Pediatric Obesity Guidelines
By Dr. Ryan Oughtred, CBE, DCOM. Weight Loss Doctor in Vancouver
As we approach the two-year mark since the American Academy of Pediatrics (AAP) released their 2023 guidelines on pediatric obesity, it's important to acknowledge that Canada still lacks specific guidance for children living with Adiposity-Based Chronic Disease (ABCD) or weight-related concerns.
Since June 2023, Semaglutide 2.4 mg (Wegovy) has been available to pediatric patients in Canada. Despite this advancement, many patients and families remain unaware that this treatment option exists for them. In the months since its approval, numerous children and adolescents could have benefited from this medication but likely didn't have access due to a lack of awareness.
The Emphasis on Behavioral Health and Lifestyle Therapy
The AAP guidelines (as well as many other expert guidelines) place significant emphasis on behavioral health and lifestyle therapy. While I'm a strong advocate for behavioural therapy—I make my living from it—I believe we need to examine whether our longstanding biases are at play here. We understand that obesity is largely genetically and environmentally determined. Expecting a child to engage their executive function for Cognitive Behavioral Therapy (CBT) for weight management is a substantial demand.
Families can manage their child's environment to some extent, and addressing individual factors like medications or mental health is certainly beneficial. However, with so many variables beyond our control in children and youth, I feel that medications should not be offered as some kind of second-line treatment that needs to be earned or delayed in any way. Educate families and children about what is available to them, and let them choose. There are currently 4 obesity medications available in Canada for patients 12 years of age and older.
Reconsidering the Treatment Approach for Pediatric Patients
If there's one patient group where we might consider discontinuing therapy at some point, perhaps it could be when pediatric patients reach older ages? When an individual reaches around 25 years of age, their executive function is fully developed, they've completed university—a period that also poses high risks for weight gain—and they are socially more stable. Perhaps that's the appropriate time to explore a psychological and behavioural approach for weight management?
Weight is Progressive - Earlier Treatment is Better
By offering effective medical treatments earlier, we may prevent the progression of obesity and its associated health complications. Moreover, we know that pediatric patients experience negative bias, stigma, discrimination and bullying by their peers related to their weight. We should take action and offer kids and their families a choice at potentially preventing the social and health harms of ABCD/ Obesity.
I am a ABCD/ Obesity/ Weight Loss Doctor in Vancouver - if you're seeking support for yourself or someone you love, please reach out. Whether it be through education, intensive behaviour therapy, obesity medication, or other supports and treatments, together, we can explore what is best for you.
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