# Pediatric Obesity Intervention Selector > Select the right treatment tier for a child with obesity — behavioural, pharmacologic, or surgical — using the CMAJ 2025 pediatric obesity guideline. Trigger when a clinician asks what to do for a child with obesity, which intervention to start, whether to escalate treatment, or when to consider medication or surgery for pediatric obesity. - Skill: `dromlakhani/pediatric-obesity-intervention-selector` (Agent Skill) - Install (CLI): `npx skillmds@latest add dromlakhani/pediatric-obesity-intervention-selector` - Raw SKILL.md: https://api.skillmd.com/api/skills/dromlakhani/pediatric-obesity-intervention-selector/raw - Safety review: pending (external: skill-scanner PASS, skillspector PASS) - Works with: Claude Code, Claude.ai, OpenAI Codex - Category: Coding & Dev Tools - Author: dromlakhani (https://skillmd.com/u/dromlakhani) - Updated: 2026-09-08 - Page: https://skillmd.com/skills/dromlakhani/pediatric-obesity-intervention-selector --- # Pediatric Obesity: Intervention Selector Step-by-step guide to selecting the appropriate intervention tier for a child (0–18 years) with obesity. Based on CMAJ 2025 Clinical Practice Guideline (Ball et al., doi: 10.1503/cmaj.241456). --- ## Step 1 — Gather Key Information Before recommending anything, confirm: - **Age** (years) - **BMI z-score (BMIz)** using WHO growth charts for Canada - **What has already been tried** (duration, adherence, response) - **Comorbidities** (metabolic, mechanical, mental health — see 4Ms below) - **Family preferences and values** — what outcomes matter most to them? - **Social determinants** (food security, neighbourhood, family dynamics) > ⚠️ Use person-first, neutral language throughout. Say "child with obesity" not "obese child." Refer to BMI, weight, or growth — not "fat" or "overweight." --- ## Step 2 — First-Line: Behavioural & Psychological Interventions **All children with obesity, regardless of age.** **Strong recommendation, very low to moderate certainty.** Recommend a **multicomponent intervention** — must include at least 2 of: - Physical activity - Nutrition counselling - Psychological support (e.g., CBT, motivational interviewing) - Technology-assisted components (optional; weak evidence) Individual components alone (nutrition-only, exercise-only) are **conditional** recommendations with weaker evidence — prefer multicomponent. **Practical targets:** - Higher-intensity sessions (aerobic + resistance training) superior to low-intensity - Goal-setting, self-monitoring, problem-solving, and relapse prevention are effective behaviour change tools - At least 26 hours of contact time improves outcomes - Long-term support is essential — obesity is chronic and relapsing **Technology interventions alone:** Neither for nor against (insufficient evidence). --- ## Step 3 — Escalate to Pharmacotherapy? **Consider if:** inadequate response to behavioural/psychological interventions **AND** age ≥ 12 years. > ⚠️ No stepwise requirement — pharmacotherapy can be offered alongside, not only after, behavioural therapy. It must **always be combined** with behavioural/psychological interventions. → **Go to the Pharmacotherapy Selector skill** for agent selection. If age < 12: insufficient evidence for any pharmacotherapy — do not prescribe. --- ## Step 4 — Escalate to Surgery? **Consider if:** age ≥ 13 years AND deemed eligible after **comprehensive multidisciplinary assessment.** > ⚠️ Surgery does not require prior failure of pharmacotherapy. Consider based on severity, comorbidities, family preference, and centre availability. Surgical options: Laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB). Both: conditional recommendation, low to moderate certainty. **Requirements before referral:** - Specialized, multidisciplinary team assessment - Psychological/psychiatric clearance - Nutritional assessment - Family/caregiver involvement and support - Shared decision-making about serious AE risk → **Go to the Surgical Eligibility Screener skill** for full checklist. --- ## Step 5 — Shared Decision-Making at Every Tier At every tier, the conversation matters as much as the prescription: - Present **all options** (behavioural, pharmacologic, surgical) — no option should be withheld from discussion - Acknowledge the **balance of benefits and harms** for each option - Align on **what success looks like** — HRQoL, mood, mobility, not just BMI - Involve **both child and caregiver** in the decision (separately if helpful) - Address **social determinants** that may affect access or adherence - Refer to multidisciplinary team **where available** --- ## Clinical Guardrails - **Eating disorder vigilance:** Ask about binge eating, body image concerns, atypical anorexia — especially before pharmacotherapy or surgery. Refer to specialist if suspected. - **Don't focus solely on weight.** Improved HRQoL, depression, anxiety, and cardiometabolic markers are equally valid outcomes. - **Obesity is not a personal failing.** Genetics, physiology, and environment drive it. Frame this clearly for families. - **Lipase inhibitors (orlistat):** Suggested but not preferred — higher GI side effects and serious AE risk. Use only if GLP-1RA and metformin unavailable. - **Technology-only interventions:** Insufficient evidence — do not use as a standalone strategy. --- ## Source CMAJ 2025 Clinical Practice Guideline: *Managing obesity in children.* Ball GDC et al. CMAJ 2025 April 14; 197:E372–89. doi: [10.1503/cmaj.241456](https://doi.org/10.1503/cmaj.241456) Updated version: June 3, 2025.