Canada Pushes Obesity Drugs for Kids, Neglects Care

Canada’s national guideline for treating childhood obesity has been updated for the first time in nearly two decades, and it now recommends considering the use of weight-loss drugs in children as young as 12.

The move has sparked concern due to the limited data available on long-term use of these drugs in adolescents. The guideline itself acknowledges that the long-term safety and health impacts of GLP-1 receptor agonists in children are unknown. Evidence supporting the use of semaglutide in this age group is based primarily on a single randomized trial with just over a year of follow-up.

Guideline Recommends Drug Use Despite Limited Data

The guideline, published this week in the Canadian Medical Association Journal, includes conditional recommendations for the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) — a class of drugs that includes semaglutide, sold under brand names such as Ozempic and Wegovy.

The recommendation applies to children aged 12 and up with obesity, and the authors cite modest improvements in body mass index and some health markers, based on limited trial data. However, they also acknowledge that long-term safety and outcomes remain unknown.

The federal government, through Health Canada, has already approved Wegovy for adolescents.

The 2025 update replaces guidance last revised in 2007. It moves away from the previous “stepwise” approach, in which medication or surgery was considered only after behavioural interventions failed. The new document states there is no evidence supporting that model, and recommends all treatment options be considered from the outset.

The use of GLP-1 drugs in pediatric care is based on sparse data. The primary study cited involved 201 adolescents over 68 weeks, showing weight reductions among those who received semaglutide alongside lifestyle interventions. Adverse events, mostly gastrointestinal, were common. A smaller trial involving liraglutide in younger children showed similar patterns. Both studies were funded by Novo Nordisk, the manufacturer of the drugs.

The guideline panel rated the evidence supporting GLP-1 use in adolescents as “very low to low certainty.” Still, it included the medications as a recommended intervention, alongside traditional care methods like nutrition counselling and physical activity.

Lack of Support Systems Leaves Families Few Options

Concerns have been raised about the limited evidence base for pediatric use of GLP-1 drugs, all of which have been studied in trials funded by the drug manufacturer. The drugs are expensive —Wegovy costs approximately $4,700 annually per patient — and are not universally covered under provincial health plans.

The guideline’s release comes amid a lack of infrastructure to support obesity care for youth in Canada. There are only two surgical centres for adolescents — one in Toronto, one in Montreal — and a limited number of multidisciplinary weight management clinics nationwide. Wait times at existing clinics can exceed two years.

The document itself acknowledges these gaps, noting that “feasibility” and “availability” should guide the use of medication and surgery. However, by placing GLP-1 drugs on the same level as other therapeutic options, the guideline may create pressure on clinicians to prescribe medications in the absence of accessible alternatives.

Canada’s public health systems have not kept pace with the rising prevalence of obesity in children and youth. National data indicate that one in three adolescents is classified as overweight or obese. Most children with obesity will carry the condition into adulthood, increasing their risk of diabetes, cardiovascular disease and other chronic conditions.

Despite the limited evidence and high cost of GLP-1 drugs, neither the federal nor provincial governments have made meaningful efforts to expand access to non-drug care. As a result, families may be steered toward potentially unsafe medications simply because other supports aren’t available—reflecting a systemic failure in how Canada delivers healthcare.

The guideline encourages shared decision-making between health providers and families. But in practice, access to care is inconsistent, and families may be left with few options beyond prescriptions—if they can afford them.