Loading ...

Obesity Canada has published an updated guideline for managing obesity in children and adolescents.

An earlier guideline for managing obesity in adults, which was published almost 20 years ago, added limited information about children. This is the first time that a guideline has been developed exclusively for children and adolescents.

The new document stresses behavioral and psychological interventions as the cornerstone of care and includes input from children and their families as to their values and preferences.

The guideline was published online on April 14 in CMAJ.

Family Support Needed

Pediatric obesity is a chronic, stigmatized, progressive disease that can impair the health and well-being of children and their families. In Canada, about 1 in 4 children aged 11 years or younger and 1 in 3 adolescents aged 12-17 years have an elevated body mass index (BMI), suggesting overweight or obesity. Worldwide, the prevalence of pediatric obesity has tripled over the past 30 years.

The new guideline contains 10 recommendations. Of these, five focus on behavioral and psychological interventions, three on pharmacological interventions, and two on surgical interventions.

“The earlier guideline was a combination of adult and pediatric guidelines, and, to be honest, the pediatric was sort of an add-on, so when it came time to do the second guideline, it was decided to do the pediatric version separately,” co-author Geoff Ball, PhD, RD, professor and associate chair (research) in the Department of Pediatrics at the University of Alberta in Edmonton, Alberta, told Medscape Medical News.

Involving parents in drafting the guidelines was also a first. “This time around, we had parents involved right from the beginning: From establishing the research questions to evaluating the evidence to helping with the research review of what we did to drafting the guidelines,” said Ball. “We had caregivers involved right from the beginning, and so we recruited a group of parents and a group of healthcare provider staff [to talk] about what outcomes mattered to them.”

Somewhat surprisingly, Ball noted, health-related quality-of-life issues and anxiety and other mental health problems topped the list of what mattered to patients and their families.

“You might think it’s all about waist circumference or body fat or weight, but when we ask families and healthcare providers about what outcomes matter to them, we hear things like health-related quality of life, anxiety, depression, adverse events; those were the highest priorities for them; it wasn’t the weight and blood pressure and lipids. So, that is what we really keyed in on when writing the guideline because that’s what people told us was important to them.”

Sanjeev Sockalingam, MD, scientific director of Obesity Canada, agreed that the behavioral component in the new guidelines is important. “Historically, people have focused on weight loss as a primary goal and BMI. We really wanted to shift that focus for children and youth to help them to think holistically about health outcomes that include quality of life and mental health, which they show is very important to them,” he said. Sockalingam did not help draft the guideline.

Another first for the guidelines is their suggestion that when all else fails, pharmacological interventions may be considered in older children.

“Medications may be a viable option for ages 12 and above. Not alone, in combination with behavioral interventions. But it’s an option that we shouldn’t wait for unnecessarily because many of these children are going to grow up to be adults living with obesity. If we can intervene, we can have a tremendous impact if we use all the tools that we have available,” said Sockalingam.

“Unfortunately, Canada is a bit delayed in recognizing obesity as a chronic disease, despite the 74 scientific societies who did so in The Lancet Commission,” guideline co-author Julie St-Pierre, MD, PhD, associate professor of pediatrics and director of the Bariatric Fellowship Program at McGill University in Montreal, told Medscape Medical News.

Only Alberta, of all the provinces, has recognized obesity as a chronic disease, said St-Pierre. “We need to catch up. No matter where you are right now in Canada, to apply these guidelines, we need financial support because most of our multidisciplinary clinics work with grants and out of our own pockets. It’s not supported by the government now. So, if we want to deal with the most prevalent pediatric disease in Canada, the number one disease in kids below age 18 years, we must have support. The science is clear.”

This guideline was supported financially by Obesity Canada and an Alberta Health Services Chair in Obesity Research awarded to Ball. Ball reported having financial relationships with the Alberta Health Services Chair in Obesity Research, the Canadian Institutes of Health Research, the Women and Children’s Health Research Institute, Novo Nordisk Canada, and Obesity Canada. St-Pierre reported having financial relationships with Eli Lilly and Company and Novo Nordisk Canada. Sockalingam reported having no relevant financial relationships.