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Childhood obesity

What's new

Obesity Canada has released a new guideline for the management of obesity in children, emphasizing collaborative, family-centered care that prioritizes behavioral and psychological support, incorporating nutritional, physical activity, and psychological interventions. Pharmacotherapy with GLP-1 receptor agonists or biguanides, combined with behavioral and psychological interventions, is suggested for patients aged ≥12 years, while lipase inhibitors should be avoided. Laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass are the suggested techniques for bariatric surgery in children. .

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of childhood obesity are prepared by our editorial team based on guidelines from the American Diabetes Association (ADA 2025), the Obesity Canada (OC 2025), the U.S. Preventive Services Task Force (USPSTF 2024,2017), the American Academy of Pediatrics (AAP 2023), the Endocrine Society (ES 2017), and the American College of Endocrinology (ACE/OS/AACE ...
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Screening and diagnosis

Indications for screening: as per AAP 2023 guidelines, measure height and weight, calculate BMI, and assess BMI percentile using age- and sex-specific growth charts or growth charts for children with severe obesity at least annually to screen for overweight, obesity, and severe obesity in all children aged 2-18 years.
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  • Diagnosis

Diagnostic investigations

Initial assessment: as per OC 2025 guidelines, use person-first language and avoid negative, stigmatizing language. Recognize that obesity is a complex, chronic, and relapsing disease that requires establishing a positive relationship with children and families, and includes providing long-term support for obesity management for children and families.
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  • Evaluation for comorbidities

  • Evaluation for underlying etiologies

Medical management

General principles: as per OC 2025 guidelines, adopt a nonjudgmental, nonstigmatizing approach that encourages patients and families to engage in obesity management interventions, including discussing expectations for improving health outcomes.
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  • Weight loss medications

Nonpharmacologic interventions

Behavioral lifestyle interventions: as per OC 2025 guidelines, consider offering nutritional, physical activity, and psychological interventions for managing obesity in pediatric patients aged ≤ 18 years.
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Surgical interventions

Bariatric surgery
As per OC 2025 guidelines:
Consider offering laparoscopic sleeve gastrectomy, in combination with behavioral and psychological interventions, for managing obesity in pediatric patients aged ≥ 13 years deemed eligible candidates based on a comprehensive health assessment by a specialized, multidisciplinary team.
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Consider offering Roux-en-Y gastric bypass, in combination with behavioral and psychological interventions, for managing obesity in pediatric patients aged ≥ 13 years deemed eligible candidates based on a comprehensive health assessment by a specialized, multidisciplinary team.
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Specific circumstances

Patients with diabetes mellitus
As per ADA 2025 guidelines:
Consider offering metabolic surgery for the treatment of adolescent patients with T2DM and class 2 obesity (BMI > 35 kg/m² or > 120% of 95th percentile for age and sex, whichever is lower) and having elevated HbA1c and/or serious comorbidities despite lifestyle and pharmacologic interventions.
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Perform metabolic surgery only by an experienced surgeon working as part of a well-organized and engaged interprofessional team, including a surgeon, endocrinologist, registered dietitian nutritionist, behavioral health specialist, and nurse.
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Preventative measures

Healthy lifestyle: as per ES 2017 guidelines, promote and participate in the ongoing healthy dietary and activity education of children and adolescents, parents, and communities, and encourage schools to provide adequate education about healthy eating.
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