prior research has focused on individual outcomes.⁹ We surveyed caregivers to examine perceived family health behaviors following GLP-1 initiation. Guided by the FEM, we examined caregiver-reported concern for child weight as a contextual factor that may shape caregiver motivation and household health behavior change.

Materials and Methods

Study Design and Participants

We conducted a cross-sectional survey as part of a larger study examining experiences with GLP-1 medications for weight management among adults (n = 203). Participants were recruited between April and August 2025 via social media advertisements and ResearchMatch. Eligible participants completed an identity and medication verification with study staff via Zoom, followed by a self-administered survey in REDCap.^17,18 Eligibility criteria for the larger study included being ≥ 18 years of age and having initiated a GLP-1 medication prescribed for weight management within the prior 6 months. For the current analysis, we focused on participants who reported having at least one child aged ≤18 years living in their household (caregivers). This study was reviewed and approved by the University of Florida Institutional Review Board (IRB202101933).

Measures

Caregivers reported sociodemographic characteristics. Survey items, guided by the FEM,¹⁶ assessed disclosure of GLP-1 use to children and child responses to that disclosure, perceived changes in household food availability and foods offered to children, perceived changes in children’s eating habits and physical activity, and caregiver focus on managing children’s nutrition and physical activity since GLP-1 initiation. The survey included 8 study-team–developed items, which were pretested and revised using cognitive interviews in the target population (n = 5).

To account for caregivers with multiple children, questions asked caregivers to report changes in “any” child. Caregiver concern for child weight was assessed using a single item adapted from the Concern about Child Weight subscale of the Child Feeding Questionnaire.¹⁹ Caregivers reported their level of concern about their child becoming overweight (not concerned, somewhat concerned, very concerned) and whether a pediatrician had ever raised concerns about their child’s weight (yes/no). Except where noted, items were developed by the study team.

Data Analysis

Descriptive statistics were used to characterize the sample and summarize survey responses, with continuous variables reported as means and standard deviations, and categorical variables as frequencies and percentages.

We examined how clinician and caregiver concern for child weight (caregiver reported) was related to perceived changes in the household food environment and caregiver approaches to children’s nutrition and physical activity. Pediatrician concern (caregiver reported) was dichotomized as ever versus never concerned, and caregiver concern was dichotomized as not concerned versus somewhat or very concerned because of small cell sizes. Outcomes included changes in foods offered to children (more healthy versus no change) and changes in caregivers’ approach to managing children’s nutrition and physical activity (more focused versus less focused or no change). Respondents who reported being unsure were excluded from analyses for the relevant outcome (n = 3). Associations were assessed using Pearson chi-square tests. Analyses used complete-case data, with sample sizes varying by outcome.

Results

Fifty-eight caregivers completed the survey (Table 1). At the time of survey completion, caregivers had been using GLP-1 medications for a mean of 2.31 months (SD = 1.73), with 27.5% (n = 16) using semaglutide and 72.4% (n = 42) using tirzepatide. The oldest child had a mean age of 11.4 years (SD = 5.1), and nearly half (48.3%) were adolescents aged 12–17.

Table 1.

Caregiver Sociodemographic Characteristics (N = 58)

Characteristic	N (%)
Age (years), mean (SD)	44.5 (7.1)
Women	49 (84.5%)
Duration of GLP-1 use (months), mean (SD)	2.31 (1.73)
GLP-1 medication type
Semaglutide	16 (27.5%)
Tirzepatide	42 (72.4%)
Race
White	53 (91.4%)
Black/African American	5 (8.6%)
Other	3 (5.2%)
Ethnicity
Hispanic	5 (8.6%)
Marital status
Married	43 (74.1%)
Living with a partner	4 (6.9%)
Divorced	8 (13.8%)
Separated	1 (1.7%)
Widowed	1 (1.7%)
Single/never married	1 (1.7%)
Employment
Working full-time	38 (65.5%)
Working part-time	7 (12.1%)
Unemployed, searching	2 (3.4%)
Unemployed, not searching	6 (10.3%)
Retired	2 (3.4%)
Disabled	2 (3.4%)
Student	1 (1.7%)
Education
Graduate degree	25 (43.1%)
Bachelor’s degree	20 (34.5%)
Associate degree	3 (5.2%)
Some college/no degree	6 (10.3%)
High school/trade/technical	4 (6.9%)
Financial security
After paying bills, I still have enough for special things	25 (43.1%)
I have enough to pay bills but little to spare for special things	24 (41.4%)
I have enough to pay bills because I have to cut back on things	4 (6.9%)
I have difficulty paying bills no matter what	5 (8.6%)
Children in household
1 child	27 (46.6%)
2 children	22 (37.9%)
3 children	4 (6.9%)
4 children	4 (6.9%)
6 children	1 (1.7%)
Oldest child age (years), mean (SD)	11.4 (5.1)
Oldest child age categories
1–5 years	11 (19.0%)
6–11 years	16 (27.6%)
12–17 years	28 (48.3%)
18 years	3 (5.2%)

*Race categories are not mutually exclusive; participants could select more than one race. Therefore, percentages may sum to >100%.

GLP-1, glucagon-like peptide-1.

Regarding weight-related concerns, 53.4% of caregivers reported no concern about their child’s weight, while 25.9% were somewhat concerned and 20.7% were very concerned. Most caregivers (72.4%) reported that a pediatrician had not raised concerns about their child’s weight, whereas 27.6% reported that such concerns had been raised (Table 2).

Table 2.

Caregiver-Reported Family Practices, Child Behaviors, and Weight-Related Concerns Following Glucagon-Like Peptide-1 Initiation (N = 58)

Survey questions	N (%)
Do your children know that you are taking a GLP-1 medication for weight management?
Yes, they are fully aware	21 (36.2%)
Yes, they know, but I have not discussed it in detail	12 (20.7%)
No, they do not know	24 (41.4%)
Not sure	1 (1.7%)
If your children know about your GLP-1 use, have they asked you questions or shared thoughts about it?
Yes, they have asked why I am taking it	7 (20.6%)
Yes, they have expressed curiosity about how it works	9 (26.5%)
Yes, they have asked if they should take something similar	2 (5.9%)
Yes, they have expressed concerns about it	2 (5.9%)
No, they have not asked anything	16 (47.1%)
Other	2 (5.9%)
How concerned are you about your children’s weight being high?
Not at all concerned	31 (53.4%)
Somewhat concerned	15 (25.9%)
Very concerned	12 (20.7%)
Has a pediatrician raised concern about any of your children having a high body weight?
No	42 (72.4%)
Yes	16 (27.6%)
Since starting a GLP-1 medication, have you changed the foods that you offer to your children? This could include foods you cook for them or buy for the household
Yes, the food options have become healthier	27 (46.6%)
No, I have not changed foods offered to my children	29 (50.0%)
Not sure	2 (3.4%)
Yes, the food options have become less healthy	0 (0%)
Since starting your GLP-1 medication, do you feel that your approach to managing your children’s nutrition and physical activity has changed?
Yes, I am more focused on it	29 (50.0%)
Yes, I am less focused on it	1 (1.7%)
No, it has not changed	27 (46.6%)
Not sure	1 (1.7%)
Since starting your GLP-1 medication, have any of your children’s eating habits changed in any way?
Yes, they have become healthier	16 (27.6%)
No, they have stayed the same	39 (67.2%)
Yes, they have become less healthy	0 (0%)
Not sure	3 (5.2%)
Since starting your GLP-1 medication, have your children’s physical activity habits changed in any way?
Yes, they have become more active	14 (24.1%)
No, they have stayed the same	42 (72.4%)
Yes, they have become less active	0 (0%)
Not sure	2 (3.4%)

Almost half of caregivers (46.6%) reported offering healthier foods to their children since starting a GLP-1. Half of caregivers (50.0%) reported that they had become more focused on managing their children’s nutrition and physical activity. Additionally, 27.6% observed healthier eating in their children and 24.1% observed increased physical activity, while most reported no change (Table 2).

Pediatrician concern for child weight was significantly associated with changes in foods offered to children following GLP-1 initiation (χ² = 5.36, p = 0.021). Among caregivers who reported pediatrician concern, the majority reported changing to more healthy food offerings for their children (79%); whereas among those without a report of pediatric concern (n = 42), a minority reported a change in food offering (38%). Caregiver concern about child weight was not significantly associated with changes in foods offered to children. Neither pediatrician nor caregiver concern for child weight was significantly associated with reported changes in caregivers’ approach to managing children’s nutrition and physical activity.

Overall, 36.2% of caregivers reported that their children were fully aware of their medication use and 20.7% reported partial awareness, while 41.4% indicated children did not know and 1.7% were unsure. Among caregivers whose children were aware of their medication use (n = 34), 47.1% reported that children had not asked any questions, while 20.6% asked why the caregiver was taking the medication, 26.5% asked how it works, 5.9% asked whether they themselves should take something similar, and 5.9% expressed concerns.

Discussion

This study describes caregiver perceptions of family health behaviors following caregiver GLP-1 initiation. Findings suggest that caregiver GLP-1 use may be associated with meaningful shifts in family health dynamics, particularly in healthier household food availability and foods offered to children.¹⁵ These patterns align with the FEM, which emphasizes how parental behaviors and routines shape the broader family environment and, in turn, children’s health behaviors.¹⁶

Half of caregivers reported offering healthier foods to their children and being more focused on managing their children’s nutrition and physical activity since starting a GLP-1 medication, consistent with a potential ripple effect in which caregiver treatment coincides with broader family-level change. Because children of caregivers with obesity are at increased obesity risk,^9–11 caregiver GLP-1 initiation may represent an important moment for strengthening family-level practices that support obesity treatment and prevention.

A quarter of caregivers observed improvements in children’s nutrition or physical activity, and most reported no change, suggesting that caregivers’ GLP-1 use may more readily influence caregiver-controlled aspects of the home environment than downstream child behaviors. Prior family-based obesity research has shown that changes to the household environment often preceded observable changes in child behavior and may require additional time, reinforcement, or support to translate into sustained behavioral change among children.^10–12,20 These findings suggest that upstream, caregiver-controlled aspects of the home environment may be an important early target for supporting healthier child behaviors.

Caregivers who reported that a pediatrician had previously expressed concern about their child’s weight were more likely to report offering healthier foods after beginning GLP-1 treatment themselves. Prior literature demonstrates that pediatrician counseling and expressed concern can influence parental awareness and dietary practices^10,11 and that parents often underestimate or do not perceive excess weight in their children.^9,10 These findings suggest that GLP-1 initiation may represent a timely opportunity for brief, family-focused counseling by pediatricians to reinforce health-promoting routines and reduce obesogenic exposures.

Strengths of this study include its novel examination of family-level impacts of caregiver GLP-1 use across multiple domains of household environment and child health behaviors. The small and homogeneous sample, reliance on caregiver report, social desirability and recall bias, lack of direct parent and child anthropometric measures, and missing information on caregiver role are limitations of the study. Future studies using objective and validated measures, larger and more diverse samples, and prospective designs are needed to determine whether these perceived family-level changes translate into sustained improvements in child health behaviors and weight outcomes.

Conclusions

In this cross-sectional survey, caregiver GLP-1 use was associated with perceived improvements in household food environments and greater caregiver focus on children’s nutrition and physical activity. Caregiver-reported pediatrician concern for child weight was also associated with healthier foods being offered, suggesting that clinician input may play an important role in shaping family-level responses during caregiver weight management. These findings highlight caregiver GLP-1 initiation as a potential opportunity to support family-centered obesity prevention strategies. Future studies using longitudinal designs and objective measures are needed to better understand the direction and durability of these associations.

Authors’ Contributions

I.G.: Conceptualization; methodology; writing—original draft; and writing—review and editing. M.A.M.: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; and writing—review and editing. D.F.: Conceptualization and writing—review and editing. D.E.J.-S.: Conceptualization and writing—review and editing. K.G.: Writing—review and editing.

Footnotes

Consent to Participate

There was written consent, but signed documentation of consent was waived due to the low risk.

Data Availability

The data and code used in these analyses are available upon request for research-related purposes.

Author Disclosure Statement

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding Information

This work was supported by funds from the University of Florida College of Health and Human Performance.

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