Are GLP-1s the answer to fighting childhood obesity?
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00:49A web series where host Michelle Spina sits down with members of Gen Z to share real perspectives and experiences on money, life, and what comes next.Paid content with Dejardé.Now streaming on CBC Gem.This is a CBC podcast.I'm Catherine Cullen.This is the current podcast.The World Health Organization saysGLP1 weight loss drug should be an option for some kids.
01:19This month, the WHO issued its first guideline on childhood obesity,looking at everything from diet and lifestyle changes to semi-glutide injections.In Canada, 25% of children between 4 and 11,000,years of age are considered overweight or obese based on their BMI. That number jumps to 33% fortweens and teens. So when are weight loss drugs right for kids? In Canada and the U.S.,the guideline is to consider all medical interventions, including GLP-1s, for children 12 yearsand up. There are weight-loss drug trials underway for children as young as six. My next guest,Amber, hopes GLP-1s may soon be an option for her eight-year-old daughter. The first
02:02family lives in the United States, we are only using Amber's first name to protect her daughter'sidentity, as we'll be discussing her medical history and the mental health impacts of childhood obesity.Amber, good morning. Good morning, Catherine. Thanks for having me. Thank you for talking to us. Tell us a bitabout your daughter, what she like. So my daughter is one of the most wonderful people I've everknown. I am honored to be her mom, and I am just so proud of her every day. She enjoys lots ofgames and her family and drawing, just kind of typical eight-year-old things.And what is her experience, your family's experience with childhood obesity?So it starts with my journey, I guess. I was always a tall, kind of bigger child. And then I think
02:53that that has kind of translated into some of those similar struggles for my daughter. But with her,she also has some diagnoses like autism, ADHD, where she's had to take some medications that reallyhelp her with her behavior and her ability to go to school. And those medications have unfortunatelymade her really hungry. And she's on two of them that do that. And so we struggle with that. And then on theother side, she also has some sensory issues coming with that autism to where there's certain foods that she justabsolutely cannot eat because of her sensory struggles. So combined with that, we have, since shestarted her medications when she was age four, she's gained a significant amount of weight, unfortunately,that we just cannot get off of her. And what are your doctors say about it?
03:48That's really the frustrating part, Catherine, is we have gone to, I can't tell you how manydoctors between a primary physician to an endocrinologist to a lifestyle medicine doctor,And she's never quite bad, quote unquote, enough for her to need any medical intervention until we're right at that borderline.They keep telling us to, you know, keep trying various foods and increase her exercise.But it seems like they just want to wait until bad is bad for us to have any medical intervention.And it's really frustrating and scary for us because I don't know, I don't know what else to do for her.But you feel like she's close to a tipping point.Like there's no question for you that her weight is a problem for her health.
04:37Absolutely.She, again, like I said, she's very happy, but she does get bullied at school because of her size.And, you know, she doesn't care.She's a very resilient young lady, but, you know, kids can be mean.And on the other side of that, she is in that pre-diabetic region of her blood work and hertriclycerines and things like that to the point where, you know, we are, we are very close to thatthat pre-diabetes range in her blood work. But every doctor keeps saying, you know, let's watch it.Let's continue on with trying a new food every week and, you know, doing what you can for her,
05:19for her movement, things like that. And nobody will really take us seriously.What does she say to you about it? She, I don't think,wants to let me know that it upsets her. It's making me a little emotional, but she, she wants tojust kind of keep pushing on and she says, mom, let's eat healthy today. And I really havenever tried to ever limit, you know, a snack if she wants, you know, a string cheese or or a littleorange or anything like that. I let her have that. But she always focuses on on eating healthy.and I know that that term for her means something because she thinks that she's unhealthy.And I hate that.
06:03We really push body image positivity and, you know, all bodies are beautiful.But there is that negative connotation that she has.And I think that she has some internal feelings of, you know, less than because of her size.And that just kills me.I'm sorry that you and your family are dealing with this.It's got to be hard as a mom to watch your daughter struggling with this.You know, it is because you want to protect them from anything and everything you can.And at this point, you know, we have done everything that we know that we can.
06:38So tell me with the GLP ones then, where does that come into the conversation?Is this something that you've brought up with doctors or your daughter?How did that come into play?So I have tried GLP ones myself. I actually started out from a similar standpoint with I had some high blood sugar and whatnot. And so my insurance ultimately paid for me to be on a GLP one. And I was able to lose 100 plus pounds, which was amazing. It made my blood work so much better. It made me feel better about myself, you know, made me overall more healthy. So kind of in that same vein,when I was looking at things to help my daughter, you know, even looking at medical intervention,because I've been getting that desperate, for lack of a better term, you know, that is broughtup over and over on every Google search. But because of her age, she's only eight, she doesn'tqualify for them. There is a GOP one that is in studies right now for young children, but it hasn't
07:49been approved yet. And so I don't want to say that we don't want to take the easy way out.But at this point, we need some help. We need some intervention in that way to help her even getkick started on this. It's interesting. I'm sorry. It's interesting to me that you say take the easyway out. That's how you look at these drugs, even though your daughter is struggling.I don't think it's the easy way out. I think that that's the stigma,these drugs, especially in the area that I live in, everybody is almost ashamed to say that they are onGLP one when ultimately it's making people so much healthier and with little to no side effects.And, you know, I've talked to my own doctor about this and about mine and she has, you know,
08:39no qualms about me being on anything like that. And so I feel like, you know, if this is a medicationthat is meant for this, why not be able to have it for kids who genuinely need it?One of the complexities here, of course, is a relatively new group of drugs.The WHO, the World Health Organization's guidance recommends avoiding GLP ones for children under 10.They also stress the need for caution among children and teens, given limited long-time research.Does that give you pause at all for your daughter?I think it may be briefly does, but on the other side of that, we are really dealing with something that can affect her health long term as well.The obesity is hard on her joints. It's hard on her, especially her feet, her knees, everything like that, her blood work.
09:36You know, diabetes is a long-term health struggle as well that can be absolutely deadly.So I think that dealing with any long-term effects that we might see on the other side, if we can at least get some of this GOP one to help her, you know, it's kind of six one one, one might have dozen the other, but I would rather try that and see than have her have some other, you know, lifetime health concerns.So where does this leave you and your daughter, Amber? You're just stuck in a holding pattern right now because she can't access the drugs.We really are. Nobody is, I don't want to say, confident enough, but doctors kind of keep referring us off to other doctors saying that, oh, well, if somebody wants to prescribe a medication, you'll have to go see this doctor or you'll have to go see this doctor.The lifestyle doctor that we've seen at a big children's hospital in our area, they just keep saying, well, her blood work,is, you know, concerning, but let's just keep trying with this, with the diet and the exercise.And we push exercise as much as we can with trampoline parks and guided medal winninglittle races that she can get so it's really motivating.
11:03But ultimately, we're stuck until she gets worse or reaches a certain age.Amber, I really appreciate you telling us about your daughterand I'm sorry your family's struggling,but she sounds like a pretty remarkable young lady.I wish you guys all the best.Thank you so much, Catherine.Have a good to do your day.You too.
11:23Amber is a parent navigating childhood obesitywith her eight-year-old daughter.We are not using her last name to protect her daughter's identity.I just tallied up my cost for this semester.And between tuition, campus fees,and a very expensive textbook I've barely opened,my budget is stretched thin.Yeah, it's a lot to juggle at once.
11:45Right?It feels like everyone else somehow got a manualon how to navigate student lifeand figure out their finances,and I missed the memo.Trust me, nobody got a manual.When I started school last year,I felt the exact same way.
12:00Everyone's just figuring it out as they go.Honestly, just knowing other peopleare asking the same questionsmakes me feel a whole lot better.You're definitely not the only onetrying to make sense of it all.Navigating school and your finances comes with a lot of big questions.If you're figuring out your next steps, check out Count Us In.
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12:57So when you're choosing a domain, see the difference a Canadian choice can make.Visit choose.ca for more details.Well, Dr. Stasha Hadjanakis is a pediatric endocrinologist and medical director of Chio'sCenter for Healthy Active Living. She has prescribed GLP ones in her practice. Hello.Hello. Hi, Catherine.Good morning. How familiar are stories like the one we just heard from Amber about her daughter?Oh, so incredibly familiar. Just how hard these families are working, the challenges they're facing the complexity of their experience, including neurodiversity, things such as ADHD and autism, of impacting body weight.regulation, the experience of bias, discrimination, the delay in accessing care, the frustration
13:52and being able to access care for their children, all of it is very familiar.Also important to say that not everybody's experience is the same, of course, and there are manykids living with obesity who are doing well and who are healthy.So, yeah.How often are you asked about GLP ones for kids these days?Fairly often, but there's both trepidation, but also interest in accessing supports that will or may be helpful for a youth living with obesity.more often when there's some family experience with GLP1 agonist.Yeah.
14:49So when families ask you, I wonder, like, what do you evaluate when you considerwhether or not weight loss drugs are right for the child, the patient you're dealing with?Absolutely.So we really, really need to complete a comprehensive assessment.really understand the youth's lived experience with obesity,understand what challenges they may be facing,including physical difficulties, metabolic health issues,what coexisting mental health concerns might be present,
15:25what neurodevelopmental differences might be present,what's the social context in which the young person is living,what are their goals and values and preferences,what are they looking for?and based on that comprehensive assessment,which looks at challenges and strengths and health issues,together we collaboratively come to an agreement on a care planthat makes sense for the patient and families.
15:53And that may or may not include pharmacotherapy like JLP1 Agonis.If I could give you an example, a case example,I could tell you about two young boys.I've met, I've changed their names, you know, both 12 years of age, both have a high BMI based ongrowth curves, a BMI of 32. And Jeff, Jeff is doing well. He's metabolically well. He's physicallyfeeling well. He's got no mental health concerns. He's engaged in activity that he enjoys.He's well supported in his community. He's got lots of positive friendships. And on the other hand,we have Aaron. He's also as a BMI that's elevated, same as Jeff, but he's also struggling with
16:41type 2 diabetes. He has coexisting ADHD. There are a lot of social stressors in his family.He's struggling to get to school. So you can imagine the care plan for those two boys is going to becompletely different. For Jeff, we're just going to try and encourage him to continue in the paththat he's on, be there if anything changes for him, continue to monitor things for him.For Erin, a GLP1, Agnes might make sense to help his type 2 diabetes, but we're also going topay attention to his ADHD and the social stressors that he's experiencing.So it's all very individualized.One thing I wonder about doctor is if you do prescribe a GLP1 to a child, is that child
17:29likely to stay on that drug essentially forever if they want to make a doctor?their weight? Right. That's an excellent question. So based on adult studies, we see that as wecome off the medicine, the people do experience some weight regain over the year off the medicine.So when I'm talking about this with my patients and families, we review the evidence. If a patientis interested in trying off.We go slow, decreasing the dose slowly,making sure we're still achieving the health outcomes we're looking for,and continuing to monitor.
18:10And that might mean coming off for some patients,as long as we're monitoring things togetherand collaboratively deciding whether it's worth staying offor whether we need to restart the medicine at some point.Unlike the WHO guidelines, the Canadian guidance doesn't stipulate that weight loss drugs should only be tried after lifestyle change.Is there a case to be made for starting kids on GLP-1s right away?So yes, so I think that in terms of the decisions around when to introduce a GLP1 Agnesreally depends on how the young person we're seeing what they're coming with.
18:56for someone who has been living with obesity but hasn't accessed care in some time and they'realready living with metabolic health issues, possibly physical limitations related to body weightand size, we wouldn't want to withhold a treatment that's evidence-based and could improvetheir health. And I think it's important to recognize what behavioral and psychological supportsor lifestyle intervention can do and what it can't do.And that's based really on the science of body weight regulation.So lifestyle intervention will improve health.What that means is the way we feed our body, the way we move our body,
19:41the way we sleep, the way we cope with stress will improve health.But change in body weight is modest.Now, not everybody who has a high body weight needs to lose weight to be healthier,but for those kids who are struggling with physical limitations related,to body weight or metabolic health issues related to body weight, it feels wrong to withholdthe treatment that could help improve their health and quality of life while they wait sixmonths. Let me ask you about the other side of this, doctor.Yes, yes.
20:14Which is, you know, there is a lot we don't know about GLP-1s. There's the potential for impacton the growth of these children. How should we think about that piece of this?Yeah, so we need to be cautious. We need to be mindful and make sure that these are prescribed in a thoughtful way by people with experience with these medicines, making sure our patients and families have support with the support of an interdisciplinary expert team as we're prescribing these medications that we're keeping an eye on growth parameters and nutritional parameters. So done in a very thoughtful.weigh and weighing the risks and benefits.So if you think about Jeff and Aaron, you know, it would be, even though they both qualifytechnically for a GLP1 agonist, we wouldn't want to introduce that for Jeff, who's doing well.Why introduce something that could cause harm?But for Aaron, it could change his trajectory with type 2 diabetes, for example.
21:17We just have a moment left, doctor.I just want to ask you 30 seconds here, one overarching thought you would give parents.who are wondering about this?I would say, I want to tell parents that we're here to support them,that we recognize the complexity of the condition,that we'll take into account their values and preferences and workto help them access evidence-based care to improve the health and well-being of their children living with obesity.It's a complex issue.
21:50I can hear your care for your patients and your answers, doctor.Thank you so much for your time.Thank you, Catherine. Thank you.That's Dr. Stasha Hadjanakis.She's a pediatric endocrinologist and medical director of Chios Center for Healthy, Active Living.For more CBC podcasts, go to cbc.ca.ca slash podcasts.
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