Not just fitness and diet: New childhood obesity guidelines address stigma

CBC

09-05-2025

1st set of guidelines for kids since 2007
⭐️HERE'S WHAT YOU NEED TO KNOW⭐️
Health professionals who treat children living with obesity have a new set of guidelines to follow.
These were released on April 14 in the Canadian Medical Association Journal.
The guidelines haven't been updated since 2007. And it's the first time medical professionals have guidelines for children and youth patients (aged 18 and under) that are separate from adults.
The guidelines were developed by medical doctors and obesity researchers over four years, in partnership with the nonprofit health charity Obesity Canada.
They include evidence-based recommendations for things like nutrition, exercise, counselling, and in some cases, medication and surgery
The paper also recommends that health-care professionals approach treatment collaboratively with a child and their family. It recommends combining different types of treatment.
It also focuses on not using stigmatizing language and being aware of stigma and weight bias.
Stigma is negative attitudes, beliefs or behaviours about a particular quality or person.
'These guidelines obviously are amazing and great and overdue and speak to the fact that obesity is a real medical condition,' said Sandra Elia, the chair of Obesity Matters, an advocacy group.
What is childhood obesity?
Obesity is a complex disease that involves abnormal or excessive fat accumulation that presents a risk to health.
Some of the health risks for children living with obesity are high blood pressure, heart disease and Type 2 diabetes, according to the Public Health Agency of Canada.
The guidelines approach obesity as a chronic disease, meaning it can last a long time or come back.
'It's not something that just goes away,' said Geoff Ball, the director of the Pediatric Centre for Weight and Health at the University of Alberta and one of the lead authors of the new guidelines.
He said many kids who struggle with obesity growing up will also deal with it as adults.
About 80 per cent of 12- to 18-year-olds living with obesity will carry the disease into adulthood, according to Obesity Canada.
The new guidelines advise doctors to avoid stigmatizing language when speaking with patients about living with obesity. (Image credit: World Obesity Federation)
Ball also stressed that the new recommendations are not just about shrinking body size.
'This is not just about body weight,' he said.
'This is about helping people with obesity be as healthy as they can be.'
A patient could receive medical support that improves their health and still remain at the same weight, said Ball.
New guidelines address stigma, biases
The guidelines include a word that doesn't appear in previous guidelines: stigma.
All three experts we spoke to said that many people assume obesity is a person's fault.
It's not a 'moral failing' or the fault of the parents, said Ball.
Those sorts of judgments are a form of bias and stigma that can have a negative impact on health, said Ball.
This includes increasing the likelihood of anxiety, depression and deterring patients from accessing health care.
WATCH — Mental health, mental illness and stigma explained
The new guidelines tell health-care professionals to take into account 'social determinants of health,' which include housing and access to nutritious food.
'We usually tell people that they just need to eat less and move more and they can manage this, and it's just not that simple,' said Ian Patton, director of advocacy and public engagement at Obesity Canada.
'It's not just about what you eat or do,' said Ball. 'It's the environment that we live in that determines a lot of the choices that we make day-to-day.'
Another way to tackle stigma is to address how doctors and health-care professionals are speaking to patients.
The guidelines recommend using person-first language. Person-first language emphasizes the individual first and their disability or health condition second.
Instead of calling a person 'obese,' a health-care provider should say a 'person living with obesity.'
Guidelines are limited by available data
Ball said there are some limits to the information.
'No guideline is perfect. We know that there are limitations in us as humans and also in data.'
He said that there is not a lot of information about certain groups of people, including kids living in northern communities and kids from lower-income families.
There is also a lack of evidence around the long-term effects of some medications, such as GLP-1 agonists like those known under the brand names Ozempic and Wegovy.
Wegovy has been approved by Health Canada for some children aged 12 and up with obesity. Ozempic has not been approved for kids.
Another issue is accessibility to treatments, said Ball. For example, there are very few clinics that provide weight loss surgery for pediatric patients in Canada, according to Ball.
Depending on where people live, their health insurance and their income, some treatments may not be available or may be too expensive.
'Everyone should have the right to access services and be treated fairly and with respect,' said Ball.
What should kids and families take away?
Kids and their families can use these guidelines to help them have discussions with their doctor, said Patton.
Clinical practice guidelines are usually meant for health-care professionals but Patton said these recommendations were purposely written in a way that non-professionals can understand.
Elia said that before anything else, the approach should be to make sure a child doesn't feel judged.
'The first thing we need to start from is making sure that the child understands that they are good, they are worthy and they are unconditionally loved,' she said.
She said that kids should avoid stepping on the scale and obsessing over their weight. If they do need to be weighed by their doctor, they don't need to know the number.
Patton said everyone has a role to play.
He said he hopes that society gets better about weight bias and stigma.
'I would hope that we stop commenting on people's bodies altogether. Fat jokes aren't cool.'