For the first time in nearly two decades, Canada has updated its national clinical guideline for childhood and adolescent obesity — and this time, the focus isn’t on numbers on a scale.
Instead, the new approach recommends focusing on quality of life and mental health, and even includes medications like GLP-1s for kids 12 and up when needed.
GLP-1 drugs like Ozempic and Wegovy have been approved by Health Canada for adolescents aged 12 and up who have obesity and who haven’t succeeded in weight loss with diet and exercise alone. However, the medication has not been approved for younger children.
Published Monday in the Canadian Medical Association Journal, the new guidelines, developed with the help of Obesity Canada, make 10 recommendations and nine good practice statements for managing obesity in children.
“Families want care that actually improves how their kids feel — mentally, emotionally and physically,” Lisa Schaffer, executive director of Obesity Canada, said in a Monday media release.
“We know the time to act is now. Waiting until children become adults to provide meaningful, evidence-based support only increases the risk of complications and prolongs the impact of living with a stigmatized chronic disease.”
Obesity is a complex, chronic, progressive and highly stigmatized disease that increases the risk for more than 200 health conditions, the guidelines say. And rates are on the rise.
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In Canada, around 25 per cent of children aged four to 11 and 33 per cent of those aged 12 to 17 have a body mass index (BMI) that may indicate they are overweight or obese, the guidelines say.
More than 50 per cent of children aged seven to 11 who live with obesity will continue to do so through adolescence, and roughly 80 per cent of teens aged 12 to 18 will carry the condition into adulthood, according to Schaffer.
Because obesity is so complex, the guidelines (updated for the first time since 2007) emphasize evidence-based options for managing it, focusing on shared decision-making between kids living with obesity, their families and health-care providers.
While weight loss may be a part of someone’s journey, it’s no longer the sole — or even primary — measure of success.
Instead, the authors recommend multicomponent interventions that include physical activity, nutrition and psychological support as the foundation of care. Where appropriate and accessible, medications or surgery may also play a role.
This includes GLP-1 medications.
The guidelines recommend GLP-1 medications for managing pediatric obesity, but with caution. They acknowledge that while these drugs can help with weight loss and some health markers, the evidence on long-term benefits and side effects is still unclear, and results can vary from person to person.
The guidelines also suggest that under some conditions, two types of weight-loss surgery for kids aged 13 and over may be helpful.
This includes laparoscopic sleeve gastrectomy and gastric bypass. Both surgeries work by limiting the amount of food the stomach can hold or changing how food is digested, leading to weight loss and health improvements when combined with behavioural and psychological support.
However, the authors note, they do come with some risks, like mild side effects such as nausea and stomach pain, and, in rare cases, more serious complications.
“With only two surgical centres, a patchwork of multidisciplinary obesity management clinics, and widespread lack of equitable and affordable access to treatments in Canada, we know families currently have very few practical options,” Dr. Sanjeev Sockalingam, scientific director of Obesity Canada and professor of psychiatry at the University of Toronto, said in a statement.
“The guideline authors have given us a solid, transparent and interpretable foundation on which we can begin to advocate and educate toward establishing a new standard of obesity care for children and adolescents — they have a right to evidence-based care to improve their health and wellbeing.”
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