The Current - Advocate welcomes new tools to manage childhood obesity

Episode Date: April 17, 2025

Al Martin has lived with obesity since his teens. He says new guidelines for treating childhood obesity will offer new tools to help kids, but some approaches — like weight loss surgery — shouldn���t be taken lightly. Matt Galloway discusses the stigma around weight with Martin, an advocate with Obesity Matters, and Dr. Stasia Hadjiyannakis, one of the guidelines’ authors.

It's on. A federal election is here and party leaders are racing around Canada to convince you to give them your vote. We're seeing a lot of spin, a lot of promises and a lot of accusations swirling around. And we are here to filter through the noise. I'm Catherine Cullen, host of The House. And every Saturday we want to slow you down and make sure you're getting the big picture and deep context and everything you need to make politics make sense. Because democracy is a conversation and we're here for it. This is a CBC Podcast. Hello, I'm Matt Galloway and this is the current podcast. Nearly one in three kids and teens living in Canada are overweight or living with obesity.

That is nearly triple the rate from 30 years ago. For two decades, the Canadian guidelines on how to treat children and teens living with obesity remained unchanged, but earlier this week new clinical practice advice was released, including recommendations for weight loss drugs like Ozempic and weight loss surgery in some cases for kids 12 and over. There is also a strong emphasis on fighting the stigma associated with obesity. In a moment, we'll hear from one of the authors of these new guidelines. But first, we're joined by Al Martin. He is an advocate with Obesity Matters and Obesity Canada. He's the father of two teenagers. He has personal experience with this

issue as well. Al, good morning. Hey, good morning. You yourself have struggled with obesity, right? That's correct, yeah. I pretty much, once the onset of puberty happened, I started to get much larger. I started to pack on more weight, more excess adipose tissue, and I didn't really struggle with health ramifications from it immediately, which is one of the main parts of the definition of what living with obesity really is. It's not just excess adiposity or excess fat tissue. It's also having complications and health concerns from it. But I did start to develop those in my late teens or early twenties. And it's definitely something that I worry about for young people, including my own children,

coming up behind me. And obesity is something that's run in my family for a very long time. Yeah, what was that like as a teenager? I mean, I wanna talk about the stigma that's around this because these guidelines are hoping to reduce that stigma. For you, how did that impact you? Yeah, so I can remember like in junior high

being like teased and mocked in the swimming pool and a bunch of kids calling me a whale and trying to throw me around and stuff. And I was actually enough bigger than them that they really couldn't do that, but it hurts. There's a sting to that. There's this internalized bias is already there because the messaging we get is that

living in a larger body is wrong, that it's not okay and something that needs to be fixed. And there's a huge industry trying to sell diet products, diet culture to everyone from young children to adults. And there's that constant messaging. When you live in a larger body and live with obesity, it's something that you, you worry about and you, you, you concern yourself with, and when people call that out and mention it, especially when you're a young person, you don't have as many tools to deal with that.

Did you also feel it in the healthcare sector? I mean, it's not just, as I was saying, it's not just teenagers and the mean things that they would say to each other. I mean, certainly we're talking about pediatric obesity in the clinical guidelines that came out, but each other. I mean, certainly we're talking about pediatric obesity in the clinical guidelines that came out, but for me as an adult,

I encountered a situation that I've remarked upon many times and people are taken aback by it, but what really drove me into working with Obesity Canada first and then Obesity Matters and other organizations was the fact that when I went to a doctor, I was not treated like a regular person who needed treatment for specific issues that I was there for. My weight and my excess adipose tissue were always on the forefront. It was always brought up as something that I should deal with without any real attention

to how I would deal with that, even though I've done so many times dieting on my own, losing weight successfully for a while, but then always reaching a plateau and never breaking through it. And my body just doesn't want to get below a certain weight. It never wants to do that no matter what I do to change it. And so that needs an intervention whether it be a pharmaceutical or a surgery in my case that's what I'm aiming for but I what really struck me was one doctor told me and in fact they didn't tell me they told my wife that I needed to lose weight and that really that stung me in a way because I was not being addressed directly by

the healthcare professional but another doctor later that same year said, hey, you're struggling with this. I wanna help you. And they helped prescribe to me and refer me to a bariatric program. You mentioned that this runs in your family as well. And as a dad, I mean, how does this affect your kids? You know what, I think directly what affects me is living in a larger body is that they know that I'm

worried about it and my wife, their mother also lives in a larger body. So they see us struggling. They see me struggle with some health issues that I've had over the last few years. Some of them not related to living in a larger body at all, but certainly not helped by it. But my daughter is already starting to deal with developing a larger body, and I see her maybe going down the same path that I have and that her mother has, and it is something that worries me, but I'm really glad that we have some new recommendations, some new tools available to help young people. It may or may not be right for her at this time, but when and if that does happen,

we now have at least a few more tools in the toolbox. Those tools include recommending perhaps weight loss drugs like Ozempic or Wigovie, also surgical interventions like weight loss surgery for some children. Is that, are those things that you would consider for your kids? I certainly would if the time came when that was the best option, I would certainly do that. And I think I'm less hesitant to think about the pharmaceutical

interventions because I'm already myself on on a GLP one inhibitor Which is which is called ozempic. I take it for diabetes, but it it is as we're govee it is prescribed for weight loss and and to help people living with obesity and it is effective for many people I Haven't experienced any specific weight loss with it, but I have noticed that it's helped curb my appetite, which is probably good for helping me regulate. It is also a huge thing to take on getting a bariatric surgery, which because I'm now in line to get a bariatric surgery, I've been investigating it thoroughly. I would not jump into surgery for a child without some very serious consideration.

Yeah, because you could imagine there are people who would listen who would say, you know what, I mean, that seems like a big leap to consider giving young people those drugs or to look at bariatric surgery. Yeah, it does seem extreme. But living in a large body is an extreme experience. The amount of actual weight on your joints, and in my case, where my adiposity is developed, it pushes in on my organs and has a deleterious effect on them. A young child going through that would want to try every other method, but some children develop obesity in such an early age that by the time they're in their teens, they may have over a

decade of experience living with obesity and its comorbidities. And there's over 200 different health conditions related to it. So it's a very serious disease. It's a very serious list of complications that can arise. So for some children, it might be the best option, but certainly not something that would be taken lightly. And certainly, what's not being suggested here is that we should just open up the floodgates and let every child get bariatric surgery. Because it is a seriously involved process and a lifelong effect on nutritional uptake. And it requires taking supplements for the rest of your life.

And it affects, you know, your entire abdomen is being worked on and your digestive tract. So it's certainly not something anyone would go into taking it lightly or just jumping into it. And I also want to point out that the guidelines certainly not something anyone would go into taking it lightly or just jumping into it. And I also want to point out that the guidelines are not intended to help deal with societal pressure to look a certain way. They're about health. They're about the health and welfare of young people.

Al, it's really good to talk to you about this. I really appreciate you being as open as you have been in speaking about this. Thank you so much. Thank you, Matt. Thanks for the opportunity. Al Martin is an advocate with Obesity Matters and Obesity Canada. He also lives with obesity. He was in Welland, Ontario. In the fall of 2001, while Americans were still grappling with the horror of September 11th, envelopes started showing up at media outlets and government buildings filled with a white lethal powder, anthrax. But what's

strange is if you ask people now what happened with that story, almost no one knows. It's like the whole thing just disappeared. Who mailed those letters? Do you know? From Wolf Entertainment, USG Audio and CBC podcasts, this is Aftermath, the hunt for the anthrax killer. Available now. Dr. Stasha Hajianakis is a pediatric endocrinologist at the Children's Hospital of Eastern Ontario, also known as CHEO. She works with children with obesity and their families and is also one of the authors of these new clinical practice guidelines we've been talking about for managing childhood obesity. She's in our Ottawa studio. Good morning to you.

Good morning. In writing these guidelines, you know, would have heard from people like Al Martin, the parents of kids and from kids themselves who are struggling with obesity. What did they tell you about what they need from the healthcare system? Absolutely. I think I was so grateful for Al for taking the time to speak to us and sharing his experience. I'm deeply sorry for some of the experiences that he has had in the healthcare system. And I think our goals in working with children and parents of children with obesity and youth is to change that narrative

and really change those experiences in all sectors of society. A broad recognition of the complexity of body weight regulation, an understanding that our weight is beyond individual control and that there should not be any guilt or shame associated with our body weight. That healthy, strong bodies exist across a wide range of body shapes and sizes, that people of all shapes, sizes and abilities are capable of wonderful things throughout all sectors of society. And our goal is really to help them achieve their best possible health.

And when their bodies are struggling and if their bodies are struggling in relation to having a higher body weight, then we should be there to provide compassionate evidence-informed therapy. Can you give me an example just briefly of what that conversation sounds like in your office with one of those young patients? Yeah, I think of what is important as a healthcare provider, I think is to stay curious, to stay open to really, I think a lot of the young people that we're seeing want a safe space to speak of their experience of living at a higher body weight, what that has meant for them through their lifetime, how it has impacted them potentially socially,

physically, are there some physical challenges getting in the way of things that they might want to do? What are their values and preferences? What are their goals, their interests, their dreams? And how can we alleviate any potential barriers that are there in relation to body weight and how and help them achieve their goals. Including obviously health and mental health and social goals. Yeah. For many, for many doctors and presumably for many people who are listening, that formula

for weight loss is still eat less and move more. The ideas that, you know, that calories and calories out, for example, is that not still important in managing weight? The really the science of body rate regulation calories out, for example. Is that not still important in managing weight? Really the science of body rate regulation is pretty clear that our bodies, you know, we have a genetic vulnerability to gaining weight more easily. That genetic vulnerability is exploited depending

on our exposures in our environment and our social and biologic exposures. And then once weight is gained, it becomes neuroendocrinologically locked in. Like our bodies defend against weight loss. Weight loss is possible. What's much more challenging is sustaining weight loss because of metabolic adaptation that happens in our bodies, changes in our appetite hormones, all in an effort to regain weight. So the struggle to decrease weight and sustain

weight loss is a difficult one. It's important though, to note that not everybody with a higher body weight needs to lose weight to be healthier. Uh, but for those for whom their weight is causing significant health issues, whether that's physical limitations or metabolic health changes like diabetes or cholesterol abnormalities, then we

really need, we have tools now that can alleviate that, that, that health burden or that health risk. Well, and one of those, one of those tools is, is the use of weight loss medications like GLP-1s for some patients, drugs like, like Oz risk. Well, and one of those tools is the use of weight loss medications, like GLP-1s for some patients, drugs like Ozempic and Wigovia, which is, it's proved for kids 12 and not Wigovia is. And that recommendation has received a lot of headlines. What is, what's the criteria as you understand it for

recommending surgery or weight loss drugs to kids? Yeah. as you understand it, for recommending surgery or weight loss drugs to kids. That's right, yeah. So from my perspective, really, you sort of sit down and look at the health risks that may be associated with having a higher body weight for the person, the young person in front of you,

and going through the different areas of health that can be impacted by body weight, whether that be metabolic health like cholesterol issues or blood pressure or blood sugars or biomechanical health challenges where the higher body weight is making things physically more difficult for a young person. And having a conversation with the young person and their caregiver and their family. Let's look at this, okay, are there any health risks associated with having a higher body weight for you right now? What are our options in terms of alleviating or mitigating that health risk? And we have really three main approaches. We have behavioral mental

health supports, we have medication, and we have surgical supports. And I think the conversation is related to health risk and what are the health outcomes that are most important to the family, and what is the context in which they live and what is feasible for each individual family. Let me ask you about the health risk. This is something, I mean mean there are very few studies on what the long-term side effects of these drugs would be particularly on children and this has raised questions around whether we actually know enough to to prescribe drugs like this to young

people. Have a listen to Dr. Dan Cooper, a professor of pediatrics at the University of California in the United States. The guidelines down there are the same but they've been in place for more than two years. Take a listen. If I'm a busy Canadian pediatrician, I see a kid like this, I want to do something. Pediatricians want to help their patients. I got this new pill that wow, it's working. And we say, well, I'm going to use it. And my concern is we don't know what the long-term effects of this medication are on brain development, on muscle development, on motivation, apathy, things like that. I would believe that every child and adolescent who is given these medications should become part of a study. We should have access to what happens to weight. We should have access to their levels of physical activity.

We should do formal cardiopulmonary exercise testing. We should do true extensive behavioral assessments as well. I know this sounds like a lot, but I worry that unless we do this, we might kick ourselves in five years and discover that we had created with these medications, one, a dependency on a medication that these individuals may have to take for the rest of their lives, or two, that there

were alterations in brain chemistry anatomy that we did not anticipate. Dr. Given what we don't know, are you comfortable with that? Yeah, so I think there are different. Obviously, Dr. Cooper raises a number of important points. And anytime we move to prescribe a medication as a responsible clinician, really discussing what we know of the medication, what we don't know of the medication, the guidelines were really looked extensively on published data around GLP-1 agonists in kids, but he's at Dr. Cooper's right that they've really been approved for use in children over the last five years. But I think what, and I agree with what he's saying in terms of making sure that we collect data on

children who are using these medications and following long term. At the same time, I think we can't also ignore the health implications or health risks that a young person may be presenting to us with in the moment and knowing what living with that over the long term may also, the implications of that as well, not just in the long term, but even in the short term. I guess one of the other concerns is that there are doctors like yourself

who have had affiliations with the companies that make these weight loss drugs. You've had affiliations with Novo Nordisk, you've received honoraria for lectures, payment for attending an advisory board meeting. I just wonder, given what he's saying, how the public can be sure that there's no conflict or bias around the recommendations as a result of what's going on? Absolutely fair question. Yes.

I think I would, what the, I hope that the methodology in the clinical practice guidelines reassures people that there were systematic reviews that looked at all published data in the literature, not just at pharmacotherapy, but also behavioral and mental health supports, surgical approaches, pharmacotherapy, and that those with conflict of interest were excused from voting on the final recommendations for pharmacotherapy. So I think the guideline committee had done a good job to try and mitigate bias, but you raise an important and absolutely important point. Just given, I mean, the scale of this, as I said, nearly one in three kids and teens

in Canada are overweight or living with obesity. This is top of mind for so many people and people are looking for answers, but also for, as we've just had a robust discussion on this. Doctor, thank you very much for being part of this. Thanks so much for the conversation. Dr. Stasia Hajianakis is a pediatric endocrinologist at the Children's Hospital of Eastern Ontario in Ottawa, one of the co-authors of a new clinical practice guideline for managing childhood obesity.