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Childhood obesity guidelines provide recommendations for care, quality of life
Summary:
The updated Canadian guidelines are informed by evidence-based recommendations from SickKids researchers.
Obesity Canada has published the first update to Managing Obesity in Children: A Clinical Practice Guideline in over 20 years.
The updated guidelines, published in CMAJ (Canadian Medical Association Journal), emphasize evidence-based and patient-informed recommendations and were informed by three scoping reviews of the available research, two of which were led by researchers at The Hospital for Sick Children (SickKids).
In Canada, approximately 30 per cent of children are living with overweight or obesity, a condition which is associated with a variety of health challenges including reduced quality of life, depression and diabetes. Building upon previous guidelines, this update engaged children and youth experiencing obesity, and their caregivers, throughout the process of developing the guidelines to ensure that the resulting recommendations reflect their priorities. Key among those priorities was improving quality of life and mental health.
“A lot of people think we can’t actually make a difference in children and adolescents lives who are living with obesity – we can,” says Dr. Catherine Birken, Senior Scientist in the Child Health Evaluative Sciences program, Staff Paediatrician in the Division of Paediatric Medicine and co-author of the new guidelines. “Treatments are effective, but are often most effective when they are combined to address what matters most to patients and families.”
Read more about SickKids’ contributions to this important update to care guidelines for children and adolescents with obesity:
Strategies for effective behavioural and psychological supports
By reviewing 73 randomized controlled trials with 6,305 participants, Birken and a leadership team from SickKids, CHU Sainte-Justine and Dalhousie University evaluated the effectiveness of behavioural and psychological interventions for managing obesity in children and adolescents.
The systematic review, published in Pediatric Obesity in March 2025, found that across numerous studies multicomponent interventions, which included at least two of nutrition, physical activity, psychological and technology-based interventions were associated with improved outcomes including quality of life, mental health, body mass index and body weight, and cardiometabolic outcomes (including blood pressure, lipids and insulin resistance). Physical activity interventions alone also showed improvements in cardiometabolic outcomes, and BMIz, a body mass index score standardized against children of the same age and sex, with the largest benefits for youth aged 13 to 18 years, while changes in nutrition and technology interventions showed small benefits for BMIz.
Outside of physical health, psychological interventions and multi-component interventions provided moderate benefits for depressive symptoms and were associated with small improvements in health-related quality of life.
The researchers stress that a combined approach to obesity management which reflects the goals of the individual child, adolescent, and their family is crucial to effectively treat and prevent the long-term health concerns associated with paediatric obesity.
"It’s important for care providers to engage children and youth living with obesity, and their families, as early as possible...."
"...Behavioural interventions are the cornerstone, but adjunct treatments with pharmacological or surgical options may be beneficial options for managing obesity in children aged 12 years and older."
Dr. Jill Hamilton
Head of the Division of Endocrinology, Director of the Centre for Healthy Active Kids, Senior Associate Scientist in the Translational Medicine program and co-author of the new guidelines.
Evidence-informed guidelines for surgical intervention
Led by Dr. Jill Hamilton and first author Dr. Krista Oei, Staff Physician at SickKids, this systematic review and meta-analysis evaluated the effectiveness of bariatric surgery for managing obesity in children and adolescents. Published in Pediatric Obesity in November 2024, the review included 63 publications with over 6,000 participants and focused on surgical techniques such as roux-en-y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric band.
Their findings showed that bariatric surgery led to significant improvements in health-related quality of life compared to baseline and non-surgical interventions, as well as substantial reductions in BMI, weight and improvement in cardiometabolic outcomes such as lipids, blood pressure, and insulin resistance. For other outcome measures, such as depression and anxiety, there was little to no improvement compared to non-surgical interventions.
While adverse events were rare, the research team notes that they were not reported consistently across all studies, and health-care providers should clearly inform patients and their caregivers of any potential health benefits and risks. Overall, the findings showed that bariatric surgery can be a viable option for adolescents with obesity.