It’s been three years since Christophe Legault, now 12, was diagnosed with obesity and started treatment.
He had been having trouble at school — his grades were dropping, he was being bullied and he was struggling to participate in sports such as basketball, his favourite.
The program he’s been following at Maison de Santé Prévention, a semi-private, subsidized clinic in Montreal, involves intensive lifestyle and nutrition counselling, including finding out what kinds of food and exercise work for him and his family, who pay for the treatment.
With help from doctors, nurses, nutritionists and other experts, the family made changes around the kinds of foods they eat, and Christophe started walking to school instead of taking the bus.
“It makes me proud that I made a lot of progress,” Legault said. “If I didn’t have that treatment, it would have been really hard.”
The kind of early, intensive intervention Christophe is part of, is in line with the American Academy of Pediatrics’ new clinical guidelines to treat obesity, announced in January. The guidelines shift doctors’ approach from so-called “watchful waiting” — to see if a child outgrows obesity — to more aggressive treatments.
The recommendations include intensive, one-on-one health and lifestyle treatment — at least 26 hours over three months, for children as young as two who have a body mass index in the 85th percentile or higher.
But the AAP also recommends physicians offer weight-loss drugs for kids 12 and up with obesity, and referrals for bariatric surgery for teens 13 and up with severe obesity, defined as having a body mass index of 35 or higher.
“Many of these children, especially teenagers, are going into adulthood with obesity and by the time they’re in adulthood, they already have many of the comorbidities,” said Dr. Madeline Joseph, medical director for the UFHealth Pediatric Weight Management Center in Jacksonville, Fla.,and one of the authors of the U.S. guidelines.
WATCH | New U.S. childhood obesity guidelines recommend surgery, drugs:
New U.S. childhood obesity guidelines recommend surgery, drugs
3 days ago
Duration2:30
As Canada prepares to release new guidelines for treating childhood obesity, some experts are criticizing the United State’s new guidelines, which recommend more aggressive treatments like medication and surgery for children as young as 12 and 13 years old.
There are 14 million children in the U.S. who have obesity, affecting one in five children across the country, according to the U.S. Centers for Disease Control and Prevention. Joseph said with more than 14 million children with obesity, there evidence has shown the old approach just didn’t work.
“We cannot watch these kids really struggle and their health is in jeopardy without offering them some solutions,” she said.
New Canadian guidelines on the way
In Canada, where about one in 10 children has obesity, treatment guidelines are also in the process of being updated. A team of more than 50 experts across the country is reviewing the latest evidence and consulting families with children who have obesity to determine the best approach.
“Eating less and moving more is a very simplistic view of a complex problem,” said Dr. Geoff Ball, a professor at the University of Alberta and a chair in obesity research who is working on the guidelines with the advocacy group Obesity Canada.
“Over time as researchers and health professionals, we’ve taken a much broader, more comprehensive view of obesity.”
Christophe Legault, 12, and his mother, Marie-Eve Theriault. Legault started treatment for obesity when he was nine years old, after his mother noticed he was have trouble at school and struggling to participate in sports he loved. (Dave St-Amant/CBC)
Dr. Melanie Henderson, a pediatric endocrinologist and researcher at Sainte-Justine Hospital in Montreal, said obesity is a chronic disease affected by environment, socio-economic factors, genetics, lifestyle and more.
Henderson, who is also working on the Canadian guidelines, said children with obesity are at risk of high blood pressure, cholesterol problems, and diabetes. They also have higher rates of anxiety and depression. Left untreated, children can carry those health problems into adulthood.
“The first line really remains healthy lifestyle choices and working with the families to try and overcome some of the barriers,” she said.
Still, Henderson said that treatment doesn’t work for all children, and not everyone has access to programs focused on that approach.
“There is a subset of children despite making all their efforts living with very severe obesity and very severe complications,” she said.
For them, Henderson said, medication and bariatric surgery need to be openly discussed as treatment options.
Stigma can also play a role in how children with obesity are treated within the health-care system and beyond, said Dr. Yoni Freedhoff, medical director of the Bariatric Medical Institute in Ottawa.
Focusing solely on lifestyle changes, he said, “adds to the stereotype that it’s just a matter of control.”
“There’s genes and hormones that we can’t control and these medications can help level the playing field,” he said.
Focus on prevention
Dr. David Ma, professor of health and nutritional sciences at the University of Guelph, worries that following the U.S.’s lead and including recommendations for drugs and surgery in Canada’s guidelines could undermine efforts aimed at prevention.
“Certainly there is some evidence to demonstrate efficacy in individuals, in children, who are the most extreme cases in terms of being overweight,” he said.
“The concern is that these are simply Band-Aid solutions and that we really need to get to the root cause of why these children are overweight and obese.”
In the U.S. a further set of guidelines is expected that will look specifically at prevention.
Ball said Canada’s guidelines, expected later this year, will focus on treatment, for now. He said prevention guidelines could follow but will take the work of many stakeholders – in schools, communities and health-care settings.
VANCOUVER – Contract negotiations resume today in Vancouver in a labour dispute that has paralyzed container cargo shipping at British Columbia’s ports since Monday.
The BC Maritime Employers Association and International Longshore and Warehouse Union Local 514 are scheduled to meet for the next three days in mediated talks to try to break a deadlock in negotiations.
The union, which represents more than 700 longshore supervisors at ports, including Vancouver, Prince Rupert and Nanaimo, has been without a contract since March last year.
The latest talks come after employers locked out workers in response to what it said was “strike activity” by union members.
The start of the lockout was then followed by several days of no engagement between the two parties, prompting federal Labour Minister Steven MacKinnon to speak with leaders on both sides, asking them to restart talks.
MacKinnon had said that the talks were “progressing at an insufficient pace, indicating a concerning absence of urgency from the parties involved” — a sentiment echoed by several business groups across Canada.
In a joint letter, more than 100 organizations, including the Canadian Chamber of Commerce, Business Council of Canada and associations representing industries from automotive and fertilizer to retail and mining, urged the government to do whatever it takes to end the work stoppage.
“While we acknowledge efforts to continue with mediation, parties have not been able to come to a negotiated agreement,” the letter says. “So, the federal government must take decisive action, using every tool at its disposal to resolve this dispute and limit the damage caused by this disruption.
“We simply cannot afford to once again put Canadian businesses at risk, which in turn puts Canadian livelihoods at risk.”
In the meantime, the union says it has filed a complaint to the Canada Industrial Relations Board against the employers, alleging the association threatened to pull existing conditions out of the last contract in direct contact with its members.
“The BCMEA is trying to undermine the union by attempting to turn members against its democratically elected leadership and bargaining committee — despite the fact that the BCMEA knows full well we received a 96 per cent mandate to take job action if needed,” union president Frank Morena said in a statement.
The employers have responded by calling the complaint “another meritless claim,” adding the final offer to the union that includes a 19.2 per cent wage increase over a four-year term remains on the table.
“The final offer has been on the table for over a week and represents a fair and balanced proposal for employees, and if accepted would end this dispute,” the employers’ statement says. “The offer does not require any concessions from the union.”
The union says the offer does not address the key issue of staffing requirement at the terminals as the port introduces more automation to cargo loading and unloading, which could potentially require fewer workers to operate than older systems.
The Port of Vancouver is the largest in Canada and has seen a number of labour disruptions, including two instances involving the rail and grain storage sectors earlier this year.
A 13-day strike by another group of workers at the port last year resulted in the disruption of a significant amount of shipping and trade.
This report by The Canadian Press was first published Nov. 9, 2024.
The Royal Canadian Legion says a new partnership with e-commerce giant Amazon is helping boost its veterans’ fund, and will hopefully expand its donor base in the digital world.
Since the Oct. 25 launch of its Amazon.ca storefront, the legion says it has received nearly 10,000 orders for poppies.
Online shoppers can order lapel poppies on Amazon in exchange for donations or buy items such as “We Remember” lawn signs, Remembrance Day pins and other accessories, with all proceeds going to the legion’s Poppy Trust Fund for Canadian veterans and their families.
Nujma Bond, the legion’s national spokesperson, said the organization sees this move as keeping up with modern purchasing habits.
“As the world around us evolves we have been looking at different ways to distribute poppies and to make it easier for people to access them,” she said in an interview.
“This is definitely a way to reach a wider number of Canadians of all ages. And certainly younger Canadians are much more active on the web, on social media in general, so we’re also engaging in that way.”
Al Plume, a member of a legion branch in Trenton, Ont., said the online store can also help with outreach to veterans who are far from home.
“For veterans that are overseas and are away, (or) can’t get to a store they can order them online, it’s Amazon.” Plume said.
Plume spent 35 years in the military with the Royal Engineers, and retired eight years ago. He said making sure veterans are looked after is his passion.
“I’ve seen the struggles that our veterans have had with Veterans Affairs … and that’s why I got involved, with making sure that the people get to them and help the veterans with their paperwork.”
But the message about the Amazon storefront didn’t appear to reach all of the legion’s locations, with volunteers at Branch 179 on Vancouver’s Commercial Drive saying they hadn’t heard about the online push.
Holly Paddon, the branch’s poppy campaign co-ordinator and bartender, said the Amazon partnership never came up in meetings with other legion volunteers and officials.
“I work at the legion, I work with the Vancouver poppy office and I go to the meetings for the Vancouver poppy campaign — which includes all the legions in Vancouver — and not once has this been mentioned,” she said.
Paddon said the initiative is a great idea, but she would like to have known more about it.
The legion also sells a larger collection of items at poppystore.ca.
This report by The Canadian Press was first published Nov. 9, 2024.
