GLP-1 drugs in Canadian children: what emerging safety data means for pediatric obesity care

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

A study published in Pediatrics in October 2026 documented a 310-fold increase in GLP-1 receptor agonist prescriptions for US children aged 8 to 11 with obesity since 2019, even though no drug in this class is currently approved for that age group by the US Food and Drug Administration (FDA) or by Health Canada. For Canadian families navigating pediatric obesity care, the study's findings land in a system where access to these medications is already uneven: semaglutide (sold in Canada as Wegovy, manufactured by Novo Nordisk) is approved by Health Canada for chronic weight management in adolescents 12 and older, but provincial drug plans cover it inconsistently, and no Canadian clinical society has issued formal guidance on GLP-1 use in children under 12.

The study was led by Dr. Babak J. Orandi, a transplant surgeon and obesity medicine specialist at NYU Langone in New York. His team analyzed prescription data from more than 3.5 million children aged 8 to 11 with obesity. Despite the dramatic percentage increase, the absolute numbers remain small: only 0.6% of eligible children received a GLP-1 prescription. Of those who did, 94% had severe obesity, and many already had obesity-related complications including sleep apnea, prediabetes, hypertension, and metabolic dysfunction-associated steatotic liver disease (a condition formerly called fatty liver disease, in which fat accumulates in liver cells and can progress to cirrhosis). Orandi's broader argument, grounded in his transplant practice, is that adolescents with severe obesity are up to nine times more likely to develop chronic kidney disease in young adulthood, and that childhood fatty liver disease increases mortality risk 40-fold while becoming the fastest-growing cause of liver transplants in young adults.

What this means in Canada

Health Canada approved Wegovy (semaglutide 2.4 mg weekly injection) for adults in 2021 and extended that approval to adolescents aged 12 and older with obesity in 2023, mirroring the FDA's timeline. Liraglutide (sold in Canada as Saxenda, also by Novo Nordisk) holds a similar Health Canada indication for adolescents 12 and older. Neither drug has a Health Canada indication for children under 12, and off-label prescribing in that age group, while not prohibited, sits outside any approved framework.

Provincial coverage is fragmented. As of October 2026, Ontario's OHIP-linked drug benefit programs and the Ontario Drug Benefit (ODB) formulary do not list Wegovy for pediatric patients. Quebec's RAMQ covers Wegovy for adults meeting specific criteria but has not extended coverage to adolescents. British Columbia's PharmaCare and Alberta's AHCIP similarly lack a pediatric listing. Some private insurance plans cover Wegovy for adolescents when prescribed by a specialist, but families without employer benefits face out-of-pocket costs that can exceed $400 CAD per month.

The Canadian Pediatric Society (CPS) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) have not issued a joint position statement on GLP-1 use in children under 12. The CPS published a practice point on pediatric obesity management in 2023 that acknowledged GLP-1s as an emerging option for adolescents but did not address younger children. The SOGC's mandate does not extend to pediatric obesity directly. Health Canada has not signalled a review of the age threshold for GLP-1 approvals.

Canadian families seeking specialist care can access pediatric obesity programs at academic centres including the Hospital for Sick Children in Toronto, the Montreal Children's Hospital, and BC Children's Hospital in Vancouver. Telehealth platforms such as Maple and Telus Health offer access to physicians who can assess pediatric obesity, though prescribing GLP-1s to children under 12 remains outside approved indications on any platform.

What changed

The Orandi study is the first large-scale prescription-trend analysis to quantify off-label GLP-1 use in the 8-to-11 age group. The 310-fold increase sounds alarming, but the baseline was near zero in 2019, so the absolute number of children receiving these drugs remains a fraction of those who might clinically qualify. What the data do confirm is that US pediatricians are already moving ahead of regulatory approvals in severe cases, a pattern that historically precedes formal label expansions.

The American Academy of Pediatrics (AAP) published clinical practice guidelines in 2023 that included GLP-1 receptor agonists as a treatment option for adolescents 12 and older with obesity, alongside intensive lifestyle intervention. Those guidelines generated significant public debate, including concern about medicalizing childhood. Orandi's response to that concern is direct: children with obesity complications have already had their childhood medicalized by the conditions they are living with, not by a prescription.

The data also show a disparity in who receives these prescriptions. Access in the US study correlated with insurance status and geography, a pattern that maps onto Canada's provincial patchwork. Children in lower-income households or in provinces without formulary coverage are less likely to reach a specialist, let alone receive a prescription.

What Canadian patients should know

If your child is under 12 and has obesity, no GLP-1 drug is approved by Health Canada for their age group. A physician can prescribe off-label, but this requires documented clinical justification, informed consent, and typically a specialist referral. Most pediatric endocrinologists and obesity medicine physicians in Canada are reserving these conversations for children with severe obesity and documented complications.

For adolescents aged 12 and older, Wegovy and Saxenda are Health Canada-approved options. Getting coverage requires navigating your provincial formulary or private insurer. A referral to a pediatric obesity clinic at a children's hospital is the most reliable path to specialist assessment and, where appropriate, a prescription.

Lifestyle intervention remains the first-line recommendation across all Canadian and international guidelines for children of all ages. GLP-1 medications, where prescribed, are used alongside dietary counselling and physical activity support, not instead of them.

Parents who have questions about their child's weight trajectory should start with their family physician or pediatrician. Science & Humans (scienceandhumans.com) offers adult obesity medicine services in Canada but does not serve pediatric patients.

Limitations and open questions

The Orandi study is a US prescription-trend analysis. It does not include Canadian data, and the regulatory and coverage context differs substantially. The study does not report long-term outcomes for children who received GLP-1s under age 12, so the effects on growth velocity, bone density, and pubertal timing remain unknown.

Orandi himself flags this gap: FDA approval for younger children could broaden insurance coverage and reduce access disparities, but it could also open the door to use in less severe cases where long-term safety data do not yet exist. Health Canada has not indicated a timeline for reviewing the age threshold. The SOGC and the Canadian Pediatric Society have not issued updated guidance since the 2023 AAP guidelines were published.

What the study does not resolve is whether the children who received GLP-1s off-label in the US experienced better long-term outcomes than those who did not. That question requires prospective data, and those trials are not yet complete.

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This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

Editorial note

Hormone Journal articles are written by our editorial team and reviewed against published clinical guidelines, with a focus on Canadian patient access. We do not promote specific clinics or providers.