Future clinical guidelines for treating obesity in children and teenagers should reflect contemporary research addressing quality of life, behaviour change and family-oriented treatments that support nutrition and play.

That’s according to a new study led by RSCI University of Medicine and Health Sciences, which highlights the need for clinical guidelines to incorporate new evidence about treatments - such as exercise therapy, sleep therapy, medications and surgery – and ways to address family poverty, deprivation, access to healthy food and safe places to play.

The research, published in the journal Frontiers in Nutrition examined the main recommendations from nine international guidelines for treating obesity in children and adolescents.

The current clinical guidelines for treating obesity in children and teenagers provide recommendations relating to evidence-based approaches to treating obesity in the early years of life.

The researchers say that further information and guidance is needed around how health professionals are trained to assess and treat child and adolescent obesity, optimal ways to address obesity-related stigma and bias, the use of clinical staging for obesity severity and how treatment success should be defined.

They also say that the existing guidelines lack recommendations related to managing limitations in physical fitness or to the transition of adolescents with obesity into adult healthcare services.

“Obesity is a chronic disease that is negatively affecting the physical and mental health of increasing numbers of children worldwide, and rates of obesity are increasing particularly quickly among young people from low-income households,” says Dr Louise Tully, from the RCSI School of Physiotherapy.

“We need to prioritise access to quality care for children who have health complications related to obesity in order to improve their quality of life and slow down or reverse breathing difficulties, joint pain, non-alcoholic fatty liver disease and early type 2 diabetes. Clinical guidelines exist to guide general practitioners (GPs) and other health and social care professionals on how to help children and their families, but to date no-one had looked at these guidelines in a systematic way.”

Senior author on the study and Principal Investigator of the RCSI Obesity Research and Care Group, Dr Grace O’Malley highlighted the timeliness of the work.

“For the first time in Ireland we are seeing direct investment in healthcare services for child and adolescent obesity through the HSE’s Obesity National Clinical Programme.

Our clinical guideline work will support health professionals and policy makers, ensuring the design and implementation of obesity services are guided by scientific evidence. Our work also identified clear gaps within existing clinical guidelines for childhood obesity and will help researchers to develop future studies with significant impact for children, families and the health system.”

The researchers systematically reviewed and analysed nine high-quality guidelines. They compared similarities and differences between these guidelines and recommendations, and identified gaps in the current evidence.

“We found that family-orientated treatments are recommended as the first steps of treatment for childhood obesity and that different approaches are needed as the child develops into an adolescent. Unfortunately, very little research to date has focused on the importance of adolescent health and the transition services required for adolescents moving from paediatric healthcare into adult healthcare,” says Dr O’Malley, who holds a joint position at RCSI and Children’s Health Ireland Child and Adolescent Obesity Service.

“Treatment should address a number of different factors in the child’s life to support high-quality nutrition, child development, play, sleep and family dynamics while being delivered by a range of health professionals with training in obesity care.”

The study also identified that a greater emphasis is needed regarding managing complications of obesity, improving quality of life and addressing the practical or social barriers to care, such as food insecurity, limited cooking skills, inadequate housing, and access to safe, fun and age-appropriate active play.

‘Guidelines for Treating Child and Adolescent Obesity: A Systematic Review’ is published as an open access article in Frontiers in Nutrition.

This work will be shared through open access platforms, health professional networks, scientific associations, patient advocacy groups and with health policy makers in Ireland and across the world through our collaborators and stakeholders in obesity research, clinical practice, media and advocacy.

The study was a collaboration between RCSI University of Medicine and Health Sciences, Children’s Health Ireland, University College Dublin, St Vincent’s University Hospital, Dublin, St Columcille’s Hospital Weight Management Service, Loughlinstown, University of Limerick and University Hospital Limerick. The research received funding from the Department of Health - Sláintecare Integration Fund, the Health Research Board, and the HSE Health and Wellbeing Division.