Illustration by Marley Allen-Ash
Thomas Verny is a clinical psychiatrist, academic, award-winning author, public speaker, poet and podcaster. He is the author of eight books, including the global bestseller The Secret Life of the Unborn Child and 2021’s The Embodied Mind: Understanding the Mysteries of Cellular Memory, Consciousness and Our Bodies.
In Canada 25 per cent of four- to 11-year-olds and 33 per cent of 12- to 17-year-olds are overweight or obese. [1] In the U.S. 14.4 million children and adolescents are affected by obesity. [2] International reports suggest that the global prevalence of pediatric obesity has tripled over the past 30 years, [3] a trend that likely accelerated during the COVID pandemic. [4]
Celebrities including Oprah Winfrey, Kathy Bates, Elon Musk, Rosie O’Donnell, and many others have been quoted in the media as having lost considerable weight by taking drugs like Ozempic and Wegovy (both semaglutides) and Mounjaro and Zepbound (dual agonists tirzepatide). In the wake of this publicity, a growing number of obese adults and children have been prescribed Ozempic or similar medications.
These drugs fall into the class of compounds known as GLP1 (glucagon-like peptide 1) agonists and the GLP-1/GIP dual agonists. They assist with weight loss by mimicking a natural hormone, GLP-1, that regulates appetite and digestion. It slows down food movement in the stomach, produces a feeling of fullness for longer, and sends signals to the brain to reduce hunger. Over time, this leads to reduced caloric intake and, consequently, weight loss.
In response to the growing concern among health providers of the alarming rise of obesity among children and adolescents, the Canadian Medical Association Journal recently published “Managing obesity in children: a clinical practice guideline.” [5] The paper is 54 pages long, compiled by 54 authors who make 10 recommendations and nine good practice statements for managing obesity in children.
Wider benefits of Ozempic, Wegovy put pressure on Canadian insurers to expand drug coverage
The Canadian study included youth, caregivers and multidisciplinary health care providers; it noted the magnitude of benefits and harms of each intervention, so that caregivers and health care providers can make informed decisions. The guideline rightly emphasizes that managing pediatric obesity requires support for both children and their families.
The authors offer “practical strategies to implement and sustain healthy behavioural changes, along with medication or surgical treatments when appropriate and accessible.” Here, I begin to question the wisdom of the guideline. I wonder how their “practical strategies” work for doctors practising in the community rather than inhabiting the ivory tower of academia.
For example, regarding the use of drugs, the guideline states: “We suggest that glucagon-like peptide-1 receptor agonists be considered, in combination with behavioural and psychological interventions, for managing obesity in children aged 12 years and older [conditional recommendation, very low to low certainty of evidence].” OK. So, when your child’s pediatrician or family doctor reads this “suggestion,” it tells them that Ozempic or a similar drug should be considered. Well, any physician who has not been living in a cave somewhere in the Himalayas has read in their medical journals and/or attended conferences discussing glucagon-like peptide-1 receptor agonists. This is not news to them.
To make matters worse, the guideline indicates that evidence for this recommendation is low to very low. If you were a doctor, would you ever prescribe a drug to a patient (unless it was an anti-cancer drug of last resort) that had a low or very low probability of success? How is this helpful to a pediatrician or a lay person?
When diet, exercise and weight loss meds have proven unsuccessful, and a child faces significant health issues owing to excess weight, the guideline says, “We recommend neither for nor against using technology interventions [why call metabolic or bariatric surgery technology except to avoid the term surgery?] for managing obesity in children aged 18 years and younger [conditional recommendation, very low to low certainty of evidence].” How practical is that? Can you call a recommendation, that is not a recommendation, a recommendation?
Ask a doctor: Why won’t my doctor prescribe Ozempic for weight loss?
Perhaps the fact that of the 54 authors of the guideline only 15 were MDs and only two (yes, two) were practising pediatricians, might explain the theoretical vs the practical position this guideline has taken. The project was co-led by Dr. Geoff Ball, a professor of pediatrics and Alberta Health Services Chair in Obesity Research. That position came with funding used for the guideline. The rest came from Obesity Canada, which receives funding from what they euphemistically refer to as their Focus Partners, that on closer inspection turn out to be – surprise – big pharmaceuticals Novo Nordisk, maker of Ozempic and Wegovy, Lilly, maker of Mounjaro and Zepbound, plus Desjardins and Boehringer Ingelheim.
When I wrote to Lisa Schaffer, the executive director of Obesity Canada, inquiring just how much money these pharma companies donated, I received no answer.
Scientists are still puzzled by how the GLP-1 drugs affect the brain’s eating control systems. This is not slam dunk. The way the body controls food intake is incredibly complicated. Prof. Harvey J. Grill of the University of Pennsylvania has studied the neurobiology of energy balance for years. Unique to his team’s approach is the perspective that the neural control of food intake is anatomically distributed rather than centred in any one region of the brain. [6] Their perspective is also shaped by the notion that environmental factors influence feeding behaviour by creating associations between environmental cues and reward experiences, and that food palatability is flexible and can be altered by these reward experiences.
Clearly, obesity can lead to a host of medical problems, including diabetes, liver disease, heart disease, cancers, sleep apnea and increased mortality. This is a serious condition. Therefore, prevention and treatment, especially early on, is paramount. The new weight loss drugs can be miraculous in the short term but are not a panacea. And, as indicated above, we do not really know all the effects they may have on our brains.
It seems to me that you can gain and retain weight in two ways. You put more calories into a normally functioning body than you put out. That’s psychological. It often has the hallmarks of an addiction. Or, you have a normal caloric intake, but you retain more than you put out. That’s physical. In other words, your body does not metabolize the food you ingest properly. I am referring to conditions such as hypothyroidism, Cushing’s Disease, diabetes, insomnia, sleep apnea, and taking common medications such as antipsychotics, antidepressants, epilepsy drugs, and beta-blockers (for high blood pressure) which can lead to weight gain and, will of course, be managed accordingly.
Cheaper, generic versions of Ozempic could come to Canada as early as next year
If you are going to treat a child for obesity, or an adult for that matter, it is essential to know whether the weight gain is psychological or biological in origin. Often one leads to the other when both need to be addressed.
Although it is an accepted fact that the primary prevention of obesity in children is an essential public health issue, [7] this guideline does not address it. It should be noted that a recent Brazilian study of 728 infants found that more than 80 per cent of them consumed ultra-processed foods before age two, despite global health recommendations. Ultra-processed foods can harm gut microbiota diversity linked to gastrointestinal issues and obesity. The researchers found that breastfeeding attenuated the harmful effects of consuming ultra-processed foods on the composition of the gut microbiota. And children who received breast milk and did not consume ultra-processed products did even better in the long run. [8] It is time that health care providers started to pay attention to early factors associated with obesity rather than essentially closing the metaphorical barn door after the horses have trotted off.
Many studies show that a considerable number of children and adolescents who are obese use food as a maladaptive coping mechanism in response to experiences of childhood trauma. [9] Therefore, whenever possible, physicians should speak with the child or adolescent on their own a few times and inquire carefully about a history of physical, sexual or emotional abuse, neglect, parental arguing or violence, separation or untimely death of a parent. Bullying may be another issue that a child may hesitate to talk about in the presence of a parent. [10] Depression or treatment for depression with antidepressant drugs may be a contributing factor in weight gain. [11] Obviously, all the above produce additional stress on both child and parent, which exacerbates the problem.
We don’t know how much genetics contributes to obesity. What we do know is that if either parent or both parents are obese a discussion with them about their lifestyle is indicated. Do they dine as a family and talk to each other or eat separately while watching TV? What kinds of food do they eat? How often do they eat out and if so, where? Parents are role models for their children. If you are a parent keep in mind that you need to practice what you preach.
Unfortunately, caloric restriction (dieting) as the sole treatment for obesity has proven ineffective as any achieved weight loss alters physiology in a way that facilitates weight regain. The same can be said about weight loss drugs and bariatric surgery. All the pediatricians I spoke to agreed that sustainable weight loss involves a balanced approach, including increasing healthful food consumption, participation in physical activity for enjoyment and self-care reasons, improvement in self-esteem and self-concept, stress management, and adequate sleep. They hardly ever prescribe Ozempic and similar drugs because of rare but serious side effects, a lack of long-term studies in children and because most children don’t like the prospect of weekly needles.
According to the CMAJ paper, “Obesity is a complex, chronic, progressive, and highly stigmatized disease that increases risk for more than 200 health conditions.” This is a mantra that gets repeated over and over again, by many health providers and organizations. I do not think obesity is a disease. It can certainly lead to ill health but so can many other habits or activities such as smoking, driving a car or skiing.
Obesity, as I see it, is neither a moral failing nor a disease but rather a multi-factorial psychosomatic condition that must be approached with empathy and support free of preconceived notions, keeping in mind that more attention to early prevention would decrease the need for treatment later.
References
1. Hampl, S. E., Hassink, S. G., Barlow. S. E., Bolling, C. F., … & Okechukwu, K. (2023). Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics, 151(2).
2. Press Release, Obesity Canada, 2025
3. Kerr, J. A., Patton, G. C., Magied, A. H., … & Azzolino, D. (2025). Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. The Lancet, 405(10481), 785-812
4. Dietz, W. H. (2023). The COVID‐19 lockdown increased obesity disparities; will the increases in type 2 diabetes continue?. Obesity, 31(3), 699-702.
5. Ball, G. D., Merdad, R., Hadjiyannakis, S., … & Johnston, B. C. (2025). Managing obesity in children: a clinical practice guideline. CMAJ, 197(14), E372-E38933
6. Grill, Harvey.
7. Lister, N. B., Baur, L. A., Reinehr, T., … & Wabitsch, M. (2023). Child and adolescent obesity. Nature Reviews Disease Primers, 9(1), 24.
8. Faggiani, L. D., de França, P., Qi, L., & Cardoso, M. A. (2025). Effect of ultra-processed food consumption on the gut microbiota in the first year of life: findings from the MINA-Brazil birth cohort study. Clinical Nutrition.
9. Offer, S., Alexander, E., Flint, S. W., & Lawrence, B. J. (2022). The association between childhood trauma and overweight and obesity in young adults: the mediating role of food addiction. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 27(8), 3257-3266.
10. Hadjiyannakis, S., Ibrahim, Q., Hamilton, J. K., … & Morrison, K. M. (2019). Obesity class versus the Edmonton Obesity Staging System for Pediatrics to define health risk in childhood obesity: results from the CANPWR cross-sectional study. The Lancet Child & Adolescent Health, 3(6), 398-407.
11. Petimar, J., Young, J. G., M. F., Heerman, W. J., … & Block, J. P. (2024). Medication-induced weight change across common antidepressant treatments: a target trial emulation study. Annals of internal medicine, 177(8), 993-1003.
