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how to face rising rates of obesity in teens: 'we have to recognize there are multiple factors'
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beyond the fast-food culture, other environmental risk factors that have become common themes for youth include poor sleep, screen time and limited physical activity, all of which interact with our biology.
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why is obesity rising in teens, putting them at risk of all kinds of additional health problems down the road?
according to the first
international guidelines on managing childhood obesityfrom the world health organization (who) released in october, the global statistics are grim: in 2024, 400 million children and adolescents aged five to 19 were overweight. the prevalence of overweight, including obesity, among children and adolescents at these ages has risen dramatically from just eight per cent in 1990 to 20 per cent in 2024.
here in canada, dr. sanjeev sockalingam is helping to solve this with new programs for youth carrying excess weight, and education for health-care providers to understand what’s driving obesity and how to recognize a young person at risk. the solution is no longer about getting to your best weight or a magic number on the scale—it’s about untangling the complexity of chronic disease for each individual.
complexity of obesity is lifelong
“now we see that obesity is associated with more than 200 other illnesses,” says dr. sockalingam, a medical psychiatrist in toronto and scientific director of
obesity canada.
“oftentimes treating obesity can improve other health conditions, which are not the initial points of discussion for many health-care providers. you still get stuck on the very outdated way of thinking about weight or weight loss. even people living with obesity are focused on that because of society. but really this is about health improvement.”
ultimately, he’d like to see the emerging science, medications and other treatments become part of early intervention for youth to prevent multiple complications later on. he says preventing obesity will improve overall health as the population ages.
dr. sockalingam started his career integrating physical and mental health. he recognized early on that complex diseases like liver disease and mental health disorders were underpinned by metabolic diseases like obesity.
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“in my mental health clinics, unfortunately, there is a bidirectional relationship,” he says. that causal link influenced his research and clinical care for people living with obesity in specialty programs at toronto hospitals, including sickkids for vulnerable youth. in his view, treatment must support emotional health, lifestyle habits and the mental and physical factors that all contribute to rising obesity.
teens are vulnerable and still developing
the support groups he’s run for young people with obesity have been a highlight. “youth have had to deal with so much stigma and discrimination, and the resilience that they have to continue to seek help even when they were getting [outdated] recommendations,” he says of the push to exercise more.
“i think their willingness to talk openly about their mental health challenges that are so intertwined with identity and their growth as human beings, and how that is linked to obesity and the impacts that it’s had on their physical health and development. so i think that has been remarkable—the vulnerability and the openness.”
although the current focus on medications like glp-1s has provided more hope and options for patients, the solution is not simply just a pill or injection. he says these medications also come with challenges and discussions around understanding obesity as a chronic health condition.
“there’s a biology behind this. that biology is not limited to fat cells in our periphery. it’s in our organs, including the liver and our brains have effects from hormones in relation to fat deposits and their impact and inflammation. so all of these things are really critical for us to untangle the complexity, but actually have more specific ways we can intervene and improve health generally for patients.”
he talks about the definitive genetic components that show obesity is hereditary and family history puts people at higher risk. “those genes also have impacts on the biology of our brain where our hunger centres are, how activated they are, how sensitive our reward pathways are to environmental cues. we do have the obesogenic environment where high calorically dense foods are highly available at our fingertips in our society right now.”
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beyond the fast-food culture, other environmental risk factors that have become common themes for youth include poor sleep, screen time and limited physical activity, all of which interact with our biology.
further, family modelling is also a factor, such as how people experience their childhood through exposure to nutritious foods, how eating is perceived and the rise in mood and anxiety among teens, which can predispose them to developing obesity. even medications for mental health conditions can cause weight gain for people down the road.
“it’s a double-edged sword, right? if we don’t treat depression or anxiety, people are more likely to develop obesity, and if we treat it, we must be informed that there are some treatments that might predispose someone to developing obesity,” he notes.
“i think what it underscores in teens is that we have to recognize there are multiple factors. and that’s probably important for us as people are being seen by pediatricians, family doctors and nurse practitioners, that they understand what factors we can actually modify and treat early on to maybe alter their trajectory in terms of developing obesity.”
the canadian medical association journal (cmaj) released
new guidelines on how to treat children and teenagers living with obesity in 2025. the emphasis has moved away from the outdated “move more, eat less” approach to early intervention, individual care, behavioural and psychological support and, in some cases, additional medical or surgical interventions.
physical and mental signs of obesity risk
so, what should frontline health-care providers be looking for in teens?
first, as dr. sockalingam outlines, is recognizing the biases and how kids are affected.
“bullying in schools, social perception, social identity are so highly intertwined with living in larger bodies. that can have a negative impact coming into a health-care setting,” he says of teens being reluctant to open up. primary care providers need to start by asking for permission to talk about obesity and improving health through weight loss.
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“and then it’s assessment,” he explains of looking at a patient’s physical health and mental health.
“what are some of the physical health conditions that someone might have? if someone is developing diabetes in their teens or high cholesterol and high blood pressure, putting them at risk of heart attacks in the near future, then that’s a more urgent type of intervention that we might do than where someone who’s maybe a higher bmi but doesn’t have all these other health conditions.”
screening for mental health conditions is part of the assessment to determine engagement and a suitable treatment path. social determinants are a factor as well, considering socioeconomic status and whether families can afford healthier foods. or is housing an issue that affects sleep, mental health and quality of life? are there physical limitations that affect mobility and decrease physical activity, like early osteoarthritis or injuries that may be a result of living with excess weight, for example?
another important part of treatment is family involvement and support,
with evidence referenced in the cmaj guidelinesdemonstrating that family interventions are critical to the health outcomes of kids and teens. if the family learns about nutritional literacy and eats better, the youth will benefit. if a caregiver takes their teen to counselling to support healthy behaviour changes, that’s a benefit.
another pillar of obesity treatment is medications. historically, the diabetes medication metformin has been prescribed for youth, “and now glp-1 receptor agonists like semaglutide are in trials in adolescents from ages 12 to 18 that show significant improvements both in weight loss that is sustained while on treatment, but also other health benefits,” he says.
however, those medications are not risk-free. “they come with the same side effects we see in adults, like gastrointestinal side effects, so we have to make sure people are taking these medications regularly. they’re not a fad diet where you go off and on them. it’s a chronic disease. and so we have to really work with patients and families to understand that.”
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metabolic and bariatric surgery are also in the toolbox, especially where patients have significant health issues associated with obesity, where other treatments may not have worked. surgical procedures require a thorough assessment by an interdisciplinary team and ongoing follow-up.
“these are not short-term treatments. these are lifelong changes that we need to support people.”
dr. sockalingam’s hope is that momentum in obesity medicine can be life-changing for teens.
“most importantly, now that we have more treatments available and programs emerging, the hope that it provides for young individuals who could have had a trajectory where they continue to be isolated, stigmatized, dealing silently with mental health and psychological complications from all of that. now they can have some corrective experiences that could open up aspects of their life that wouldn’t be possible had we not had an opportunity to intervene early on.”
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