Growing Healthy: Weighing in on Childhood Obesity Guidelines

“My child’s weight has really gone up…” This could be the opening to your next SOO encounter or clinic visit. 

Writing the SOO this month? See how to approach NEW GUIDELINES on the exam, at the end of this article!

Following the adult obesity guidelines released in 2020, new pediatric obesity guidelines were released this week to help!

Obesity in the pediatrics population can lead to decreased life quality and shorten lifespan in children and their families. 

A large proportion of children with obesity maintain their obesity into adolescence, and further then into adulthood. The health consequences of obesity necessitate a robust family-oriented intervention strategy for pediatric obesity. Here are the major recommendations made in partnership with Obesity Canada for managing pediatric obesity, which replaces the existing guidelines:

Behavioural and Psychological Interventions:

1. Management from multiple different components (ie, activity, nutrition, psychology…) is more effective than a single management strategy. 

2. Conservative management options include patient centered physical activity regimes, nutritional counseling, Cognitive behavioral therapy, and websites/smartphone applications.

3. Goal setting, self-monitoring, and problem solving incorporated into plans led to improved outcomes.

Pharmacologic Interventions:

4. Know the 2 classes: GLP-1 agonists, Biguanides are recommended in children aged 12 and older, in combination with behavioural and psychological interventions

5. Lipase inhibitors are NOT recommended

   
   

   Of note, the newer medications (e.g. dual GIP/GLP-1 receptor agonists such as Tirzepatide (Mounjaro) are available in Canada but NOT mentioned in this guideline.

   
   

Surgical Interventions:

6. Laparoscopic sleeve gastrectomy and Roux-en Y gastric bypass can be considered for patients age 13 or older after being cleared by a multidisciplinary team, and in combination with behavioural and psychological interventions

Good Practice Statements for Health Care Providers:

1. Use person-first language, avoid negative and stigmatizing language

   
   

2. Acknowledge the complexity of obesity, and importance of family relationships and longitudinal support

3. Assess physical growth using World Health Organization (WHO) growth charts

   
   

4. Acknowledge social determinants of health in the decision-making process for recommendations and access to resources for patients

   
   

5. Complete a health assessment for patients including a framework (e.g. 4Ms of Obesity management= Metabolic, Mechanical, Mental Health, Social Milieu), considering consequences of obesity and barriers to management (e.g. risk of eating disorders)

   
   

6. Explore children and families expectations for improvement health outcomes

   
   

7. Use resources such as 5As for Pediatric Obesity Management to provide structure in a respectful manner

   
   

8. Recommend obesity interventions based on evidence, feasibility, and availability

   
   

9. Use a multidisciplinary environment where available

What if new guidelines came out right before my CCFP Exam?

The CFPC says in the exam FAQ that “you should always answer according to what represents the best practice in family medicine at the time of the examination. You will never be penalized for staying current.” In other words, you will look like a SUPERIOR CERTIFICANT if you mention “new guidelines just released on this topic…” and you won’t lose marks for it, even if the exam question was created before the guidelines were released.

If you are an R1 hoping to study at a relaxed pace for the Spring CCFP exam, attending The Review Course in August is a great way to level up! Register here

Source