Canada issues new guidelines on childhood obesity

A pediatrician involved in creating new treatment guidelines for obese children in Canada says the “alarming” rise in obesity has led to a greater need for surgery among teenagers. whose mental and physical sufferings are often more severe in adulthood.

Dr Melanie Henderson, researcher and pediatric endocrinologist at Sainte-Justine Hospital in Montreal, said the guidelines expected to be published later this year will go beyond measures that define obesity as body mass index to include children’s overall quality of life experience.

New guidelines published in the American Academy of Pediatrics last month recommend earlier drug intervention for children 12 years of age and older and bariatric surgery for those 13 years of age or older and obese. severe after repeated failed attempts at intensive behavior change.

Henderson, co-director of the children’s hospital’s family-focused program, said the Canadian guidelines would also focus on interventions without delay given the growing prevalence of obesity and the resulting risk of obesity. serious health consequences. It includes various professionals working with children to improve their fitness and nutrition and offering advice.

“We don’t have a lot of data on the best interventions to improve some mental health issues and quality of life,” she said. for example, is missing even though those issues are addressed in different intervention programs.

“All of this will be emphasized in the actual instructions,” she said.

Henderson is part of a group of clinicians and researchers around the country that came together in 2019 to create new guidelines with research support from the Obesity Foundation of Canada and the University of California. Alberta.

She says there is more acceptance that drugs and weight loss surgery should be offered early on as options for a small group of children because obesity is a chronic disease compared with a risk factor for other diseases. other disease.

“We’re having honest discussions about this in the small group of kids who have serious consequences of obesity. We’re talking about earlier cardiovascular disease, earlier Type 2 diabetes, increased disease. blood pressure earlier. All of these factors lead to earlier death. So these are no small complications.”

An estimated 27% of children in Canada are overweight or obese. Of those, about 10% are obese, three times more than 30 years ago, Henderson said.

“It is alarming that we are seeing a very dramatic increase in childhood obesity,” she said, adding that while genetic factors are an important factor, The reduction in physical activity at school and a more sedentary lifestyle at home is part of the problem. To address these issues, behavior change is required – and that is the case even for children who are prescribed medication or surgery, which requires a commitment to eating a healthy diet.

“We used to think childhood obesity wasn’t a big deal, that they would get over it when they got older,” she said. “But in reality, that’s been disproved. So young children grow up to be obese teenagers and obese adults.”

Obese children are three times more likely to develop depression than non-obese children, said Henderson, because stigma and shame extend beyond the school grounds to health professionals, who may be biased. especially for people who are severely overweight.

Among the drugs used to treat childhood obesity in Canada is Orlistat, a drug that inhibits the absorption of fat in the intestines, which is particularly effective in adolescents but is not often prescribed due to side effects. including digestive problems.

Another drug, Metformin, is primarily used to control Type 2 diabetes in adults and is prescribed off-label. However, the lack of data means that it is difficult for doctors to know who will respond well to it.

Henderson says a class of drugs called GLP-1 agonists are injected and approved for use in children 12 years of age and older, adding that they are probably the best option for reducing hunger, but they don’t work. costs almost 400 dollars a month.

Bariatric surgery, which involves shrinking the stomach to reduce food intake, was introduced in Canada to adolescents in 2010 as part of the SickKids Group’s two-year Obesity Management Program, or STOMP. , at the Hospital for Sick Children in Toronto.

“We needed to cover all possible treatment options, and we have good data that bariatric surgery is effective,” says Henderson. “It’s effective in children, and in fact, it’s effective in reversing some of those complications. In particular, for high blood pressure and Type 2 diabetes, it’s more effective in adolescents. years compared to adults.”

Dr Julius Erdstein, director of the department of adolescent medicine at Children’s Hospital Montreal, said bariatric surgery, starting at age 15, is “easy” for teenagers enrolled at the hospital. Center of Excellence in Juvenile Obesity and is struggling with issues like kidney failure, diabetes injections and sleep apnea.

“If we had five kids having surgery a year, about 10 percent of the patients referred to us, that would be a lot of money,” Erdstein said, adding one surgery will be performed after two years of behavioral intervention.

“There are a lot of children who need it. We can’t afford it and it takes a long time to prepare for the surgery,” he said of the clinic for people with a body mass index over 35 and disfigured. severe illness. or a BMI over 40. BMI is a measurement based on height and weight, and obesity is defined as a BMI equal to or higher than the 95th percentile for people of the same age and sex.

“This is about people with life-threatening, life-changing medical conditions that we really haven’t had in the past,” says Erdstein. “If the medical community didn’t have the tools, there would be a lot of snake oil sellers. Behavioral and lifestyle interventions are at the core of what we do but most of the evidence shows the results of this.” That, even with intensive interventions, is not very large.”

He said a 400-pound 15-year-old can, after about six months of medical assistance, lose between 20 and 40 pounds, but that’s not a significant enough difference from surgery, which can lead to to half that weight. There are different types of surgery, says Erdstein, some of which require strict rules to be followed, such as portion restriction and avoidance of carbonated beverages, but this intervention is “unparalleled” in improving overall health, says Erdstein.

He notes that a lot of education is devoted to preparing children for surgery. “You have to be very careful about what you eat and when. So that’s an important thing. You’re making a commitment to taking vitamins for the rest of your life.”

Dr Tom Warshawski, pediatrician and president of the Childhood Obesity Foundation, said US recommendations on drugs and surgery were “reasonable” for Canada but the main intervention beyond the guidelines The next step would be a policy change to restrict the marketing of unhealthy foods and beverages. children.

“Without a doubt, we know that the main cause of the worldwide epidemic of unhealthy weight gain is the consumption of ultra-processed foods. And a big driver of children’s consumption. children, why they are often lured by these foods, is marketing.”

Warshawski said it’s time for a law banning commercial advertising targeting children under 13 in Quebec to be extended to the rest of Canada due to rising obesity-related healthcare costs, most recently due to more screen time and less physical activity during the pandemic.

This report by The Canadian Press was first published on February 17, 2023.

The Canadian Press health insurance is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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