The Canadian Paediatric Society has updated its advice for physicians who care for children, recommending a ‘health at every size’ approach.John Moore/Getty Images
Doctors should discourage teenagers from dieting because it can be dangerous to their physical and mental health, according to new advice from a panel of Canadian pediatricians.
In its first statement on adolescent dieting in more than 20 years, the Canadian Paediatric Society advised physicians who care for children to instead promote a “health at every size” approach that focuses on how adolescents exercise, eat, sleep and socialize, rather than how much they weigh.
Teens who restrict calories or cut out food groups in a quest to change their appearance can experience unintended negative consequences, said Megan Harrison, chair of the CPS’s adolescent health committee.
For instance, they might find themselves low in iron or calcium or without adequate bone density. Girls may have irregular periods or lose them altogether.
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Dieting in adolescence also raises the risk of anorexia, binge-eating disorders and other afflictions. “We know that dieting is a precursor for many to go on and develop eating disorders,” said Dr. Harrison, an adolescent-health physician at CHEO, a children’s hospital in Ottawa. “So that’s a big worry that we have.”
The new CPS statement, titled “The Dangers of Dieting in Adolescence” and published Thursday, doesn’t diverge in major ways from the group’s last statement on the subject in 2004, Dr. Harrison added.
But the new guidance puts a stronger emphasis on the concept of health at any size, and doubles down on encouraging doctors to check their own biases against people who are overweight or obese.
One thing that has changed is the prevalence of dieting among teens in a social-media-saturated era, even if dieting isn’t the word they would use to describe how they eat.
“Dieting has always been common in adolescence, so that’s not necessarily different, but I think it’s even more common now,” Dr. Harrison said. “By the time you get to high school, about 50 per cent of youth have tried to change their bodies through dieting. And that’s increased over time.”
The new statement is aimed at doctors who treat adolescents of all sizes. When it comes to teens who are overweight or obese, the panel says that “referral to an interdisciplinary pediatric obesity program may benefit some adolescents.”
However, the CPS doesn’t recommend primary-care doctors treat them any differently from their thinner peers.
That’s in part because dieting “can also have a paradoxical effect and lead to the consequence of weight gain,” said Debra Katzman, an adolescent-medicine specialist at the Hospital for Sick Children in Toronto.
Dr. Katzman, who was not involved in writing the new CPS statement, is among the health care providers who saw firsthand the spike in eating disorders after the arrival of COVID-19, particularly among adolescent girls.
She said it appears the rate of such disorders has begun to subside but hasn’t fallen to pre-COVID levels.
Last spring, Obesity Canada released a clinical-practice guideline on the treatment of children and adolescents with obesity. It said doctors should provide nutritional and exercise advice to young patients with obesity, but should also consider offering them bariatric surgery or GLP-1 drugs, the class of medications that includes Ozempic.
Geoff Ball, the lead author of the Obesity Canada guideline, said the new CPS statement condemning dieting for teens of all sizes doesn’t conflict with his group’s advice.
“I’ve been in this field for about 25 years, and I remember when we first started this work, there was a lot of focus on weight,” Dr. Ball said.
Now, he said, many physicians have come around to emphasizing health at every size because “they’ve seen firsthand how harmful some of these attitudes and behaviours are for kids. So it’s good that it’s reflected in this document.”
Have you tried Ozempic or Wegovy for weight loss?
For a future story, The Globe and Mail’s national health reporter Kelly Grant is looking to speak with people who have tried Ozempic or Wegovy for weight loss.
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