Should kids living with obesity be on GLP-1s? New global guidance says yes

Should kids living with obesity be on GLP-1s? New global guidance says yes — in some cases

World Health Organization has released its first-ever guidelines on managing childhood obesity

The first-ever international guidelines on managing childhood obesity from the World Health Organization (WHO) are raising the profile of GLP-1 treatments for kids and teens — but with strict criteria and a high degree of caution.

The new global guidance, released on Wednesday, recommends a broad range of interventions to manage diet, boost physical activity and change behaviours for the rising number of global youth living with obesity. And in certain cases, for some older children and teenagers, that could also mean medication or bariatric surgery.

The WHO doesn't recommend medical treatment, surgery or weight-loss devices for children up to the age of nine, the organization notes.

For older youth from the age of 10 to 19, medical treatments may be considered only when a supervised lifestyle program hasn't achieved results, the guidance states, while bariatric surgery should only be an option under strict conditions for youth living with severe obesity.

"The foundation of obesity care for children and adolescents is not medicine or surgery, but access to comprehensive support that enables healthy eating, physical activity and sustainable behaviour change," said Dr. Luz María De Regil, the WHO's director of the department of nutrition and food safety.

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London, Ont.-based pediatric endocrinologist Dr. Marina Ybarra welcomed the organization's cautious acknowledgement of medications as one avenue to tackle obesity.

Here in Canada, two GLP-1s are approved for weight management for youth aged 12 and up, but young patients typically have to pay for the drugs through their parents' insurance or out of pocket, said Ybarra, who works with Western University and leads the London Health Sciences Centre Children's Hospital pediatric weight management clinic.

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"The news about WHO encouraging GLP-1 as a possible treatment for children living with obesity — I think it's very good news," she said.

"Because maybe that will help us to get funding through the public system in Canada for children living with obesity. That's my biggest hope."

170 million youth living with obesity

The WHO's new guidance is meant to tackle skyrocketing rates of obesity among global youth.

Roughly 170 million children and teens around the world between the ages of five to 19 were living with obesity in 2024, the WHO noted. Obesity prevalence in this age group has also quadrupled since 1990, rising from two to eight per cent.

The global recommendations echo recent Canadian guidance to manage obesity in children. That long-awaited 2025 update also called for behavioural and psychological support and, in some cases, additional medical or surgical interventions.

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But Canadian physicians recommend only using GLP-1s to manage obesity in children after the age of 12, two years above the WHO's cutoff due, and don't stipulate that medical intervention should only be tried after lifestyle changes.

"There is no evidence to support a stepwise approach whereby pharmacologic and surgical interventions should be offered only if behavioural and psychological interventions prove ineffective," reads the guidance published in the Canadian Medical Association Journal.

"Using shared decision-making with families, health care providers should consider all intervention options."

The WHO, in contrast, focused on the "practicality and universality" of diet, physical activity and behavioural changes as the pillars of obesity management, and it stressed the need for "structured long-term follow-up" in cases where patients use medication alongside other lifestyle interventions.

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Caution around GLP-1 use among children

GLP-1s and other similar medications — known by household brand names like Ozempic, Mounjaro, Rybelsus, Wegovy and Zepbound — have exploded in popularity among adults to treat obesity and diabetes, and for general weight loss, even without a clear medical need.

The drugs work by mimicking the body's glucagon-like peptide-1 hormone, which helps manage appetite, slow digestion and regulate blood sugar.

Ybarra stressed the medications are now an effective tool for many young patients with obesity, helping to both reduce weight and improve quality of life.

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While some children and teens face similar side effects to older patients, including nausea and other gastrointestinal issues, "we didn't see many of the severe complications that were seen in the adult population," Ybarra noted.

Younger and younger patients are also trying this growing class of drugs.

One U.S. study, published in the medical journal Pediatrics in September, revealed a 310-fold increase in GLP-1 prescriptions for children ages eight to 11, shooting up from 0.03 per cent to more than nine per cent between 2019 and 2026 — though overall use in this younger group remains rare.

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Still, the WHO stressed the need for caution regarding GLP-1 use among children and teens, given limited research and the potential for misuse among certain groups, such as athletes or patients with eating disorders.

The WHO's new guidelines note that overall evidence linked to various medication treatments for childhood obesity, including GLP-1s and other drugs such as metformin or sibutramine, was "generally of low quality due to short term follow-up and evaluation, and [due to] the small numbers of studies and participants."

Ybarra agreed there's a lack of long-term data for the use of GLP-1s among youth, given how new these drugs are for younger patients.

"The data we have though, it's very reassuring and helpful — in terms of there's more benefits than risks."

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Drug trials underway for younger kids

As for the line in the sand regarding children under 10 avoiding GLP-1s, the WHO's María De Regil stressed in a Tuesday news conference that the agency "recommends prioritizing other interventions in this age group."

"However, it is clear that the research is going in this area," she said. "Some national pediatric associations may recommend it."

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Denmark's Novo Nordisk and U.S.-based Eli Lilly are among the drug makers currently trialling pediatric obesity medications for kids as young as six, though María De Regil wouldn’t speculate on how any of those ongoing trials might change the WHO's recommendations.

Major questions still remain about how children should safely use these types of drugs, and for how long, stressed María De Regil.

"We realize that this is a rapidly evolving field," she said.

Senior Health & Medical Reporter

Lauren Pelley is a senior health and medical reporter for CBC News. She's a two-time RNAO Media Award winner for in-depth health reporting in 2020 and 2022, a silver medallist for best editorial newsletter at the 2024 Digital Publishing Awards, and a 2024 Covering Climate Now award winner in the health category. Contact her at: lauren.pelley@cbc.ca.