This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle.
Obesity guidelines for treating children and teenagers is changing for the first time in nearly 20 years, with the Canadian Medical Association Journal (CMAJ) releasing new advice including using modern weight loss drugs and surgery when appropriate.
In Canada, roughly a quarter of 4- to 11-year-old kids and a third of 12- to 17-year-old teens have a body mass index (BMI) that qualifies them as overweight or obese. Reports estimate childhood obesity rates are three times higher than they were 30 years ago.
Medical science and attitudes toward obesity have changed significantly since the first set of guidelines were released in April 2007. While the original recommendations were focused on weight management and BMI, the new ones prioritize improving overall health, quality of life and mental well-being (like depression and anxiety) over weight loss alone.
The guide included 10 recommendations spanning behavioural, psychological, surgical and pharmaceutical interventions; it also had nine good practice statements, which move away from the historic “eat less, move more” approach. Health-care practitioners are urged to get child and family participation to set goals without using judgmental or stigmatizing language, which many professionals view as steps in the right direction.
But some experts are wary of the move toward early intervention and relying on surgery and GLP-1 medication like Ozempic or Wegovy. “I truly believe that jumping to solutions like weight loss medications or surgeries isn’t the answer to improving children’s health and well-being,” Toronto-based registered dietitian and intuitive eating coach Jenn Baswick told Yahoo Canada.
If a child is struggling with their eating patterns, movement or weight, Beswick said she feels the best approach is to tackle the root cause, not apply what she called “a potentially harmful band-aid solution.”
Baswick noted she believes many struggles with weight stem from a child’s poor relationship with food, body and movement. She recommended working on improving their relationship with food, their bodies and movement to foster a more meaningful and long lasting change. Instead of “eat less, move more,” she stressed teaching children how to nourish and regulate themselves around food on a deeper level. “Many adults actually struggle with these issues as well,” she said.
Jumping to solutions like weight loss medications or surgeries isn’t the answer to improving children’s health.Jenn Baswick
Brittany Brown, a registered dietitian and lactation consultant in Halifax, also noted a holistic approach is essential while working with children living with obesity: “Surgical and pharmacological interventions may be medically effective, but we know from working with adults that it’s possible to eat your way through GLP-1s and weight loss surgeries, suggesting this isn’t a long-term solution.”
When working with families, Brown focused on five domains of health — nutrition, physical activity, sleep, mental health and social connections — which help tackle the root causes of weight issues.
What families can do
The new guidelines acknowledge that obesity is a complex issue with genetic, physiological, environmental and socioeconomical factors at play and recommend using multiple interventions. Improving mental health and quality of life are front and centre, rather than focusing solely on weight loss.
Likewise, Brown advised against getting caught up in rigid meal plans and obsessing over calories, instead focusing on more holistic strategies as a family.
Practice mindfulness at meal times
Brown suggested ditching screens like TV, phones, video games and other distractions while eating, which may lead to poor food choices. Instead, she encouraged being mindful around meal times.
One study published in Mindfulness found that kids who were given mindfulness-based eating sessions ate significantly less food and overall calories. They also chose fewer unhealthy foods compared to a control group given nutritional education sessions. Other studies link mindful, compassionate parenting with lower levels of emotional distress among children, which can reduce the likelihood that kids will turn to food to cope.
Follow a whole food approach
The CMAJ guidelines recommended avoiding judgmental and stigmatizing language, which could include labelling foods as “good” or “bad.”
Instead, focusing on adding nutritious choices rather than eliminating specific foods can be a more effective mindset, according to Brown. “Add in foods that exist in nature and reduce the foods that have unrecognizable ingredients or claims, like being fat or sugar free,” she said.
Enjoy meals as a family
Family meals are an opportunity to cook and enjoy healthy foods together. Research shows that children and teenagers who eat with their families often have better nutrition, stronger family relationships and improved mental health. Kids who eat in a family setting also tend to eat more vegetables and less fast food than those who don’t.
“We take so much away from a meal shared with someone else, including opportunities to nurture our social connections and mental health,” said Brown.
Spend time outside
Brown recommended spending time outside every day, which is associated with better cardiovascular fitness, motor skills and Vitamin D levels. “Time in the sun encourages the body to produce serotonin, which tells our body to make melatonin to wind down at the end of the day,” she said. Without these hormones, our sleep cycles become imbalanced, according to Brown, which is linked to higher odds of childhood obesity.
Make movement fun
Finding fun ways to incorporate physical activity as a family can increase motivation and promote healthy habits, according to Brown. “That can be a family walk to a playground after supper, a hike on a weekend or a dance party in your kitchen on a rainy day,” she said. “Let’s not forget children learn through play — find ways to keep health fun.”
How to talk to your kids about weight
One framework Baswick said parents can use to talk to their kids about their relationship with food is the Satter Division of Responsibility (sDOR), a guide that helps teach kids to trust their hunger and fullness cues. It’s an option that aligns with the CMAJ’s recommendation that families come together to make health decisions.
“I highly recommend parents and caregivers take some time to consider this root cause-focused framework to really support their children in making informed choices about food in an encouraging way rather than a restrictive way,” she said.
Children and youth with obesity, who are already in a vulnerable period of life, are often ostracized just for existing.Brittany Brown
Another primary goal of the new CMAJ guidelines is to reduce stigmatizing language around body weight. “Fat bias is a real problem in the Western world, often coexisting with shame and years of degradation for living in a bigger body,” shared Brown. “Children and youth with obesity, who are already in a vulnerable period of life, are often ostracized just for existing.”
Brown recommended adults communicating with children and youth living with obesity brush up on their language skills before broaching this sensitive topic. “In a world where loved ones, health-care providers and society already tell this population how they should feel about their body, I like to ask children and youth directly how they feel about their health, including where they feel change could be useful,” she said, stressing it’s best to approach conversations with empathy, curiosity, compassion and kindness.
“Targeting obesity with a holistic approach makes it more likely that our children will be individually invested in supporting their journey towards optimal health — at any size — today and into their future.”
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