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Don't use weight loss drugs, surgery in young children, family docs told

03/30/2015 12:02 EDT | Updated 05/30/2015 05:59 EDT
TORONTO - Family doctors should monitor the growth of children and teens in their care, new expert advice on treating children and teens who are overweight or obese suggests.

But the recommendations discourage family doctors from prescribing weight loss drugs to young children and they say these doctors should not routinely refer children for weight loss surgeries.

In essence, the guidance says doctors should be keeping an eye on their young patients' growth, and could recommend specialized healthy weight programs that involve dietitians, psychologists and other medical professionals for children and teens who are overweight or obese. But it suggests that prescribing weight loss drugs or surgeries should not be a routine part of primary care and should generally be left to specialists.

The guidance is from the Canadian Task Force on Preventive Health Care, a federal government-appointed group that periodically assesses medical evidence on health issues and advises primary-care doctors on how to deal with them. The guidelines, the first in 20 years on this subject, are published Monday in the Canadian Medical Association Journal.

Earlier this year the task force published guidance for managing weight problems among adult patients. It too recommended that primary-care doctors weigh their patients and calculate a patients' body mass index, or BMI.

The task force says doctors should weigh and measure the height — or length, in the case of children who are not yet standing — of the children and teens in their care. That data should be compared to standardized growth charts to see how children are developing vis-a-vis their peers, says Dr. Patricia Parkin, who chaired the working group that developed the guidelines.

The task force says there isn't enough evidence to recommend that doctors offer normal weight patients access to healthy lifestyles programs as a means of preventing obesity, though Parkin says there may be individual cases where a doctor or a family might decide doing so makes sense. These programs could be offered to children and teens who are overweight or obese — as long as their benefits are not oversold.

"We need to be cautious about the expectations around what improvements the family might expect," says Parkin, a pediatrician and researcher at Toronto's Hospital for Sick Children.

Guidelines like these, which are designed to be based on the highest quality scientific evidence, underscores the key problem in weight loss and weight control. While the need is great, there are no obvious, time-tested solutions to the burgeoning problem of obesity in this age group.

"Unfortunately the evidence base of successful, long-term interventions to prevent or treat childhood obesity is both inadequate and unclear," says Mark Tremblay, a leader in the field of childhood obesity research. Tremblay is director of the healthy active living and obesity research program at the Children's Hospital of Eastern Ontario's Research Institute in Ottawa.

"(It's) a complex problem that requires solutions that are multi-sectoral," says Dr. Catherine Birken, a pediatrician and obesity researcher who works with the SickKids Team Obesity Management Program, known as STOMP. The program, one of several operating in Ontario, is run through the Hospital for Sick Children.

"It can't just be the doctors. It has to be a ... team. It has to involve mental health. It has to engage families. ... It has to be accessible to people."

An editorial published by the journal argues schools too must play a role, by making physical education mandatory all the way through school, selling healthier foods and drinks in cafeterias and fostering a positive attitude toward physical activity.

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