Managing childhood obesity: New canadian guidelines released

Study outlines behavioral, pharmacologic, and surgical strategies for treating childhood obesity, highlighting the benefits and trade-offs of each intervention.

Study: Managing obesity in children: a clinical practice guideline. Image Credit: Shutterstock AI Generator / Shutterstock.com

A recent Canadian Medical Association Journal study provides evidence-based recommendations to manage pediatric obesity.

Recommendations to manage pediatric obesity

In the current study, the researchers categorized their recommendations into five behavioral and psychological interventions, three pharmacologic interventions, and two surgical interventions. Multicomponent interventions that incorporate at least two interventions based on nutrition, physical activity, psychology, and technology were strongly recommended.

Nutritional interventions involving specific dietary patterns, such as low-fat, low glycemic index, and Mediterranean-style diets, have successfully been used to manage child obesity. Research has also demonstrated the beneficial effects of physical activity interventions including aerobic or resistance training, with the combination of both aerobic and resistance training most effective.

The certainty of evidence on the efficacy of psychological interventions was moderate. Nevertheless, the researchers recommend psychological interventions for managing obesity in children 18 years of age and younger, including counseling and standardized cognitive behavioral therapies.

The recommendations were neither for nor against technological interventions.

Among children 12 years of age and older, behavioral and psychological interventions should be combined with glucagon-like peptide-1 receptor agonists (GLP-1RAs), such as exenatide, liraglutide, and semaglutide. Biguanides can also be combined with behavioral and psychological interventions to manage obesity in this pediatric patient population. Lipase inhibitors were not recommended to manage obesity in children.

Surgical interventions can also be used to manage obesity among children. Laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass surgery in combination with behavioral and psychological interventions could be considered for managing obesity in children aged 13 years and older.

Pros and cons

Multicomponent interventions had a small beneficial effect on depression and a greater effect on anxiety. However, no evidence was provided on the effect of these interventions on health-related quality of life (HRQoL).

Moderate to large beneficial effects for triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were reported.

There was no data on the effects of nutritional interventions on HRQoL, depression, and anxiety. Nevertheless, favorable effects were reported for body mass index (BMI), weight, cholesterol, LDL-C, and homeostatic model assessment of insulin resistance (HOMA-IR).

For physical activity interventions, small effects on HRQoL and BMI z score (BMIz) were observed, with little to no beneficial or harmful effects reported for depression and anxiety. Significant improvements in systolic blood pressure, total cholesterol, LDL-C, triglycerides, and HOMA-IR were observed, whereas moderate effects on diastolic blood pressure and HDL-C were reported.

Psychological interventions had a moderate effect on depression and small effect on HRQoL. Significant improvements in both BMI and weight were also associated with psychological interventions.

Evidence from randomized controlled trials (RCTs) suggests that GLP-1RAs and biguanides have little to no effect on HRQoL, depression, and anxiety, despite the efficacy of GLP-1RAs in reducing BMIz, BMI, and weight. Small beneficial effects were observed for HOMA-IR, triglycerides, and systolic blood pressure.

For laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass surgery, a very large beneficial effect on HRQoL was reported. Although mixed results on the impact of laparoscopic sleeve gastrectomy on improving anxiety and depression were observed, BMI and weight decreased significantly because of this procedure. This surgical approach was associated with large beneficial effects on systolic blood pressure, HOMA-IR, HDL-C, and triglycerides.

For Roux-en-Y gastric bypass surgery, small beneficial effects on anxiety and depression were observed, whereas large beneficial effects on LDL-C, HDL-C, HOMA-IR, and BMIz were reported. The effect of this procedure on triglycerides was large, whereas this surgery had a moderate impact on both systolic and diastolic blood pressure levels.

Study limitations

A key limitation of the current study is that it solely focuses on obesity management, rather than prevention. Furthermore, the steering committee and guideline panel lacked representation from different ages and backgrounds.

The literature searches were completed in 2023, which may have prevented the consideration of more recent studies when devising these recommendations. This is particularly relevant for pharmacologic interventions, which is a rapidly evolving area.

Conclusions

Obesity is a complex disease that increases the risk of long-term medical complications, as well as reduced quality of life and longevity. The guidelines outlined in this study provide evidence for the benefits and potential adverse effects associated with various obesity management interventions, which facilitates informed decision-making between obese children, their families, and healthcare providers.