It’s been three years since Christophe Legault, now 12, was diagnosed with obesity and began treatment.
He struggled at school — his grades were declining, he was bullied, and he struggled to participate in sports like basketball, his favorite sport.
The program, which he attends at the Maison de Santé Prévention, a semi-private, subsidized clinic in Montreal, involves intensive lifestyle and nutritional counseling, including what types of diet and exercise for him and his family who pays for the treatment, function.
With the help of doctors, nurses, nutritionists and other experts, the family changed their diet and Christophe started walking to school instead of taking the bus.
“It makes me proud that I’ve made great strides,” said Legault. “If I hadn’t had this treatment, it would have been really difficult.”
The type of early, intensive intervention Christophe is participating in is consistent with the American Academy of Pediatrics’ new clinical guidelines for the management of obesity, announced in January. The guidelines are shifting doctors’ approach from so-called “vigilant waiting” — to see if a child grows out of obesity — to more aggressive treatments.
The recommendations include intensive, individualized health and lifestyle treatment – at least 26 hours over three months, for children aged two years with a body mass index in the 85th percentile or higher.
But the AAP also recommends physicians offer weight-loss drugs to children ages 12 and older with obesity and bariatric surgery referrals to youth ages 13 and older with severe obesity, defined as having a body mass index of 35 or greater.
“Many of these children, especially teenagers, go into adulthood with obesity, and by the time they’re into adulthood, they already have many of the comorbidities,” said Dr. Madeline Joseph, medical director of the UFHealth Pediatric Weight Management Center in Jacksonville, Fla. and one of the authors of the US guidelines.
CLOCK | New US guidelines on childhood obesity recommend surgery and medication:
According to the US Centers for Disease Control and Prevention, there are 14 million children in the US who suffer from obesity, affecting one in five children nationwide. Joseph said there was evidence from more than 14 million children with obesity that the old approach just didn’t work.
“We cannot look on as these children are really struggling and their health is in jeopardy without offering them solutions,” she said.
New Canadian guidelines on the way
In Canada, where about one in ten children suffer from obesity, treatment guidelines are also being updated. A team of more than 50 experts across the country is reviewing the latest evidence and providing advice to families with children living with obesity to determine the best approach.
“Eating less and moving more is a very simplistic view of a complex problem,” said Dr. Geoff Ball, a University of Alberta professor and obesity research chair who works with the advocacy group Obesity Canada on the guidelines.
“Over time, as researchers and health professionals, we have come to take a much broader and more inclusive view of obesity.”
dr Melanie Henderson, a pediatric endocrinologist and researcher at Sainte-Justine Hospital in Montreal, said obesity is a chronic disease influenced by environmental factors, socioeconomic factors, genetics, lifestyle and more.
Henderson, who is also working on the Canadian guidelines, said children with obesity are at risk of high blood pressure, cholesterol problems and diabetes. They also have higher rates of anxiety and depression. Left untreated, children can carry these health problems into adulthood.
“The first line really remains healthy living and working with families to try and break down some of the barriers,” she said.
Still, Henderson said the treatment doesn’t work for all children and not everyone has access to programs that focus on this approach.
“There is a subset of children who, despite their best efforts, are living with very severe obesity and very severe complications,” she said.
For them, Henderson said, medication and bariatric surgery should be openly discussed as treatment options.
Stigma may also play a role in how children with obesity are treated within and beyond the healthcare system, said Dr. Yoni Freedhoff, medical director of the Bariatric Medical Institute in Ottawa.
Focusing solely on lifestyle changes, he said, “contributes to the stereotype that it’s just a matter of control.”
“There are genes and hormones that we can’t control, and these drugs can help level the playing field,” he said.
Focus on prevention
dr David Ma, a professor of health and nutrition sciences at the University of Guelph, worries that following the US example and including recommendations for drugs and surgery in Canadian guidelines could undermine prevention efforts.
“Certainly there is some evidence of effectiveness in individuals, in children, who represent the most extreme cases of obesity,” he said.
“The concern is that these are just patches and we really need to get to the root of why these kids are overweight and obese.”
More guidelines are expected in the US that deal specifically with prevention.
Ball said Canada’s guidelines, which are expected later this year, will focus on treatment for now. He said prevention guidelines could follow but would require the work of many stakeholders – in schools, communities and health facilities.
