The Canadian Task Force on Preventive Health Care issued its latest guidelines on the prevention and management of childhood obesity. With 1 in 3 children classified as either overweight or obese in Canada the prevalence of childhood obesity has more than doubled in the last 40 years. The Task Force’s guidelines focus on the importance of growth monitoring (height, weight and body mass index) and the critical role of primary health care practitioners. Guidelines are now available in the Canadian Medical Association Journal (CMAJ) and are being distributed to physicians across Canada.
“Child obesity is one of Canada’s top health challenges” said Dr. Patricia Parkin, chair of the Task Force child obesity working group. “Primary care doctors and health care practitioners must play a more prominent role in the broad, multi-sectoral effort to stabilize the current obesity trend,” added Parkin. “In order to encourage healthy growth patterns it is essential that primary care practitioners regularly monitor growth and have an open dialogue with families. If the child demonstrates unhealthy trends in their growth pattern, it is important that the recommended course of action is tailored to the individual needs and values of each family, especially in helping to find the right exercise, diet and lifestyle strategies.”
The mandate of the Task Force is to make recommendations based on the best evidence available. The Task Force systematically reviewed the prevention and management literature separately. Key recommendations include:
For children and youth of all ages the Task Force recommends growth monitoring at appropriate primary care visits using the World Health Organization Growth Charts for Canada.
For children and youth who are overweight or obese, the Task Force recommends that primary health care practitioners offer or refer to formal, structured behavioural interventions aimed at weight loss.
For children who are overweight or obese, the Task Force recommends that primary health care practitioners not routinely offer Orlistat or refer to surgical interventions aimed at weight loss.
“The child obesity challenge requires broad involvement across all sectors of society,” said Dr. Paula Brauer, member of the Task Force child obesity working group. “In terms of primary care practitioners, more support and dedicated research is needed to determine exactly how they can best support families and children. In particular, more randomized control trials (RCT) studies are needed. Considering the importance of the issue the evidence is surprisingly limited.”
About Child Obesity
The prevalence of child obesity in Canada has more than doubled in the last 40 years. Presently, 1 in 3 Canadian children is overweight or obese. Excess weight in children is associated with an increased risk of cardiovascular disease, diabetes, asthma and psychological problems. Strategies for the management of child obesity in primary care settings include offering or referring families to structured behavioural interventions, pharmacological or surgical interventions. Based on the harms associated with pharmacological and surgical interventions the Task Force recommends against these options for primary care practitioners. These options may be considered by specialists in specialized obesity management programs.
About Growth Monitoring
Growth monitoring assesses the health and nutritional status of children and consists of measuring height/length, weight and body mass index (BMI) calculation or weight-for-length according to age. The Task Force recommends using the 2014 World Health Organization’s (WHO) Growth Charts for Canada, which are supported by other well respected Canadian health organizations such as such as the Dietitians of Canada, Canadian Paediatric Society, College of Family Physicians of Canada, Community Health Nurses of Canada and the Canadian Pediatric Endocrine Group.
About Structured Behavioural Intervention
Structured interventions are intensive behavioural modification programs that involve several sessions taking place over weeks to months, involve group sessions and incorporate family involvement. Interventions examined by the Task Force include behavioural programs focused on diet, increased exercise, lifestyle changes, or a combination of these.
Interventions can be delivered by the primary health care practitioners or a primary care team, or through a referral to a formal program within or outside of primary care, such as school-based or community programs. Effective interventions rely heavily on the commitment and motivation of the entire family. In order for interventions to be successful, the family must be motivated to make lifestyle changes and must commit the time required to make those changes. Unlike pharmacological treatments that can have adverse effects, such as gastrointestinal problems, behavioural interventions carry no identifiable risks.
About the Canadian Task Force on Preventive Health Care
The Canadian Task Force on Preventive Health Care has been established to develop clinical practice guidelines that support primary care providers in delivering preventive health care. The mandate of the Task Force is to develop and disseminate clinical practice guidelines for primary and preventive care, based on systematic analysis of the scientific evidence.
