Children with obesity should be offered the same menu of treatments as adults — including bariatric surgery and Ozempic-type medications for adolescents — according to new .
The guidelines were updated for the first time in nearly 20 years to ensure patients, parents and health care clinicians have the evidence they need to make decisions together, says , professor of pediatrics and co-chair of the panel of more than 50 experts that developed the guidelines.
“Talking about obesity can be a really difficult conversation to initiate and to participate in, so that's why we have recommendations based on the evidence,” says Ball, who holds the ¾ÅÐãÖ±²¥ Health Services Chair in Obesity Research and is also associate chair of research for the Faculty of Medicine & Dentistry.
“We recommend that health care professionals provide families with the evidence for the interventions — what to expect, the drawbacks — and then decide what’s best based on values and preferences, as well as availability and accessibility,” he says.
Obesity is a “chronic, stigmatized, progressive disease” according to , which reports that about one quarter of Canadian children under 12 and one third of 12 to 17-year-olds are considered overweight or obese based on their body mass index.
The guideline team included parents as well as medical experts. Together they reviewed existing evidence and surveyed families about their priorities.
“Parents told us the outcomes that mattered to them the most were adverse events, health-related quality of life, anxiety and depression,” Ball says. “Those were ranked higher than blood pressure, insulin resistance, BMI and weight, so it’s not all about the weight for people with obesity.”
The strongest evidence supports a multi-disciplinary approach where the child and family work with a team that could include a dietitian, family physician, kinesiologist, nurse, pediatrician, psychologist or social worker to implement diet changes, exercise and psychological counselling.
The evidence available for Ozempic-like medications is for children ages 12 to 17 and the bariatric surgery evidence is for those 13 and older. Adolescence is often when the impact of obesity and health risks cause families to seek treatment. All treatments should be offered along with behavioural and psychological interventions, Ball says.
Much more research is needed because of the complexity of the disease and the fact that obesity science is relatively new, he adds.
“We need to do a better job of generating the evidence to have a better vision of the benefit-to-harm ratio,” he says, noting that more research in children is also needed for factors such as gender, race, severity of obesity and the impact of taking lifelong prescriptions.
‘When you have high blood pressure and you stop taking the medication, your blood pressure is probably going to go up, so it would be expected that's the case for medication you take for obesity management as well,” Ball says.
Many Canadians in rural or remote communities do not have access to specialists who can perform surgery or feel comfortable prescribing weight loss medication, which is why Ball suggests continued training for family physicians will be required as more research and new drugs become available.
“As an advocacy tool, we're hoping the guideline will shine light on how uneven the services are and also encourage conversations about the evidence on obesity in general,” Ball says.
The guideline initiative was funded by Obesity Canada and the ¾ÅÐãÖ±²¥ Health Services Chair in Obesity Research. Geoff Ball is a member of the .
