Abstract
Pediatric obesity is an urgent and complex public health issue. Approximately one-third of Canadian children are overweight or obese, a proportion that highlights the need for effective and accessible services to improve short- and long-term health risks. In our experience, we have encountered a number of challenges common in pediatric obesity management across our clinical and research centers. For the purpose of this review, these challenges and our real-world experiences are grouped as issues that span (i) caring for children, adolescents, and families, (ii) collaborating with colleagues and (iii) working within the health care system. Collectively, we highlight a number of lessons learned from our years of experience and detail ongoing initiatives designed to optimize health services for managing obesity for children and adolescents in Canada.
Financial & competing interests disclosure
JLS Avis has received graduate scholarships from Alberta Innovates – Health Solutions (AIHS), Canadian Institutes for Health Research (CIHR), and Women & Children’s Health Research Institute (WCHRI; University of Alberta). GDC Ball has received salary support from AIHS, CIHR and Alberta Health Services; has received research grant funding from AIHS, CIHR and WCHRI. J-P Chanoine received funding support from CIHR, Eli Lilly, Serono. J Hamilton received funding support from Canadian Diabetes Association (CDA), CIHR. L Legault received: material support from CDA, CIHR, JDRF, Novo Nordick, Lilly, Medtronics; stipend support from Lifescna; and travel support from Roche Canada. KM Morrison received funding support from Canadian Institutes of Health Research; Heart and Stroke Foundation of Canada; Hamilton Academic Health Services Organization (HAHSO); McMaster University; McMaster Children’s Hospital Foundation; and was involved with Local PI – Astrazeneca sponsored clinical trial. A Wareham received funding support from Department of Health, Government of Newfoundland. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
Since the 1980s, overweight and obesity have increased from 14 to 31% and 14 to 25% among Canadian boys and girls, respectively.
There is no one size fits all approach in managing pediatric obesity; treatment plans should be tailored according to families’ unique circumstances, needs, priorities, resources and levels of readiness to change weight-promoting lifestyle habits. Individualizing care plans can occur in the context of both one-on-one and group-based interventions (e.g., psychoeducational group programs for parents), with group-based care as a more efficient and cost-effective means of health services delivery.
For management strategies to be most effective, a family-centered approach with parents playing a central role increases the likelihood of positive outcomes for children and adolescents.
While children will benefit from strategies that target parents, adolescents’ increased autonomy and development (cognitive and physical) mean that they are able to take greater ownership in establishing healthy nutrition and physical activity habits.
Mental health assessment and appropriate treatment must be included as core elements of managing obesity.
Clinicians’ therapeutic alliance with families should be built on mutual trust, respect and collaboration.
Clinical resources and tools (e.g., Edmonton obesity staging system for pediatrics (EOSS-P), 5As of Obesity Management, CONversation Cards©) can assist clinicians in developing practical, feasible and sustainable treatment plans for families, although additional research is required to build the evidence base for these resources.
Common challenges experienced in managing pediatric obesity (e.g., program enrollment, program attrition) need to be addressed. Such challenges may be attenuated by: addressing families’ common struggles encountered while making and maintaining lifestyle behavior change; clarifying families’ misconceptions and expectations regarding obesity management; building a collaborative therapeutic alliance with patients and families; and understanding the broader social/environmental impact.
Canadian clinicians and researchers have made meaningful progress in establishing collaborative research and knowledge translation activities focused specifically on managing pediatric obesity.
Tertiary-level care resources for managing pediatric obesity are limited, highlighting the importance of establishing appropriate health services at primary and secondary care levels that: allow families to access expertise and appropriate services; enable families living in rural and remote settings to connect to health services via distance support (e.g., telemedicine); and, incorporate innovative, online avenues to improve access, availability and cost–effectiveness of obesity management health services.
Weight bias and stigmatization undermine the complex nature of obesity and have a negative impact on the management of pediatric obesity.