Treating Canadian Children For Obesity

"[Pediatric obesity is a] chronic, stigmatized, progressive disease [that threatens the health and well-being of a dramatic number of children."

"[Success is most likely when children and their families receive] practical strategies to make and maintain positive behavioural changes, complemented by pharmacologic and surgical interventions, when available and indicated." 

"But there's no evidence to support that stepwise approach is effective. [Instead, families and doctors should consider] all intervention options, including the class of drugs known as GLP-1 receptor agonists, drugs behind injectable weight-loss medications Ozempic and Wegovy]."

New Canadian child obesity treatment guidelines

 

"So, try dietary interventions. If that doesn't work, up the intervention, maybe reduce energy [caloric] intake more [before adding drugs or considering bariatric surgery]."

"What is it like for a child to be on a GLP-1 for five years? Ten years? Decades? It's not unlike any other disease that's managed with medications: As soon as you take the medication away it's logical that things will regress."

"We don't know yet the long-term effects: Maybe there are some positives. Maybe there are some negatives."

"Our job is to present [families] with what we know in an objective manner and help them to make informed decisions."

Dr. Geoff Ball, professor of pediatrics, University of Alberta; co-chair, guideline panel 

Obesity Canada says the new guidelines for young people aim to move the focus from weight loss to prioritizing quality of life. (Getty Images/Stock photo)

"They develop metabolic-associated liver disease. They develop pre-diabetes. They develop abnormalities in their lipid [blood fat] profile."

"There's the underlying biology of the individual [including a genetic predisposition to weight gain]. But what's changed is really the environment that those individuals are living in."

Dr. Katherine Morrison, pediatric endocrinologist, McMaster University, guideline panel member

 

Published this week in the Canadian Medial Association Journal, new guideline in the treatment of obese Canadian children advocate dramatic -- and to some it would seem radical -- treatment options to address an epidemic of grossly overweight children who face the very same future health risks as older obese patients. The newly-published guidelines recommend in addition to standardized advice on diet and exercise, that physicians consider offering weight-loss drugs to children as young as twelve. And nor is bariatric surgery ignored as an option for teens aged 13 and over.

 

New data appears to suggest that semaglutide, Ozempic and Wegovy's active compound, can lead to substantial drops in body mass index and health problems such as high cholesterol in adolescents, in the same way that they do for overweight adults. A single randomized, placebo-controlled trial involving 201 children age 12 to 17 treated for over a year in 2022 produced evidence through data gleaned from the  trial impressive enough so that "people gasped in [the conference] crowd, the improvements were so dramatic. It was like a surgical intervention", explained Dr. Ball.

 

Despite which, a plethora of questions have been raised which are yet to be fully addressed, including who would benefit, when the drugs should be initiated and once started whether children would remain dependent on them their entire lives or risk rebounding weight gain. Possible unintended consequences for a child's growth and development, and whether the "convenience of a drug prescription could lead to abuse and overuse" was another critical question. 

An estimated quarter of four-to-eleven-year-olds, and a third of twelve-to-seventeen-year-olds in Canada, based on their body mass index, are either overweight or obese. Just over half of obese children will become teenagers dealing with obesity and 80 percent will go on to become obese adults, according to the authors of the report; sobering statistics with all they imply for both the individuals and for society at large. 

Quite apart from facing bias and stigma, children with obesity face the very same consequences to their health as do adults. Experts in child obesity point to an abundance of inexpensive, high-calorie food, poor socioeconomic conditions, rising mental distress in youth, and excess screen time taking the place of normal physical interaction with others, leading to a sedentary lifestyle. Obesity is seen now even in the toddler set. 

 

Over 50 scientists and medical experts drawn country-wide helped to develop the new guidelines, along with parental input, some suffering themselves from obesity, with with obese children. "This was not just a bunch of academics sitting in a room, coming up with what they think is important", stated Dr. Ball. 

 

GLP-1 drugs, injected subcutaneously -- usually stomachs or thighs -- mimic a natural hormone that delays gastric emptying, leaving people feeling satiated for longer periods. The brain responds in helping to control appetite. Not all children will be recommended drugs to control their obesity. Health Canada has approved Wegovy for adolescents age 12 and over, diagnosed with obesity by a doctor; children who have not responded with weight loss through diet and exercise alone.

 

Brenndon Goodman, 30, has struggled with his weight since childhood. He's hoping new guidelines in Canada to treat childhood obesity will ensure other children won't have to face the shame and stigma he experienced in the medical system. (Turgut Yeter/CBC)