Summary of recommendations for clinicians and policy-makers

The CTFPHC will continue to carefully monitor the scientific developments in the prevention and management of obesity and will report back to Canadians within 5 years with an update of the 2015 guidelines.

Recommendations

The growth monitoring recommendations apply to all children and youth 0–17 years of age who present to primary care.

• We recommend growth monitoring at all appropriate1¹Appropriate primary care visits include scheduled health supervision visits, visits for immunizations or medication renewal, episodic care or acute illness, and other visits where the primary care practitioner deems it appropriate. Primary care visits are completed at primary health care settings, including those outside of a physician’s office (e.g. public health nurses carrying out a well-child visit at a community setting). primary care visits using the 2014 WHO Growth Charts for Canada.
  (Strong recommendation; very low quality evidence)
  The prevention recommendations apply to all children and youth 0–17 years of age who have a healthy weight. They do not apply to children and youth with eating disorders, or who are underweight, overweight, or obese.
• We recommend that primary care practitioners not routinely offer structured interventions2²Structured interventions are behavioural modification programs that involve several sessions that take place over weeks to months, follow a comprehensive-approach delivered by a specialized inter-disciplinary team, involve group sessions, and incorporate family and parent involvement. Behaviourally-based interventions may focus on diet, increasing exercise, making lifestyle changes, or any combination of these. These can be delivered by a primary health care team in the office or through a referral to a formal program within or outside of primary care, such as hospital-based, school-based or community programs. aimed at preventing overweight and obesity in healthy weight children and youth.
  (Weak recommendation; very low quality evidence)
  The management recommendations apply to children and youth 2–17 years of age who are overweight or obese. Children and youth with health conditions where weight management is inappropriate are excluded.
• • For children and youth aged 2 to 17 years who are overweight or obese, we recommend that primary care practitioners offer or refer to structured behavioural interventions3³Structured interventions are behavioural modification programs that involve several sessions that take place over weeks to months, follow a comprehensive-approach delivered by a specialized inter-disciplinary team, involve group sessions, and incorporate family and parent involvement. Behaviourally-based interventions may focus on diet, increasing exercise, making lifestyle changes, or any combination of these. These can be delivered by a primary health care team in the office or through a referral to a formal program within or outside of primary care, such as hospital-based, school-based or community programs. aimed at healthy weight management.
    (Weak recommendation; moderate quality evidence)
  • For children and youth aged 2 to 11 years who are overweight or obese, we recommend that primary care practitioners not offer Orlistat aimed at healthy weight management.
    (Strong recommendation; very low quality evidence)
  • For children and youth aged 12 to 17 years who are overweight or obese, we recommend that primary care practitioners not routinely offer Orlistat aimed at healthy weight management.
    (Weak recommendation; moderate quality evidence)
  • For children and youth aged 2 to 17 years who are overweight or obese, we recommend that primary care practitioners not routinely refer for surgical interventions.
    Strong recommendation; very low quality evidence)