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Cited by 56Obesity, Physical Activity, DietObesity and Health PracticesBariatric Surgery and Outcomes

Managing obesity in children: a clinical practice guideline

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Ball, Geoff D.C., Merdad, Roah, Birken, Catherine S., Cohen, Tamara R., Goodman, Brenndon, Hadjiyannakis, Stasia, Hamilton, Jill, Henderson, Mélanie +45 more·2025·Canadian Medical Association Journal
DOI 10.1503/cmaj.241456PMC PMC12007946
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Abstract

BACKGROUND: Obesity is a complex, chronic, stigmatized disease whereby abnormal or excess body fat may impair health or increase the risk of medical complications, and can reduce quality of life and shorten lifespan in children and families. We developed this guideline to provide evidence-based recommendations on options for managing pediatric obesity that support shared decision-making among children living with obesity, their families, and their health care providers. METHODS: We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We used the Guidelines International Network principles to manage competing interests. Caregivers, health care providers, and people living with obesity participated throughout the guideline development process, which optimized relevance. We surveyed end users (caregivers, health care providers) to prioritize health outcomes, completed 3 scoping reviews (2 on minimal important difference estimates; 1 on clinical assessment), performed 1 systematic review to characterize families' values and preferences, and conducted 3 systematic reviews and meta-analyses to examine the benefits and harms of behavioural and psychological, pharmacologic, and surgical interventions for managing obesity in children. Guideline panellists developed recommendations focused on an individualized approach to care by using the GRADE evidence-to-decision framework, incorporating values and preferences of children living with obesity and their caregivers. RECOMMENDATIONS: Our guideline includes 10 recommendations and 9 good practice statements for managing obesity in children. Managing pediatric obesity should be guided by a comprehensive child and family assessment based on our good practice statements. Behavioural and psychological interventions, particularly multicomponent interventions (strong recommendation, very low to moderate certainty), should form the foundation of care, with tailored therapy and support using shared decision-making based on the potential benefits, harms, certainty of evidence, and values and preferences of children and families. Pharmacologic and surgical interventions should be considered (conditional recommendation, low to moderate certainty) as therapeutic options based on availability, feasibility, and acceptability, and guided by shared decision-making between health care providers and families. INTERPRETATION: This guideline will support children, families, and health care providers to have informed discussions about the balance of benefits and harms for available obesity management interventions to support value- and preference-sensitive decision-making.

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  • Both the 2023 AAP and 2025 CPCG guidelines recommend prescription of GLP1RA (liraglutide and semaglutide) and consider off-label prescription of metformin even though findings on weight loss effect are inconsistent.

    “Both guidelines recommend prescription of GLP1RA (liraglutide and semaglutide); and consider the off-label prescription of metformin even though findings on the Weight loss effect are inconsistent.”

    From Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan (2025) · cites this paper as [100]

    In Recommendations > Pharmacologic interventions (page unavailable), the 2025 guideline conditionally suggests considering GLP-1RAs, including liraglutide and semaglutide, and biguanides such as metformin for children aged 12 or older, alongside behavioural and psychological interventions. It describes metformin use in the reviewed trials as off-label. It does not characterize metformin’s weight-loss findings as inconsistent; it reports a reduction in weight. The cited passages also do not establish what the 2023 AAP guideline recommends. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Surgery remains indicated for youth with BMI ≥120% of the 95th percentile or BMI ≥40 kg/m2, or ≥35 kg/m2 with severe complications.

    “Surgery remains indicated for youth with BMI ≥ 120% of the 95th percentile or BMI ≥ 40 kg/m², or ≥ 35 kg/m² with severe complications [100].”

    From Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan (2025) · cites this paper as [100]

    The Recommendations > Surgical interventions section (page unavailable) conditionally suggests considering surgery for children aged 13 years and older after a comprehensive assessment by a specialized team. It does not give the claimed BMI thresholds or say that meeting them alone indicates surgery; the Practice considerations section says there is little information on which patients are most likely to benefit. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The 2025 Canadian Clinical Practice Guidelines recommend pharmacological intervention in combination with behavioral and psychological interventions for pediatric obesity.

    “Similarly, the 2025 Canadian Clinical Practice Guidelines (CPCG) recommend pharmacological intervention in combination with behavioral and psychological interventions [100].”

    From Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan (2025) · cites this paper as [100]

    The Pharmacologic interventions section recommends considering GLP-1 receptor agonists in combination with behavioural and psychological interventions. The recommendation is conditional and applies only to children aged 12 years and older; the citing sentence omits those limits and presents pharmacological intervention more broadly. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Orlistat is not approved for children aged 6-12.

    “Not approved in this range of age [100].”

    From Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan (2025) · cites this paper as [100]

    The Recommendations > Pharmacologic interventions section (page unavailable) identifies orlistat as a lipase inhibitor, recommends against its use in children, and says the cited trials involved ages 13–18. Neither that section nor the additional passages searched for approval and age limits state whether orlistat is approved for children aged 6–12. A clinical recommendation is not an approval determination. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 59

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Authors
Ball, G. D. C., Merdad, R., Birken, C. S., Cohen, T. R., Goodman, B., Hadjiyannakis, S., Hamilton, J., Henderson, M., Lammey, J., Morrison, K. M., Moore, S. A., Mushquash, A. R., Patton, I., Pearce, N., Ramjist, J. K., Lebel, T. R., Timmons, B. W., Buchholz, A., Cantwell, J., Cooper, J., Erdstein, J., Fitzpatrick-Lewis, D., Hatanaka, D., Lindsay, P., Sajwani, T., Sebastianski, M., Sherifali, D., Pierre, J. S., Ali, M. U., Wijesundera, J., Alberga, A. S., Ausman, C., Baluyot, T. C., Burke, E., Dadgostar, K., Delacruz, B., Dettmer, E., Dymarski, M., Esmaeilinezhad, Z., Hale, I., Harnois-Leblanc, S., Ho, J., Gehring, N. D., Kucera, M., Langer, J. C., McPherson, A. C., Naji, L., Oei, K., O’Malley, G., Rigsby, A. M., Wahi, G., Zenlea, I. S., & Johnston, B. C.
Affiliations
University of British Columbia (CA)
Corresponding author
Ball, Geoff D.C.
ORCID
Venue
Canadian Medical Association Journal
Publisher
CMA Impact Inc.
Published
2025-04-13
Volume
197
Issue
14
Pages
E372-E389
ISSN
  • 0820-3946 (ISSN-L)
  • 1488-2329
DOI
10.1503/cmaj.241456
PMC
PMC12007946
OpenAlex
W4409404236
Cited by
56
References
49
Citations by year
2026: 34 · 2025: 22
FWCI
50.99
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Canadian Medical Association Journal (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion, cc-by)
Funders
  • Alberta Health Services
  • Obesity Canada
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
Keywords
childhood obesity, childhood obesity management, shared decision-making, behavioral interventions, psychological intervention, multicomponent intervention, pharmacological interventions, bariatric surgery, individualized care, benefits and harms
MeSH terms
Decision Making, Shared, Child, Humans, Pediatric Obesity

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