TORONTO – A new guideline for treating obesity in children and adolescents says medication can be helpful, but that health providers should prioritize addressing nutrition, exercise and psychological needs.
Obesity Canada’s first update to the pediatric obesity management guideline in almost 20 years was published in the Canadian Medical Association Journal this week.
The organization’s scientific director, Dr. Sanjeev Sockalingam, says both the scientific understanding and societal impact of obesity have since changed dramatically.
Sockalingam says one of the major changes is the development of GLP-1 agonist drugs — such as Ozempic, Wegovy or Mounjaro — for weight loss that have been studied in adolescents 12 years of age and over.
He says the starting point for treating obesity should be a discussion with patients and their families about what their goals are and what nutrition, exercise and psychological support is needed.
Sockalingam says if those actions aren’t working then medication or bariatric surgery might be considered, but only after discussing the benefits and risks with the patient and their family.
If medications are used, it’s critical that nutrition, exercise and other needed treatments are also continued, the guideline says.
The discussion about using medication should also include the fact that more research is still needed to determine the long-term effects, Sockalingam said.
The guideline was developed by a committee of experts from several disciplines who evaluated multiple research studies on obesity. Children and adolescents, as well as their families, also gave their input about what would be helpful for them.
Obesity Canada says about one in four children age 11 years and younger and one in three adolescents between 12 and 17 years of age are considered overweight or obese.
Family doctors and other health-care providers should go beyond measuring their patients’ body-mass index, or BMI, when assessing them, the guideline says.
That means talking to kids and their families about specific goals other than weight loss, from managing blood pressure and cholesterol to improving their quality of life.
It also emphasizes that health-care providers should avoid using stigmatizing language.
“Some children with obesity and families have a history of negative interactions with health-care providers, including feeling blamed and shamed,” the guideline says.
“It is important to use encouraging, supportive words and language during clinical conversations.”
The Canadian Paediatric Society says it is reviewing the new guideline.
“Obesity is a complex and multi-faceted issue that demands an individualized response. We appreciate the time and care Obesity Canada put into the updated recommendations,” the society said in an emailed statement.
“Our subject matter experts are carefully reviewing the guidelines as we consider adopting them.”
Sockalingam, who is also the psychosocial director for the University Health Network’s bariatric surgery program in Toronto, said obesity is a chronic disease and should be treated that way.
“There are struggles across health professions, including some primary-care providers that still are not aware that obesity is a chronic disease and that it requires a multimodal treatment,” he said.
Dr. Mélanie Henderson, who was on the pediatric obesity guideline development committee, said providing comprehensive treatment often requires improved access to other specialists, such as psychologists, nutritionists, kinesiologists and social workers.
”(It’s) lifestyle and behavioural interventions that’s the heart of pediatric obesity management and it remains so, even if you have to increase your modalities by adding pharmacotherapy or bariatric surgery,” said Henderson, who is a pediatric endocrinologist and researcher at CHU Sainte-Justine in Montreal.
Those interventions need to be tailored to each child, she said. Rather than giving “sort of blind recommendations that you need to be active one hour per day,” talk about what activities the child is interested in and determine what’s doable for the family.
Mental health support may be needed to help children and teens deal with problems associated with obesity, including bullying and stigma, she said.
“Obesity is not a personal choice,” Henderson said, noting the importance of “helping kids find the confidence in themselves to make the changes, to not get discouraged.”
This report by The Canadian Press was first published April 15, 2025.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
