What’s New in Pediatric Obesity Care with Dr. Geoff Ball & Dr. Catherine Birken

– Welcome back to the Scale Up Your Practice Podcast, the podcast where we explore evidence-based approaches to obesity care in Canada. I’m Michelle McMillan.

 

– And I’m Dr. Roshan Abraham. Today’s episode is all about kids, specifically managing pediatric obesity using the newest Canadian guideline, Managing Obesity in Children: a Clinical Practice guideline.

 

– As a parent of two children who both have had pediatric obesity management, I am so excited that we’re joined today by two key contributors to this landmark work. Dr. Geoff Ball, co-lead author and a professor of pediatrics at the University of Alberta.

 

– And Dr. Catherine Birken, a fellow author on the guideline, Pediatrician at the Hospital for Sick Children, and a scientist with expertise in child growth and chronic disease prevention.

 

– So Geoff, let’s get started with you. Why was this new pediatric guideline developed and what makes it different from the previous one?

 

– Sure. Well, it was developed because it was long overdue, actually. The first guideline is maybe some listeners know was published in 2007. And Catherine was among the folks I would see regularly. This is long before COVID at conferences. And we talk about the need to update the guideline and we talk about it and talk about it. And it wasn’t until we got some money that actually kicked into gear. So we were thinking we would update it every five years, but it did take us a little while to get going. But once we had funding and then established a really nice partnership with Obesity Canada to move it forward, we got started really late 2019 with some conversations and then 2020 up until today, actually. I’m still working on the guideline last night. We’re almost at completion. So there was always interest, but then when we had money and partnership and then developed a nice cogent plan that developed over time with clinical experts, with parents, with research methodologists, that’s really when things accelerated and we were able to undertake the work. And you asked about what’s new or what’s changed since the last one,

 

– Yeah, what’s changed about the guideline.

 

– What hasn’t? Lots has changed. I’d say scientifically or methodologically lots has changed in terms of how we developed the most recent guideline versus how the guideline was originally or the original guideline was developed back in the mid 2000s. So the science has evolved for guideline development, the evidence base, Maybe we’ll talk a bit about interventions like pharmacotherapy. You’d have to be living under a rock to not know that there’s been a lot of change over the past five years or so with the emergence of GLP-1s. That’s a small part of the work that we undertook, but it’s certainly emerging and important. Behavioral interventions. There’s evidence there that’s evolved over time. Surgical interventions. That evidence base has built over time. So there probably isn’t an area that has not evolved over time and really makes our guideline timely.

 

– Well, one of the things that we like to talk about on this podcast, which is important to us, is incorporating the lived experiences. So Catherine, I’d be really interested in how, in developing this, the team ensured that, you know, you have the lived experiences not only of your pediatric patients, but obviously their families as well.

 

– Yeah, great question. And that’s one of the areas that we’re extremely proud of and that we have, it’s really an update in the methods of how we do this in a really good way. So we really tried to involve caregivers, family members, individuals with lived experience with the guidelines actually all the way through the process. So we first asked them and looked at the literature and asked them directly, you know, what are the outcomes that are important to you and your family when we’re thinking around interventions? And we framed those outcomes as critically important in our process. And families told us quality of life of our children, children and adolescents, mental health effects of children and adolescents were critically important outcomes to add to the already important outcomes of weight, growth, cardiometabolic outcomes. So we really took families with lived experiences there. When we conducted the reviews to inform the guidelines, we also wanted to better understand children, adolescents’ and families’ values and preferences. And that really helped shape the way we interpreted the evidence and how we framed those recommendations to make sure that they’re more relevant and appropriate and really reflect people with lived experience. So those are the main ways we did that.

 

– I’m actually really interested again, as a primary care physician, I’m actually quite curious, do you have an example of that? Like, how did you frame those recommendations to incorporate those values and preferences? Because that’s so critical to this work, not just for adults, but for pediatric patients as well.

 

– Yeah, well, as I mentioned before, many traditional, like systematic reviews that actually examine the strength of the evidence, they look at randomized control trials, and they look at the outcomes of those trials to inform the evidence. But what we wanted to do is say, well, are these outcomes actually the most important to families? So that’s one way. And we actually distributed those outcomes and took them into consideration in the strength and looking at the strength of the evidence. And then families were involved at all of our guideline panel meetings. We listened and heard the reviews of those values and preferences from the evidence and incorporate those into our decision-making. So those are some examples of how we did this in real time.

 

– So then, Geoff, why don’t you give us a bit of a high-level summary of what the core components were for the guidelines?

 

– Yeah, so at the end of the day, our guideline document includes 10 recommendations that were derived from three systematic reviews and meta-analyses. So we did one meta-analysis on behavioral and psychological interventions, another was done on pharmacological interventions, and another was done on surgical. So each of those independent intervention-related reviews informed those 10 recommendations that we have in the guideline. But that just gives a measure of the effects of different interventions on outcomes that mattered to patients as Catherine just reviewed. We had some that were critically important outcomes, some that we as a group deemed, with parents deemed very important, and other ones that were just important. So we kind of had a hierarchy of how those outcomes mattered to the people involved in the guideline development. But there’s all that other stuff, right? It’s not just about the outcomes and about the interventions, but about the environment within which care is provided. So one of the things we did was we created what are called good practice statements. And we went through a formal process to develop those, which I won’t bore you with, but basically they’re more or less how care should be provided. So you mentioned your background as a primary care physician. They’re intended for primary care docs, dieticians, nurses, health professionals who practice and work with kids and families to give them some level of specificity and some guidance on how they can actually put the recommendations, the 10 recommendations from the meta-analyses actually into practice. What are the things they need to be mindful of related to communication, related to the environment that care is provided in? What sorts of assessments should they be doing? All those sorts of things that you wouldn’t do an RCT on or necessarily have a meta-analysis on, but the good practices that we want clinicians to be mindful of so that they can provide the best care for the families that they see.

 

– Well, Catherine, Geoff kind of alluded to this a little bit about multi-component intervention. I am not a medical professional, but I do know from speaking with them about the adult recommendations is that, it’s not like a hierarchy. You don’t like do this and then do this and then do this. So maybe you could talk a little bit about why the multi-component interventions are so important, particularly in the pediatric field.

 

– Yeah, great question. When we speak about multi-component interventions, we looked at studies that incorporated different elements of an intervention to see what was effective because many of these interventions that are published or that we know about in the literature have different elements. So in order to summarize that evidence, we have to have some way of characterizing them. So the common elements that we talk about in multi-component intervention are physical activity, which would include reducing screen time or sedentary behavior, nutrition, the use of technology and psychological support. So when we look at this, these group of interventions, we find that the evidence shows they actually have anywhere from small to moderate, actually large benefits against these ranges of outcomes. So all the way from mental health, quality of life, body mass index, risk for cardiometabolic disease, and those are the different components. So when we saw that the intervention had at least two of these components, we consider those to be multi-component. And additionally, it was important when we looked at the literature, the evidence, they tended also to be quite acceptable to families. And then there are opportunities to tailor those multi-components to the individual needs and interests of children and families.

 

– Can I add to that a little bit, if you don’t mind, Michelle?

 

– Yeah.

 

– And Roshan.

 

– Absolutely.

 

– So Roshan, you asked earlier about what’s new or what’s different. And Michelle, you just asked about, do you do this then this then this. And I think that’s one of the things that’s different about our guideline is that,

 

– No kidding.

 

– Our job is to, as scientists and healthcare, you know, researchers is to provide the evidence and it’s up to primary care, it’s up to clinicians who work with families and families themselves to be informed and have that informed decision making opportunity to look at the evidence. And for some families, a certain multi-component intervention may be most appropriate. In other instances it may be combined with pharmacological or surgical. So the old way of doing it is you start with behavioral interventions. And if those fail, then you move up intensity, however you want to define intensity, more contact, maybe surgery, maybe pharmacology. But the approach we’re taking is that these are our recommendations for all these interventions that show some level of effectiveness and safety. And it’s, you know, up to the people taking that guideline now and having conversations with families about what’s most appropriate, given feasibility, acceptability, availability of services. So that’s very different than the old school. You’ve got to jump through these hoops and get to more intensive interventions over time based on failure, which is no evidence to support that approach in obesity management for kids.

 

– Yeah, I would say there’s not actually evidence about either way about a graded approach. You know, there is just simply isn’t evidence about that, so

 

– But I love that we’re at least talking about this because I think that we’ve tried in many ways to look at this step by step approach in not just pediatric obesity management, but in a lot of cases, even in obesity management for years. And just having this conversation open up to the importance of sort of that multi-component treatment. I mean, when I first heard about that, I thought, well, I mean, that doesn’t seem like it needs to be something so revolutionary. This is something that we should be doing. We should be incorporating this into a lot of chronic disease management. And I love that that’s what’s coming out of these guidelines.

 

– And I’d say the other thing that goes along with that, Roshan, is about providing access for families as soon as possible, removing barriers and challenges that they may have. And like I said before, we don’t need people to jump through a lot of hoops. We have the evidence. Let’s get it in the hands of people who can apply it and help them make the best decisions possible based on the best available evidence.

 

– A lot of these guidelines, like how Catherine said, you know, reduce screen time, you know, those kind of things. Those are healthy things for all families to do, right? Like, Roshan, as a family physician, I’m sure you didn’t say, oh, you have skinny kids. They can be on the computer an hour a day. Oh, the heavier kid? No, no, no computer time for that child, right? So I love that about these guidelines. What were you going to say, Roshan?

 

– I mean, Geoff was mentioning about the importance of decision making and the shared decision making process is something that’s always interested me as an academic and as a family physician, but it is especially challenging in pediatric care, let alone pediatric obesity care. So I understand why that’s emphasized so strongly. What were some of the conversations, what were some of the discussions around shared decision making? Because I’m genuinely curious about what that looked like through the guideline development process.

 

– Well, I’d say it’s a fundamental part of grade and grade is the methodological approach that we applied for guideline development. So it really depends on the strength of the evidence at the end of the day. Our recommendations varied in strength because of the evidence that we reviewed. And, but the fundamental, I guess, result of all of this is that the information should be available to clinicians and families and they should have informed discussion or shared decision making around what course of action a family would take if they seek to be proactive in managing pediatric obesity. So one of the limitations with the guideline, and we’ll talk about a lot of the good things about the guideline, of course, it’s not perfect and it won’t meet the needs of everybody. And it’s only 10 pages-ish long, so it’s not gonna provide everything for everybody. So one of the things that we will be working on with Obesity Canada is all the knowledge translation resources and tools and things that health care providers can use in their practices. So I guess if it’s one thing that I hope listeners will come away with is that the guideline is about evidence and about what’s recommended, but then how that actually gets applied into practice will be complementary to the work that we’ve done. And shared decision making will be a big part of that. So issues around terminology, you know, who do you talk with? Pediatrics is a great example right there. Catherine can attest to this as a pediatrician. There are some instances where it makes perfect sense for moms and dads and kids to be in the same room and talking about issues that are relevant for everybody. But there may be situations where a teen might wanna talk about weight management or obesity management on her own or his own. Same with the parent. It might be difficult to have those conversations together. So what we want folks to be mindful of is the need to tailor these kinds of conversations and interventions for family contexts and preference and what’s going to be best for them. And that’s, just to add to that. That’s a really important area that we could expand in our research to like best understand what are ways in which we should be communicating most effectively with families. And what to, children, adolescents and families, what do they, how do they want to communicate these types of issues? And there’s some really good work out there that we’re going to link to as well that’s been done in this area. But that’s a really important area. There’s so much stigma around weight and weight management. So I think that’s a really, really important area of focus moving forward.

 

– Yeah, I find this really interesting. I love, as a patient, you know, how we’re moving to this person centric care, not just around obesity, but in general, you know, in medicine. But I just think this is extra challenging when you’re dealing with children to adolescents to parents, like, either Geoff or Catherine, you know, if you want to speak a little bit about your thoughts about tying this into, you know, the guide and all the considerations involved in that. I’m just so curious about it.

 

– I mean, I can start off I mean, it’s not just about delivering interventions, it’s about partnerships, having good communication with families, multiple family members, children and adolescents really understanding what their barriers are, what their goals are. And, you know, what’s most important to them and then working with, hopefully, if access to an interdisciplinary team, it can really help focus on their particular goals, making sure that those goals are realistic. So I think that’s really important. And then, of course, as you mentioned, recognizing different developmental stages, like we always have to when we’re addressing, you know, children, adolescents and families. So I think those are, you know, those are core philosophies around managing any chronic disease in children or chronic illness or chronic condition. We really have to take into consideration the developmental stage and readiness of that particular person and family.

 

– I’d say to add to that, too, Catherine, as you’re talking about the developmental ages and stages, we don’t talk about it explicitly within the guideline. And it probably will come up in the knowledge translation activities and the continuing medical education that we do with Obesity Canada. But one of the challenges in the field, probably in pediatrics in general, is transition. So as boys and girls become adolescents and then young adults and transition to adult care, we talk about continuity of care and transition from pediatrics to adults. That is a really challenging time because of the life events that happen in teens. You know, they’re maybe transitioning from high school to college or moving out and having their own jobs and becoming more independent. That makes it, you know, parents have less of a direct role that sometimes makes it challenging for that transition. Catherine can attest, the pediatric world of health and health care delivery is different. And Roshan, you probably see this as well, different than adult medicine. I’ll give you a practical example. In Edmonton, where I am, we have pediatric obesity management clinic and we also have a couple different adult medicine clinics for obesity management. Those are siloed. It’s really difficult to have that transition. We really need to do a better job of helping families to make that transition, whether it’s from a children’s hospital to primary care or a children’s hospital to another tertiary center, maybe for bariatric surgery. I’ve been doing this work now for 15 or 20 years in Edmonton, and it still remains a challenge to try to connect those pieces. So we’ll talk about, as I mentioned, a lot of good things about the guideline, but it does reveal some things related to transition is a challenge. Accessibility and availability of services for all Canadians remains problematic. We can talk a little bit about that. And I know that’s where Obesity Canada has a really important role to play for advocacy and education and awareness raising.

 

– Thank you for that. And yes, I have so much brimming in my mind as a family doctor, as to what I see on a regular basis of the complexity that is just apparent within this condition, especially in the pediatric realm. And not necessarily just from a biological standpoint, but just the family dynamics, the interactions with the healthcare system. I’m really hopeful that there is actually hope through these guidelines for a lot of families. Because I know that through my time as a practitioner, but also in my time in training, I would see hope being lost, I would say, by a lot of families. Because they didn’t necessarily feel that there was trust with the system or that trust was eroding. And I think that’s because they felt it for themselves, but also felt it for the people that they would do anything for, right? Their kids. And becoming a parent myself and sort of reflecting on that as a primary care physician, not just with obesity care, but with any care in sort of the pediatric realm, I feel like a lot of this is a step forward just in the realm of hope for a lot of families where they didn’t necessarily know that this is possible for us to actually move towards. So again, it’s just so great to hear these conversations. I’m so grateful that we have the opportunity to provide a platform to talk about this more. So that, yes, there are healthcare practitioners that are listening to this, but families as well, that hopefully will listen to this and feel, hey, you know, there’s some hope in terms of how we can go to our primary care physician, whether it’s a pediatrician or a family doctor, to specialists. And to sort of see that there’s this movement that’s there. I could really see that being really valuable to a lot of patients.

 

– There is a movement and there’s a lot of interest within healthcare providers to work together, to share expertise, share learnings. And I think, you know, having an organization such as Obesity Canada really helps sort of gather the evidence, communicate, advocate for improving the system to be able to accommodate some of the issues that Geoff has raised, and also to be able to work in teams, to have access to the really important team members that are really key for these interventions to be really effective. So I think there is a lot of hope and excitement and passion in this area. So I also find that really inspiring.

 

– So let’s talk about complexity. Geoff, the guideline explicitly avoids a one-size-fits-all approach. Can you speak to that?

 

– Yeah, well, I think I mentioned earlier the need to tailor interventions, and that’s really what the shared decision-making is about. It’s that no two families are alike. They may have some shared characteristics or similar issues, but everyone is unique. So, you know, I’ve been doing this work for a number of years now, and I know from talking to families, everybody wants that tailored approach, too. So it’s not an epiphany or it hasn’t been around. I think everybody identifies the need to have their care tailored to their own context. And I think the information that we have in the guideline and the strong push for shared decision-making is emblematic of that. So I think, like I mentioned, it’s not perfect, but I think it does highlight the importance and the value of doing that.

 

– Just about the complexity that he’s talking about there, and, you know, we all have families, all families are different, you know? Catherine, I’d be interested in, you know, how the considerations were formed around diverse populations, you know? There’s all different kinds of families, there’s all different kinds of cultural backgrounds, there’s different socioeconomic backgrounds. Like this, you know, as if this wasn’t complex enough, you know, we’ve added additional complexity to it. Can you maybe speak a little bit to that diversity, please?

 

– Yeah, I mean, we really recognize and the guidelines really recognize that children from unique groups, children from racialized or Indigenous communities may face additional, really additional barriers like reduced access to some of these interventions or services, higher experiences with weight stigmatization or other forms of stigmatization in the healthcare system or beyond the healthcare system, like the education system and all the environments where children and families live. So I think the guidelines, definitely encourage clinicians and healthcare providers to provide culturally safe care and really, we do really highlight the need for equitable resources to be allocated. I think that’s also an area where we would have really preferred their evidence to be stronger or there to actually be evidence. So there’s even other groups, children with neurodevelopmental challenges, children with disabilities, like there are some really, other really important groups that, you know, we would really like more evidence or at least some evidence to inform those guidelines. So that’s really one of the key areas that we hope to improve upon moving forward. But yeah, I mean, individual care, considering the individual characteristics and needs and barriers of families is really key in implementing these guidelines.

 

– And just to add to that, Catherine, just so people are aware that when we set out to develop the guideline, we created a roadmap with the protocol. So all the science that we carried out over the years was guided by our plan. It wasn’t done sort of willy nilly. We wanted to have some structure. I mean, we sought to derive the best available evidence on interventions and including subgroups that were prioritized by parents and by healthcare providers. So from the beginning, we were interested in interventions for boys and girls of different ages. We were interested in multicultural and multi-ethnic evidence. Boys and girls who may not be typically developing. So whether they’re neurodiverse or what have you. Other sorts of characteristics that may be a bit unique. There’s very little evidence of anything beyond what we might consider typical or normal. So white, middle class, we searched internationally for evidence, mostly it was from higher income countries. So the application of our guideline to some groups would not be based on evidence. It would be based on, well, this is what we know from maybe mainstream. And then how could it be applied to groups that may differ in one way or another? So we have a section, we probably could have written three pages of the paper on all the things we didn’t know and all the limitations of the existing data. So we actually went back and forth with the editor of the journal, quite a bit about word count. And they said, you’ve got to reduce this a little bit. So there’s a lot of things we wish we could have done, but we were driven by the available evidence and that really limited us in scope. But we’re optimistic that moving forward, this will be a great place to move on. And hopefully a catalyst for research in those areas that we identified that are that are needed.

 

– And maybe that speaks to some of the healthcare practitioners who are listening to this podcast, you know, hint, hint. Areas of research we would like, you know, so there’s going to be future guides. So hopefully, more research for future guides. Right?

 

– Yeah. Well, and researchers too, if they could take the guide and say, look, these are the issues that were identified by parents and by healthcare providers who helped develop the guideline as a funder, that makes a very compelling argument to say, we want to address those gaps. So hopefully, it’s useful for people in that arena as well.

 

– I just want to say that it’s really encouraging to see the humility here around the need for culturally safe trauma informed care, and how there’s more work that needs to be done to learn, to unlearn in many ways, and provide care for populations that traditionally have been underrepresented, or worse, or much worse, within our medical communities for a long, long time for far too long. So I really appreciate that, because I don’t necessarily know if we’ve hit on that before in the podcast. And the fact that it’s coming out right now is just really refreshing. And I know that’s what we see with a lot of the work in Obesity Canada. But this really touches something in my heart for me, because again, as a primary care doc, this is something that I see on a regular basis, especially living in Edmonton. So I do appreciate that, it resonates with me. And I thank you for that.

 

– Well, thanks for mentioning that. And it’s not something that we talked about, I don’t think, along the way, but I think humility guided a lot of what we did. Just to have families participate in all the conversations and the decisions, I think it’s fair to say we were a pretty humble group. And in a lot of ways, dispassionate when we view the science, while not a lot of ways, I’d say we viewed the evidence in a dispassionate manner. Although underneath, there’s a lot of passion for the issue, and the work that we’re doing. The other thing I’d say when we develop the guideline, when you speak of humility. When we first started, I remember conversations having with people like, what chapter do you want to write? And what chapter do you want to write? And we’re very much like organically, let’s just create this. Until we talked to a methodologist and he’s like, Geoff, that is not how you develop a guideline. So we were reoriented, I’ll say, by the experts in our group that develop guidelines and do systematic reviews and meta-analyses. And I think, like Catherine said, we’re proud of a lot of the things we did. I’d say, this is probably not going to resonate with a lot of listeners, but as a scientist, from a science perspective, I think we did the best we could. I know we did the best we could in terms of transparency and objectivity and dispassionate work. And then, you know, the passion will come in how it’s translated and conveyed in the real world.

 

– So we talked about humility and one of the things that we do here on the podcast is take a little bit of a break every single episode to talk about bias. And we had a good discussion about this and I think it’d be great to share it with our listeners around either part of the guideline development or through what you do on a regular basis, what you’re finding in the way of weight bias and stigma. And just talking about that openly and from a vulnerable standpoint, I think would be great. Geoff, I think you had mentioned something that we have a callback to with the Harvard’s Implicit Association Test. So could you tell us a little bit more about that?

 

– One of the things I do in my day job is review research grants. And one of the funders requires reviewers to complete, I think it’s one or two modules. And the one that I chose to complete was related to weight bias and stigma. And, you know, this is something that I’ve lived in. I’ve been studying obesity for a couple decades now and grew up in a family of, you know, aunts and uncles and cousins with obesity and type two diabetes. So it’s been omnipresent in my life. And I was still struck by the fact that my responses when the, because the implicit test, for those of you who don’t know, is connecting different words together. And I was delayed in connecting healthy physical activity, more of the, quote, unquote, positive terms with individuals living with obesity. It’s a very small time difference from the automatic thoughts, but it’s meaningful. So for me, it just was a reminder that bias is everywhere. And even those folks who are well-meaning and very knowledgeable and experienced, that bias still exists. So if we want to provide the best care and the most equitable service and sensitive, compassionate care to people, we need to be mindful of the things that are I guess influencing our brains and our decisions.

 

– Thank you so much for that. Catherine, I think you had something a little different as well from what we’ve probably heard in the past and previous podcast episodes, just in terms of what you hear from parents and what you see on a regular basis just in the clinic where you work compared to perhaps other places in the institution that you see that sort of that difference in how to address that bias appropriately.

 

– Yeah, thank you so much. I mean, I think in terms of the environment, the environment in which we work and operate in the clinic that I work in, the healthy living clinic at SickKids, we’ve been very specific and planning that the environment, including the equipment, is comfortable for our parents and families, is appropriate. And that’s just not the case in other clinic settings that I worked in. And just raising that in the rest of the organization, I think, makes us all think a little bit about what are the environments we’re creating for families and what are families having to contend with when they come into our health care environment. And the other idea or concept that comes to mind is how are families, other families, outside of the health care system, talking to strangers at the playground making comments about their children, providing unsolicited advice, negative comments, biased comments to colleagues. And I hear that a lot in my practice. So thinking a lot about, you know, what are the ways in which we want to behave, we want to interact with people, we need to be compassionate and, you know, ask our families about experiences that they have and try to learn from that. So those are some examples of, you know, it’s omnipresent bias that exists both within and outside of health care.

 

– Thank you both for taking that time. I know we have to wrap up. Our listeners probably want to get a few nuggets of what are some of those key takeaways for clinicians. I know for myself too, I feel stuck often with pediatric obesity care, even having known the family for years. Any suggestions, any key takeaways for our clinician listeners out there?

 

– I can start. I mean, I think, you know, asking permission, ways to communicate to families before, you know, before discussing weight, you know, thinking about focusing on changes, behaviors, function, quality of life, things that are important to the families that we work with, and really making use of, you know, other experts, so other team members when you can, when possible. This is really challenging to do alone. So really, those would be some of the really key areas.

 

– Just to briefly add to that, I would say not to wait. There’s no evidence to say waiting is beneficial. These are difficult conversations to have for clinicians and for families. We link to a number of resources within the guideline that may be helpful for frontline clinicians, but it starts with a conversation that’s sensitive, humble, objective, compassionate, that needs to start. And not everyone’s going to have a great experience, it’s going to maybe a little bit bumpy if this is something that you’ve been having a difficult time with in the past, but there’s no doubt that families benefit from clinicians who are compassionate and want to help. Resources are available, the evidence exists. Start having these conversations.

 

– As I touched on earlier, you know, I’m sure, you know, all family physicians want all of their families to be happy and healthy and well functioning. Right? So you don’t have to wait until a test says a certain thing. Obviously, once it does, you know, maybe we move it up a year or something. But yeah, it was so great to hear, you know, that you’re approaching it generally to everyone. Before we wrap up, I do have to ask, we touched on this briefly before, what happens next with the guidelines?

 

– Great question. It’s going to be published in CMAJ, middle of April. That’s the, I think I might have mentioned earlier, we were working on it last night, a little bit today. The journal has been great to work with. Like, they are super responsive and supportive and they have been strong advocates of the work, just like they did with the adult guideline back in 2020 and lead up to. So they’ve been wonderful to work with. But yeah, the time crunches on. And then once it’s published, then we’re already starting work with Obesity Canada on educational curriculum that I think there’s a couple different plans that Nicole Pearson, and her team have been working on with Obesity Canada. So a group of us are helping with developing content for continuing medical education and we talked about infographics and we actually have a small grant that we’re working on that will help us with more knowledge translation activities, some whiteboard videos and some other things. So the idea is to get the messages out there through a number of different platforms and a number of different ways so that it’s accessible and available to as many people as possible. I think when they’re, and just one point, I’m not sure how many Francophone listeners we have on here, but the plan for the CMAJ article is gonna be published in English first and then the translation happens. So there will be a French, a full French version of it as well, which we’re hopeful improves accessibility, availability and impact with our French speaking colleagues.

 

– Dr. Geoff Ball, Dr. Catherine Birkin, thank you both for joining us and for your incredible work on this guideline.

 

– Thanks very much for having us.

 

– For helping move the needle on pediatric obesity in Canada, which I and parents across this country entirely appreciate it. And not only are you moving the needle, but you’re doing it with evidence, empathy, and equity. And I can’t thank you enough for all your hard work. Thank you so much.

 

– Yeah, I second that. Thank you so much. To read the full guideline, visit obesitycanada.ca. Consider taking a deeper dive into the updated guidelines through the Obesity Canada Education Hub at education.obesitycanada.ca. Thanks for listening to the Scale Up Your Practice podcast. Don’t forget to subscribe and share with your colleagues. This podcast is intended for informational and educational purposes only and does not constitute medical advice. The content shared in this podcast should never be used as a substitute for professional medical advice, diagnosis or treatments. Always seek the guidance of a qualified healthcare professional with any questions you may have regarding your health or a medical condition. The information and treatments discussed in this podcast are based on Canadian guidelines and approved practices as of the time of recording. If you’re listening from outside of Canada, please consult your local healthcare professional to ensure compliance with your region’s medical standards, guidelines, and recommendations. The creators of this podcast disclaim all liability for any decisions or actions taken based on the content discussed. Listening to this podcast does not establish a professional or patient client relationship.