Background While obesity is treated to mitigate the associated risks and complications, its definition and diagnosis are primarily based on weight and height (BMI). Management is primarily focused on weight loss or maintenance (also called a weight-centric approach), which has important limitations: current options for weight loss or weight control are mostly ineffective in the long term and may lead to increased weight stigmatisation. Weight-inclusive approaches prioritise patient-reported outcomes (PROs) and de-emphasise the role of weight loss or weight maintenance. This avoids weight stigmatisation for which children and adolescents are particularly vulnerable.
Objective To assess the representation of weight-centric and weight-inclusive perspectives in systematic reviews and guidelines for managing obesity in children and adolescents.
Method We searched for guidelines and systematic reviews on managing obesity in children and adolescents published in the last five years. We conducted a thematic analysis of their contents based on the existing literature with the support of a Citizen’s Council, including people with lived experience who act as advisors from the public in this project. Following a qualitative methodology, two independent researchers extracted quotes and coded the guidelines and reviews based on their description and conceptualisation of obesity, its causes, treatment goals and main outcomes, as well as social and psychological consequences of both obesity and treatment. These codes were grouped into themes linked to weight-centric and weight-inclusive perspectives.
Results Our preliminary analysis of a first sample of Cochrane reviews and European guidelines identified concepts that can be mapped predominantly to weight-centric perspectives: definition and diagnosis of obesity based on anthropometric measures rather than risks or presence of associated morbidity, a primary focus on achieving weight loss or maintaining weight, lack of consideration of the role of weight stigma and stigmatisation. We will continue to analyse all Cochrane and non-Cochrane reviews, as well as guidelines from different regions and organisations identified by our literature search.
Conclusions These preliminary results indicate that the full analysis of guidelines and reviews could provide useful guidance for conducting and reporting future systematic reviews and clinical practice guidelines that better fit the needs of the target population. Rethinking the management of obesity could have an important impact on the implications of this diagnosis.
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