The new guidelines on how to treat children and adolescents with obesity were published this week in the Journal of the Canadian Medical Association. The guide for families and clinicians advocates early intervention and individual care. He also offers a family -centered approach rather than an intervention targeting the child’s individual behavior change.
Personalized interventions and a behavioral approach affecting physical activity, nutrition and psychological support are to be favored in the treatment of pediatric obesity. Five of the ten recommendations go in this direction. These behavioral and psychological approaches could however be combined with surgical interventions or the prescription of drugs.
Drugs and surgery are now part of the treatment
Surgery could be considered among young people aged 13 and over. Drawing on the most recent studies on the subject, the guide suggests two operations: gastrectomy in a sleeve, which consists in removing up to 85 % of the stomach by laparoscopy, and gastric derivation of Roux-en-Y, which deviates the intestine to reduce the absorption of food.
The guide also recommends using weight loss drugs made up of semaglutide, such as Wegovy, or metformin in young people aged 12 and over. However, these products are not very accessible because of their high price and their exclusion from the reimbursement program for the Quebec Health Insurance Régie (RAMQ). Simaglutide -based drugs are only covered to treat patients with type 2 diabetes.
Drugs and surgery must however be complementary to behavioral and psychological interventions. And are not to be considered in the event of failure of these.
The guide also underlines “that no convincing data justifies a progressive approach according to which pharmacological and surgical interventions should only be proposed if behavioral and psychological interventions prove to be ineffective.”
The problem is that Quebec has few obesity management programs in children using multidisciplinary teams.
Obesity as chronic disease
The publication of the guide occurs shortly after a group of experts proposed, in January, a new definition of obesity. The report distinguishes two categories in terms of diagnosis: preclinical obesity and clinical obesity.
The first is defined as “an excess weight of weight without significant impact on health, but with an increased risk of developing long -term complications”, while the second is described as “a chronic disease characterized by symptoms or dysfunctions of organs caused directly by excess fat”.
Obesity is now considered a chronic disease by the World Health Organization and several Canadian organizations, including the Canadian Medical Association.
On the other hand, it is not recognized as such by the federal government or by Quebec. Medicines to treat it are therefore not reimbursed by public insurance plans such as Quebec Health Insurance Régie (RAMQ).
According to Obesity Canada, around 80 % of obese adolescents will remain so to adulthood, which increases the risk of more than 200 health problems. Obesity can also, for example, cause stigma at school.
The guidelines were established in partnership with Obesité Canada. Obese children, their families and their health professionals participated in their development in order to optimize their relevance and applicability.
Read also: Obesity: when the diets are no longer sufficient
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