New Canadian Guideline Promotes Patient-Centered Care for Childhood Obesity

A newly released guideline for managing obesity in children and teens encourages a patient-centered approach that prioritizes behavioral and psychological support — with a focus on outcomes that matter most to young patients and their families.

Published in the Canadian Medical Association Journal, the guideline is based on the latest research and was developed by Obesity Canada after a four-year collaborative effort. The process involved adolescents, caregivers with lived experience, health professionals, researchers, and more than 50 experts from various fields. It couldn’t come soon enough, too, since the last guideline was published in 2007.

Dr. Bradley Johnston, co-chair of the guideline committee and associate professor of nutrition and health research methods, explained that the goal was to support shared, informed decision-making by providing clear summaries of scientific evidence. The team prioritized outcomes such as mental health, quality of life, cardiovascular risk factors, and avoiding harm.

Pediatric obesity is recognized as a complex, chronic, and often stigmatized condition that can lead to more than 200 related health issues. In Canada, nearly one in four children under 12 and one in three teens between 12 and 17 have a body mass index (BMI) considered overweight or obese. Globally, severe obesity in youth is on the rise.

Dr. Sanjeev Sockalingam, scientific director at Obesity Canada, emphasized that long-term success depends on accessible, family-focused care that helps children build and maintain healthy behaviors. When appropriate and available, this may include medications or surgery.

The guideline outlines 10 core recommendations, covering nutrition, physical activity, psychological therapies, technology-based tools, medications, and surgery. It also includes nine good practice statements, with an overall recommendation to combine at least two intervention types for the best outcomes.

Lisa Schaffer, executive director of Obesity Canada, stressed the urgency of early intervention. She said:

Delaying care until adulthood increases the risk of complications and deepens the effects of living with a stigmatized chronic condition.

To support implementation, Obesity Canada has created educational tools such as infographics and videos to guide healthcare providers and families in choosing the most effective treatment paths for children struggling with obesity.

This is where GLP-1 receptor agonists also come in

Simply telling kids to “eat less and move more” doesn’t work on its own, says Dr. Sockalingam. He says obesity should be treated like any other complex chronic disease — with a range of tools.

Among those tools are medications like GLP-1 receptor agonists — including Ozempic, Mounjaro, and Wegovy — which mimic a natural hormone to help manage appetite and blood sugar. While only some of these are approved in Canada for obesity, the guidelines suggest they could be considered in specific cases, along with bariatric surgery, especially when serious health complications are involved.

Dr. Jill Hamilton, who co-authored the new guidelines and leads endocrinology at the Hospital for Sick Children, acknowledges more research is needed — particularly around the safety of medications like GLP-1s for younger patients. Ultimately, treatment decisions must respect the values and preferences of families.

Your responses and feedback are welcome!

Source: “Treat childhood obesity by reducing stigma, adding options, say new Canadian guidelines,” CBC News, 4/14/25
Source: “Health Matters: Child obesity treatment guide updated,” Global News, 4/14/25
Source: “A patient-centered approach for managing obesity in children and adolescents,” Medical XPress, 4/14/25
Image by Наталия Игоревна/Pexels

Binge Eating — What’s the Problem, Anyway?

Why is binge-eating disorder such an easy trap to fall into? An argument could be made that this is how humans were naturally trained to eat, far back in antiquity. When hunter-gatherers roamed the earth, there was no other choice. If a large animal could be brought down, sliced up, and cooked, everybody had to gobble up as much of it as possible, right there on the spot.

There were no refrigerators, and even people who never went to college can figure out that after a while, meat goes bad and makes them sick. Gathering, or reaping fruit, vegetables, and grains worked the same way. When some fruit was in season and people found a tree full of it, what else could they do but grab as much of the bounty as possible and keep their systems stoked with it until the next lucky find appeared? When food presented itself, hungry people ate while the eating was good.

It probably should not be surprising that many humans feel the ancestral urge to fill up whenever we can. Some of us are still in the situation of being forced to eat whatever is available, because of uncertainty over when another chance will occur. But millions upon millions of us are not in dire circumstances, and do not have to gorge just in case there is nothing to eat tomorrow. So let’s look at why this habit is so destructive.

Registered dietician Elyse Resch lists seven excellent reasons why anyone embroiled in a binge-eating pattern would do well to get a clue and make the effort to stop the habit. A very valid reason is that it interferes with sleep. First, it might take longer to fall asleep, but then you might wake up feeling thirst, or the jabs of acid reflux, or the simple local discomfort of a distended belly.

The second reason is very important because a condition is created in which we cannot trust the signals sent by our own bodies via the appetite hormone ghrelin or the fullness hormone leptin.

Studies show people who frequently binge-eat have lower levels of ghrelin and have difficulty responding to hormones in general. Binge-eating on a regular basis makes it harder for your body to figure out if you’re still hungry, or satiated.

The third reason is that the postprandial surges of glucose and insulin can interfere with the body’s immune system and make us more vulnerable to colds and other infectious conditions.

Next, the American Psychological Association has determined that, as with alcohol and some drugs, a food overdose can put the brain into a state of oblivion that allows the eater to escape self-awareness. Needless to say, this happens at a time when the brain most needs to be asking, “Hey, what the heck am I doing?”

The binge eater’s goal is to induce a state of peaceful relaxed bliss, but the body knows enough to reach for homeostasis, or balance. It attempts this by producing stress hormones, which in turn speed up the heart rate and produce anxious sweat, along with unpleasant irritability, and lethargy — an emotion qualitatively different from peaceful relaxation.

After consumption of a bunch of simple carbohydrates and sugar, the pancreas leaps into red alert mode trying to compensate by producing enough insulin to cope. This is a further deterrent to the body’s preferred state of homeostasis.

A reasonably balanced meal induces the brain to release dopamine, which is fine, but after overeating becomes habitual, the brain struggles to catch up and needs more and more fat and sugar input to pump out the dopamine reward. Gradually but inevitably, overeating becomes over-overeating and over-over-overeating.

Bonus list

Also from BestHealthMag.ca, here are the warning signals that a person is consuming too much sugar. Does anything strike a familiar note?

1. An acne breakout
2. A mid-day energy slump or headache
3. Dental cavities
4. High blood pressure
5. High cholesterol
6. A post-exercise energy crash from using simple sugars for fuel
7. Clothes that used to fit are too tight
8. Depression caused by systemic inflammation
9. The body doesn’t get the message that food has been taken on board, and doesn’t “feel full.”

Your responses and feedback are welcome!

Source: “7 Reasons to Stop Binge-Eating,” BestHealthMag.ca, 07/16/19
Source: “9 Clear Signs You’re Eating Too Much Sugar,” BestHealthMag.ca, 01/03/17
Image by The Digital Artist/Pixabay

Monkey See, Monkey Do

In an earlier post, the question about learning came up. Does someone with an eating disorder discover the lifestyle on their own, spontaneously? Or do they absorb the concept, either covertly or openly, from an older relative, or from a peer, or from the older relative of a peer? Or read about it in a novel, or see a TV show?

Of course these questions are already archaic, because now this dangerous information is easy to pick up from social media and other internet sources. But in the old days, how might someone have stumbled onto the idea of, for example, habitual vomiting as a method of weight control?

In the close confines of the family environment, a child can hardly avoid noticing behaviors associated with eating disorders. The thing about children is, they not only notice things, but assume that what they see at home is how things are supposed to be. By and large, it is helpful to society for children to make this assumption. Babies are born fully prepared to look at and imitate the older humans in their environment who take care of them. Parents, older siblings, and other relatives are expected to be role models, who demonstrate to babies how to form themselves into people.

Children have eyes and ears

In the past, a typical one-family home or apartment would only have one bathroom. What on earth was Aunt Cindy doing, spending so much time in there? How many moms spent extra moments in the basement, next to the wringer washing machine, throwing up into the utility sink?

What other behaviors could be discovered or learned? How many teenage girls have appreciated the convenience of making unwanted food disappear into the mouth of the family dog? And if kids don’t pick up eating disorder behaviors from grownups, how do those notions originate? For instance, is throwing up after meals, like masturbation, a behavior that any child can eventually discover on their own, without witnessing a demonstration?

A bit of history

Bulimia nervosa has been described as “insatiable waves of overeating followed by compensatory methods,” driven by the irresistible urge to overeat that is in constant conflict with the fear of obesity. Once bulimia was formally introduced into the medical literature, many more cases were identified and diagnosed, as might be expected. In successive editions of Diagnostic and Statistical Manual of Mental Disorders, as well as other literature, definitions were characterized according to the frequency with which patients employed compensatory behaviors. This fine-tuning allowed cases to be sorted into the categories of mild, moderate, and extreme.

It appears that bulimia usually kicks in at the age of 16 or 17, and the author mentions the unexpected detail that “the rates are highest among the Hispanic/Latino population, second highest among African-Americans and lowest in non-Latin whites.” (Anorexia, on the other hand, is most prevalent among non-Latin whites.) Elena Bowie writes,

Studies have found that eating disorders are inheritable, in addition to several other parental factors that can influence the susceptibility of developing an eating disorder, like parental mental illness or parents with negative views of weight…

To diagnose bulimia may be difficult because patients “are likely to hide their symptoms and physical signs are usually absent.” Often, the evidence is provided by parents or other people in a position to notice changes in behavior. Some of them notice the signs because they have had personal experience with an eating disorder, and have overcome the urge to make it a lifestyle. The author cautions,

The most important thing to take note of is that recovery from Bulimia is not a one size fits all approach and requires careful planning of the physical, psychological, and social needs to create the best possible chance for recovery.

Your responses and feedback are welcome!

Source: “History of Bulimia nervosa,” Emory.edu, 04/01/21
Image by Shutterbug75