Treat childhood obesity by reducing stigma, adding options, say new Canadian guidelines

Brenndon Goodman was nine years old when a doctor told him he would be dead by 30 if he couldn't get his weight under control.

"You're going through all the issues a normal nine-year-old goes through. On top of that, also being told you're overweight, you're an aberration. For me, I felt like I was a failure," said Goodman, 30, who lives in Thornhill, Ont.

He said he remembers endless — and unhelpful — appointments at weight-loss programs that amounted to cookie-cutter diet plans and shame. What finally worked was when a team of doctors, dietitians, specialists and psychologists at Toronto's Hospital for Sick Children started telling him about the psychological and genetic aspects of obesity.

That kind of collaborative and inclusive approach should be what all doctors and nurses take when treating children struggling with obesity, say the authors of new Canadian clinical practice guidelines published on Monday in the Canadian Medical Association Journal.

The authors say doctors should make sure patients and families are well informed and included in any decision-making.

They also say that health-care workers should provide psychological treatments like counselling for behavioural change, along with such strategies as improving nutrition and physical activity.

"In terms of, you know, the 'eat less, move more' movement, we know that alone, as a treatment for obesity, does not provide sustained success," said Dr. Sanjeev Sockalingam, a professor in the psychiatry department at the University of Toronto and scientific director at the non-profit Obesity Canada, which co-developed the new guidelines.

In some cases, the authors say, families should also be given a chance to consider medications, like GLP-1s — sold under brand names like Ozempic or Mounjaro — which mimic the naturally occurring hormone to help regulate appetite and blood sugar levels, and are widely used for Type 2 diabetes or weight loss. The guidelines also say some children struggling with weight management could be considered for weight loss surgery, under certain conditions.

It's the first time the guidelines have been updated since 2007 — and they are long overdue, say some experts.

"A lot has changed in how we manage children, and there's a lot of new literature as well," said Dr. Jill Hamilton, head of the endocrinology division at the Hospital for Sick Children and one of the co-authors of the guidelines.

"For so long, we focused on just weight or [body mass index] as an outcome," she said.

"Other outcomes are as important, or more important, than that to families. Things like improving health-related quality of life," such as high blood pressure, musculoskeletal pain, anxiety or bullying. 

The new guidelines also talk about the stigma associated with obesity.

It's a huge change from the guidelines published in 2007, where the word "stigma" isn't mentioned.