Introduction Adolescent obesity, defined as body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) greater than or equal to the age- and sex-specific 95th percentile of the 2000 US Centers for Disease Control and Prevention (CDC) growth charts,1 is a complex, chronic disease associated with increased comorbidity that extends into adulthood.2-5 The prevalence of adolescent obesity in the US has increased for nearly 2 decades, currently affecting more than 1 in 5 adolescents.6 Intensive health behavior and lifestyle intervention (eg, dietary counseling and physical activity) is recommended as first-line treatment,7,8 but BMI reduction is often small, and high attrition rates are usually observed.9-11 In 2023, the American Academy of Pediatrics (AAP) recommended antiobesity medications (AOMs) be offered as an adjunct to intensive health behavior and lifestyle counseling in adolescents with obesity ages 12 years and older.7 Significant placebo-subtracted BMI reductions from baseline to approximately 1 year have been seen with pharmacologic treatment of obesity in clinical trials of adolescents ages 12 years to younger than 18 years, with reductions of 4.6% reported for liraglutide,12 8.1% reported for mid-dose phentermine and topiramate (ie, 7.5 mg phentermine and 46 mg topiramate daily),13 10.4% reported for top-dose phentermine and topiramate (ie, 15 mg phentermine and 92 mg topiramate daily),13 and 16.7% reported for semaglutide.14 Subsequently, the US Food and Drug Administration (FDA) has approved liraglutide, phentermine and topiramate, and semaglutide for treatment of obesity in adolescents ages 12 years and older. However, these are proprietary medications and have annual costs ranging from $1100 to $15 000.