Ahead of new childhood obesity guidelines, doctors say surgery is an important option

A pediatrician involved in developing new treatment guidelines for obese children in Canada says a “shocking” increase in obesity has led to the need for surgery in adolescents whose mental and physical distress typically worsen in adulthood. said to be on the rise.

Melanie Henderson, Ph.D., a pediatric endocrinologist and researcher at the Sainte-Justin Hospital in Montreal, said the guidelines, due to be published later this year, go beyond obesity criteria such as the body mass index to assess children’s overall health. said that it included a better quality of life experience.

New guidelines published last month at the American Academy of Pediatrics recommend early intervention with medication for children 12 and older, and bariatric surgery for severely obese children 13 and older.

Canada’s guidelines also focus on interventions without delay due to rising obesity rates and the risk of serious health consequences, said Henderson, co-director of children’s hospital programs for families. Various specialists work on improving the physical strength and nutrition of children and counseling them.

“We don’t have a lot of data about the best interventions to improve mental health problems and quality of life,” she said, adding that a review of research from the past decade suggests assessments of anxiety and depression. For example, various intervention programs address these issues, but they are lacking.

“All of this will be highlighted in the actual guidelines,” she said.

Henderson is part of a group of clinicians and researchers across the country that came together in 2019 to develop new guidelines with research support from Obesity Canada and the University of Alberta.

She said that because obesity is a chronic disease rather than a risk factor for other diseases, the need to offer pharmacotherapy and bariatric surgery early as an option for some children is more accepted. said.

“We have a candid discussion about this about the subgroups of children who have serious consequences from obesity. We are talking about early cardiovascular disease, early type 2 diabetes, early hypertension. All these factors that lead to death, so these are not minor complications.”

An estimated 27% of Canadian children are overweight or obese. About 10 percent of them are obese, Henderson said, three times as much as he did 30 years ago.

“It’s very alarming to see such a very significant increase in childhood obesity,” she said, noting that genetics are a strong factor, but that declines in physical activity at school and at home ‘s sedentary lifestyle explains part of the problem. This also applies to children who are prescribed medication or who have undergone surgery who need to eat healthily.

“We thought childhood obesity was not a big deal and that it would go away as we grew up,” she said. “But in fact, it’s been disproven. That’s why very young children grow up to become obese adolescents and become obese adults.”

Obese children are three times more likely to develop depression than nonobese children, Henderson said. This is because of the prejudices and prejudices seen in health care workers beyond the schoolyard.

One drug used to treat childhood obesity in Canada is orlistat. Orlistat interferes with fat absorption at the intestinal level and is particularly effective in adolescents, but it is not usually prescribed because of its side effects, including digestive problems.

Another drug, metformin, is used primarily for the management of type 2 diabetes in adults and is prescribed off-label. However, the lack of data makes it difficult for doctors to know who will respond well to it.

A class of drugs called GLP-1 agonists, given by injection and approved for use in children over the age of 12, said Henderson, is probably the best option for reducing hunger, but costs about 10 pounds a month. He added that it would cost $400.

Bariatric surgery, which shrinks the stomach to reduce food intake, was introduced in Canada for adolescents in 2010 as part of the two-year SickKids Team Obesity Management Program (STOMP) at a hospital in Toronto.

“We need to offer all possible treatment options, and we have excellent data that bariatric surgery works,” Henderson said. “It’s been effective in children, in fact, in reversing some of these complications, especially in her teens than adults, especially with high blood pressure and her type 2 diabetes.” is.”

Julius Erdstein, Ph.D., director of adolescent care at Children’s Hospital of Montreal, said bariatric surgery beginning at age 15 is registered with the Center of Excellence for Severe Adolescent Obesity, renal failure, diabetic injections, and sleep apnea. .

“If you have five children undergoing surgery each year, which represents about 10% of the patients referred to us, that’s a huge amount,” said Erdstein, after two years of behavioral intervention. He added that surgery would be suggested.

“There are more children who need it,” he said of clinics for people over 35 with serious medical complications or with a BMI over 40. A measure based on height and weight, obesity is defined as a BMI above the 95th percentile for people of the same age and sex.

“This is about people with life-threatening, life-altering medical conditions that they have never actually had,” Erdstein said. “If the medical community had no tools, there would be plenty of people out there selling snake oil. , indicating that even with intensive intervention, the results are not that great.

He said a 15-year-old who weighs 400 pounds could lose 20 to 40 pounds after about six months of medical support, compared to surgery, which could halve the weight. , not a big difference. A variety of surgeries are available, some requiring adherence to strict rules such as limiting portions and avoiding carbonated drinks, but the interventions are “unparalleled” in improving overall health. Erdstein says it is.

A lot of education goes into preparing children for surgery, he noted. “You have to be very careful what you eat and when you eat it. So that’s a big deal. You’re committed to vitamin supplementation for the rest of your life.”

Dr. Tom Wachowski, a pediatrician and president of the Childhood Obesity Foundation, said American recommendations for medication and surgery were “reasonable” for Canada, but major interventions beyond the new guidelines were to avoid unhealthy food and obesity. Said it would be a policy shift to limit the marketing of drinks.Children.

“There is no doubt that the consumption of ultra-processed foods is a major contributor to the unhealthy weight epidemic worldwide. It’s the reason, it’s the marketing.”

Warshawski said it was time to extend Quebec’s law banning commercial advertising to children under the age of 13 to other parts of Canada as obesity-related health care costs rise. I was.

This report by the Canadian Press was first published on February 17, 2023.

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