Pediatric weight management programs in Canada: Where, What and How?

Abstract

Our purpose was to conduct a national environmental scan of pediatric weight management programs in Canada. Data were entered by program representatives regarding the history, structure, and function of their weight management programs using an online survey that our team developed in partnership with the Canadian Obesity Network ( www.obesitynetwork.ca ). Of the 18 programs that were identified, all included multidisciplinary teams that take a family-centred, lifestyle/behavioural therapeutic approach; health services were accessed primarily through physician referral. Most programs were launched in the past five years with public funding and enrolled ∼125 clients/year into one-on-one and/or group-based weight management care. Although many participated in research and were affiliated with academic institutions, most did not systematically evaluate their obesity-related programming. Based on these observations, recommendations related to program evaluation, health services delivery, and network collaborations are provided to inform future directions for research and clinical care that have both domestic and international relevance.

Recent trends in the prevalence of overweight and obesity among Canadian children

“…Although our study was unable to identify the mechanism for the observed decline in BMI z scores and rates of overweight or obesity, the introduction of BMI growth charts in 2000 may have encouraged health care providers to discuss children's overweight or obese status more openly with families. 6 In addition, numerous weight management programs, both regional and national, have been implemented (for review, see Ball and colleagues 26 ), and increasing media scrutiny may have increased public awareness of the health issues. Failure to observe a corresponding reduction in obesity rates over time may reflect greater impact of such interventions among children who are overweight or, alternatively, a lack of statistical power given the smaller numbers in the obese category.…”

Characterizing severe obesity in children and youth referred for weight management

“…This information is highly relevant from a health services perspective because many children and youth referred to weight management clinics present with SO and because most clinical programs use the severity of obesity and/or presence of obesity-related co-morbidities as referral criteria [11]. Clinical practice guidelines [12] and expert recommendations [13] highlight the importance of making positive lifestyle (nutrition and physical activity) changes in order to manage obesity.…”

The CANadian Pediatric Weight Management Registry (CANPWR): Study protocol

“…The study centres will continue their current program [25], but data collection for outcomes and determinants will be standardized amongst centres. It should be noted that all of these programs are in urban centres, are in secondary or tertiary care environments, may have relatively wide geographic referral areas and are funded under a single payer system.…”

“…Our understanding of the effectiveness of program-related factors including intervention modality (e.g., group vs individual sessions), disciplinary approach (e.g., unidisciplinary vs multidisciplinary), and behavioural techniques (e.g., self-monitoring nutrition/physical activity habits, regular weighing, goal-setting) [24] in managing pediatric obesity remains incomplete. Multi-centre research will allow us to examine the influence of determinants of responsiveness to obesity management in diverse clinical environments that extend across cultures and contexts within the Canadian health care environment [25]. …”