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Bomberg EM, Clark J, Rudser KD, Gross AC, Kelly AS, Fox CK. Clinical effectiveness and predictors of response to topiramate plus lifestyle modification in youth with obesity seen in a weight management clinical setting. Front Endocrinol (Lausanne) 2024; 15:1369270. [PMID: 38800488 PMCID: PMC11116594 DOI: 10.3389/fendo.2024.1369270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Obesity affects approximately 20% of U.S. youth. Anti-obesity medications (AOMs) are promising lifestyle modification adjuncts for obesity treatment, and topiramate is commonly prescribed in pediatric weight management clinics. It is important to determine "real-world" effectiveness of AOMs and, given shifts towards personalized approaches, characteristics potentially predicting better or worse response. We therefore sought to describe clinical effectiveness from topiramate plus lifestyle modification, and to determine if baseline phenotypic characteristics are associated with better or worse response. Methods We performed a retrospective cohort study (2012-2020) among youth (<18 years old) followed in a U.S. academic-based weight management clinic. Baseline characteristics (i.e., body mass index (BMI), liver function tests, eating-related behaviors) and outcomes (%BMI of 95th percentile (%BMIp95), BMI, percent %BMI change, weight) were determined through review of electronic health records and clinic intake survey data. Results Among 282 youth prescribed topiramate plus lifestyle modifications (mean baseline age 12.7 years, %BMIp95 144%), %BMIp95 and percent BMI change were statistically significantly reduced at each time point (1.5-, 3-, 6-, and 12-month %BMIp95 reductions: -2.2, -3.9, -6.6, and -9.3 percentage points, respectively; percent BMI reduction: -1.2%, -1.9%, -3.2%, and -3.4%, respectively; all p<0.01). Considering multiple comparisons, no baseline characteristics statistically significantly predicted response at any time point. Conclusions We found that topiramate plus lifestyle modification reduced %BMIp95 and BMI among youth in a weight management clinical setting, and that no baseline characteristics evaluated were associated with response. These results should be considered preliminary given the observational nature of this study, and prospective studies are needed to further characterize clinical effectiveness and identify and confirm potential predictors of response.
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Affiliation(s)
- Eric M. Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Justin Clark
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kyle D. Rudser
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Amy C. Gross
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Claudia K. Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
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Bensignor MO, Kelly AS, Kunin-Batson A, Fox CK, Freese R, Clark J, Rudser KD, Bomberg EM, Ryder J, Gross AC. Evaluating appetite/satiety hormones and eating behaviours as predictors of weight loss maintenance with GLP-1RA therapy in adolescents with severe obesity. Pediatr Obes 2024; 19:e13105. [PMID: 38339799 PMCID: PMC11006569 DOI: 10.1111/ijpo.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Whilst glucagon-like peptide-1 receptor agonists (GLP1-RAs) are effective for treating adolescent obesity, weight loss maintenance (WLM; preventing weight regain) remains a challenge. Our goal was to investigate appetite/satiety hormones and eating behaviours that may predict WLM with exenatide (a GLP1-RA) versus placebo in adolescents with severe obesity. METHODS Adolescents who had ≥5% body mass index (BMI) reduction with meal replacement therapy were randomized to 52 weeks of once-weekly exenatide extended release or placebo. In this secondary analysis, eating behaviours and appetite/satiety regulation hormones post-meal replacement therapy (pre-randomization to exenatide or placebo) were evaluated as possible predictors of WLM. Percent change in BMI from randomization to 52 weeks served as the primary measure of WLM. RESULTS The analysis included 66 adolescents (mean age 16.0 years; 47% female). Lower leptin response to meal testing was associated with greater WLM in terms of BMI percent change in those receiving exenatide compared to placebo (p = 0.007) after adjusting for sex, age and BMI. There were no other significant predictors of WLM. CONCLUSIONS Prior to exenatide, lower leptin response to meals was associated with improved WLM with exenatide compared to placebo. The mostly null findings of this study suggest that GLP1-RA treatment may produce similar WLM for adolescents with obesity regardless of age, BMI, sex and eating behaviours.
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Affiliation(s)
- Megan O Bensignor
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Aaron S Kelly
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Alicia Kunin-Batson
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Claudia K Fox
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Rebecca Freese
- Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Justin Clark
- Division of Biostatistics and Health Data Science, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Kyle D Rudser
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Biostatistics and Health Data Science, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Eric M Bomberg
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Justin Ryder
- Department of Pediatrics and Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics and Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy C Gross
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Christison A, Tucker J, King E, Sweeney B, Cuda S, Frank M, Kirk S. Treating Children and Adolescents With Obesity: Characteristics of Success. Child Obes 2023. [PMID: 37971786 DOI: 10.1089/chi.2023.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Background: Factors related to clinically meaningful outcomes for pediatric patients seeking care for severe obesity are not well known. Examining patient-level and program-level characteristics related to success may inform future care. Objectives: To determine factors associated with a clinically significant reduction in weight status measured by %BMIp95 after 6 months of treatment. Study Design: This is a retrospective study of youth 5-17 years of age seeking multicomponent weight management care to determine if patient characteristics, treatment recommendations, reported adherence, and additional program-affiliated class participation are associated with 6-month change in %BMIp95. Results: Among 170 children with obesity, higher reductions in %BMIp95 were seen in those with medium-high dietary adherence compared to low-none (-10.8 vs. -4.0, p = 0.002). Post hoc analysis showed higher dietary adherence among those with private insurance than public insurance (59% vs. 41%, respectively, p = 0.04). Conclusion: Children receiving multidisciplinary multicomponent weight management, who achieve clinically meaningful outcomes, are more likely to be adherent to dietary recommendations regardless of the type. Further study is needed of how best to address social determinants of health to improve dietary adherence. Clinical Trial Registration Number: NCT02121132.
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Affiliation(s)
- Amy Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Jared Tucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI, USA
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brooke Sweeney
- Department of General Academic Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, USA
- Children's Center for Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Suzanne Cuda
- Alamo City Healthy Kids & Families, San Antonio, TX, USA
| | - Michelle Frank
- The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Bensignor MO, Bramante CT, Bomberg EM, Fox CK, Hale PM, Kelly AS, Mamadi R, Prabhu N, Harder-Lauridsen NM, Gross AC. Evaluating potential predictors of weight loss response to liraglutide in adolescents with obesity: A post hoc analysis of the randomized, placebo-controlled SCALE Teens trial. Pediatr Obes 2023; 18:e13061. [PMID: 37264767 PMCID: PMC10926323 DOI: 10.1111/ijpo.13061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND As childhood obesity prevalence increases, determining which patients respond to anti-obesity medications would strengthen personalized approaches to obesity treatment. In the SCALE Teens trial among pubertal adolescents with obesity (NCT02918279), liraglutide 3.0 mg (or maximum tolerated dose) significantly reduced body mass index (BMI) standard deviation score on average versus placebo. That said, liraglutide effects on BMI reduction varied greatly among adolescents, similar to adults. OBJECTIVES To identify post hoc characteristics predictive of achieving ≥5% and ≥10% BMI reductions at 56 weeks with liraglutide versus placebo in adolescents from the SCALE Teens trial. METHODS Logistic regression analysis was performed in 251 adolescents treated with liraglutide (n = 125) or placebo (n = 126) for 56 weeks. Baseline characteristics (selected a priori) included sex, race, ethnicity, age, Tanner (pubertal) stage, glycemic status (hyperglycemia [type 2 diabetes/prediabetes] vs. normoglycemia), obesity category (Class II/III vs. I), severity of depression symptoms (Patient Health Questionnaire-9), and weight variability (weight fluctuations over time). The effects of early responder status (≥4% BMI reduction at week 16) on week 56 response were assessed using descriptive statistics. RESULTS Baseline characteristics did not affect achievement of ≥5% and ≥10% BMI reductions at week 56 in adolescents treated with liraglutide. Further, there was no association between weight variability and BMI reduction. Early liraglutide responders appeared to have greater BMI and body weight reductions at week 56 compared with early non-responders. CONCLUSIONS This secondary analysis suggests that adolescents with obesity may experience significant BMI reductions after 56 weeks of liraglutide treatment, regardless of their sex, race, ethnicity, age, pubertal stage, glycemic status, obesity category, severity of depression symptoms, or weight variability. Early response may predict greater week 56 response.
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Affiliation(s)
- Megan O. Bensignor
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Carolyn T. Bramante
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eric M. Bomberg
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Claudia K. Fox
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paula M. Hale
- Clinical Development, Medical & Regulatory Affairs, Novo Nordisk Inc., Plainsboro, New Jersey, USA
| | - Aaron S. Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rashmi Mamadi
- Global Medical Affairs, Novo Nordisk, Bangalore, India
| | | | | | - Amy C. Gross
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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O'Hara V, Cuda S, Kharofa R, Censani M, Conroy R, Browne NT. Clinical review: Guide to pharmacological management in pediatric obesity medicine. OBESITY PILLARS (ONLINE) 2023; 6:100066. [PMID: 37990657 PMCID: PMC10661861 DOI: 10.1016/j.obpill.2023.100066] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 11/23/2023]
Abstract
Introduction Newer pharmacotherapy agents (anti-obesity medication [AOM]) are revolutionizing the management of children and adolescents with obesity. Previously, treatment based on intensive behavioral therapy involved many patient and family contact hours and yielded improvements in obesity status of 1-3 percent of the 95th percentile of the body mass index (BMI). Newer AOMs are yielding more clinically significant improvement of 5-18 percent. This review provides guidance for practitioners in the care of children and adolescents with obesity who frequently have complex medical and behavioral health care needs. Specifically, we discuss the use of newer AOMs in these complex patients. Methods This review details an approach to the care of the child and adolescent with obesity using AOMs. A shared decision-making process is presented in which the provider and the patient and family collaborate on care. Management of medical and behavioral components of the disease of obesity in the child are discussed. Results Early aggressive treatment is recommended, starting with an assessment of associated medical and behavioral complications, weight promoting medications, use of AOMs and ongoing care. Intensive behavioral therapy is foundational to treatment, but not a specific treatment. Patients and families deserve education on expected outcomes with each therapeutic option. Conclusions The use of new AOMs in children and adolescents has changed expected clinical outcomes in the field of pediatric obesity management. Clinically significant improvement in obesity status occurs when AOMs are used early and aggressively. Ongoing, chronic care is the model for optimizing outcomes using a shared decision-making between provider and patient/family. Depending on the experience and comfort level of the primary care practitioner, referral to an obesity medicine specialist may be appropriate, particularly when obesity related co-morbidities are present and pharmacotherapy and metabolic and bariatric surgery are considerations.
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Affiliation(s)
- Valerie O'Hara
- Weight & Wellness Clinic, Maine Medical Center, S. Portland, ME, 04106, USA
| | - Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Roohi Kharofa
- Department of Pediatrics, University of Cincinnati College of Medicine, Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Marisa Censani
- Clinical Pediatrics, Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
| | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital Subspecialty Center, 50 Wason Avenue, Springfield, MA, 01107, USA
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Di Sessa A, Cembalo Sambiase Sanseverino N, De Simone RF, Marrapodi MM, Cirillo G, Umano GR, Guarino S, Papparella A, Miraglia Del Giudice E, Marzuillo P. Association between non-alcoholic fatty liver disease and subclinical hypothyroidism in children with obesity. J Endocrinol Invest 2023:10.1007/s40618-023-02041-3. [PMID: 36828986 DOI: 10.1007/s40618-023-02041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE We aimed (i) evaluating the relationship between non-alcoholic fatty liver disease (NAFLD) and thyroid function tests, (ii) testing if the relationship between NAFLD and thyroid dysfunction could be driven by the obesity and the IR degree, and (iii) exploring the influence of the patatin-like phospholipase domain-containing protein-3 (PNPLA3) I148M and the transmembrane 6 superfamily member 2 (TM6SF2) E167K polymorphisms on the association between NAFLD and thyroid function in children. METHODS We examined 2275 children and adolescents with obesity. Subclinical hypothyroidism (SH) was defined by thyroid-stimulating hormone (TSH) > 4.2 μUI/ml with normal fT3 and fT4. RESULTS Children with NAFLD showed higher SH prevalence than those without NAFLD (15.7% Vs 7.4%;p = 0.001) and showed an adjusted odds ratio (aOR) to have SH of 1.68 (95% CI:1.01-2.80;p = 0.04) while patients with SH had an aOR to show NAFLD of 2.13(95% CI:1.22-3.73;p = 0.008). Patients having severe obesity and IR degree presented an aOR to show both NAFLD and SH of 3.61 (95% CI:1.78-7.33;p < 0.0001). Subjects with NAFLD carrying the TM6SF2 167 K allele had lower TSH levels than non-carriers (p = 0.03) and showed an aOR to have SH of 0.10 (95% CI: 0.01-0.79;p = 0.02). No differences were found in carriers of the PNPLA3 148 M allele. A general linear model for TSH variance showed a significant association of TSH with TM6SF2 genotypes only in the NAFLD group (p = 0.001). CONCLUSION Children with obesity and NAFLD presented increase risk of SH and vice versa likely due to the adverse effect of duration of obesity, obesity degree, and IR. The TM6SF2 E167K exerts a protective role against SH in children with obesity and NAFLD.
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Affiliation(s)
- A Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio no 2, 80138, Naples, Italy.
| | - N Cembalo Sambiase Sanseverino
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio no 2, 80138, Naples, Italy
| | - R F De Simone
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio no 2, 80138, Naples, Italy
| | - M M Marrapodi
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio no 2, 80138, Naples, Italy
| | - G Cirillo
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio no 2, 80138, Naples, Italy
| | - G R Umano
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio no 2, 80138, Naples, Italy
| | - S Guarino
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio no 2, 80138, Naples, Italy
| | - A Papparella
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio no 2, 80138, Naples, Italy
| | - E Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio no 2, 80138, Naples, Italy
| | - P Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio no 2, 80138, Naples, Italy
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Cuda S, Censani M, Kharofa R, O'Hara V, Conroy R, Williams DR, Paisley J, Browne AF, Karjoo S, Browne NT. Medication-induced weight gain and advanced therapies for the child with overweight and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS (ONLINE) 2022; 4:100048. [PMID: 37990664 PMCID: PMC10662101 DOI: 10.1016/j.obpill.2022.100048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details medication-induced weight gain and advanced therapies for the child with overweight or obesity. Methods The scientific information and clinical guidance in this CPS are based on scientific evidence, supported by the medical literature, and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement addresses medication-induced weight gain and advanced therapies for the child with overweight or obesity. Conclusions This OMA Clinical Practice Statement on medication induced-weight gain and advanced therapies for the child with overweight or obesity is an overview of current recommendations. These recommendations provide a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications. This CPS also addresses treatment recommendations. This section is designed to help the provider with clinical decision making.
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Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
| | - Roohi Kharofa
- Department of Pediatrics, University of Cincinnati College of Medicine Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | | | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital Subspecialty Center, 50 Wason AvenueSpringfield, MA, 01107, USA
| | - Dominique R Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care, 98 Elm Street Lawrenceburg, IN, 47025-2048, USA
| | | | - Sara Karjoo
- Johns Hopkins All Children's Hospital Pediatric Gastroenterology 501 6th Ave S St. Petersburg, FL, 33701, USA
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Dreyer Gillette ML, Killian HJ, Fernandez C, Sweeney BR. Treating Obesity in Children and Adolescents with Special Healthcare Needs. Curr Obes Rep 2022; 11:227-235. [PMID: 36319822 DOI: 10.1007/s13679-022-00484-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE OF REVIEW This paper aims to summarize the literature regarding treatment of obesity in children with special healthcare needs and provide examples of implementation based on the available scientific evidence and the clinical experience of the authors. RECENT FINDINGS Due to the complexity of providing treatment for children with obesity and special healthcare needs, multidisciplinary teams are recommended to adapt care to meet the children's unique needs and ensure coordination of care across settings/caregivers. Medication management is often required to assist with the side effects of psychotropic medications. Children with special healthcare needs (SHCN) such as intellectual and developmental disabilities (IDD) should be considered for metabolic and bariatric surgery as they have similar outcomes to children without SHCN. Children with special healthcare needs can be successful in weight management treatment when they have access to comprehensive care including dietary, behavioral, pharmacological, and surgical interventions. Each child requires a tailored approach to ensure their special healthcare needs are addressed within the treatment plan.
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Affiliation(s)
- Meredith L Dreyer Gillette
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, USA.
- Divisions of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, USA.
- University of Missouri-Kansas City School of Medicine, Kansas City, USA.
- Division of Weight Management, Children's Mercy Kansas City, MO, Kansas, USA.
| | - Haley J Killian
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, USA
- Divisions of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, USA
| | - Cristina Fernandez
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, USA
- Division of Weight Management, Children's Mercy Kansas City, MO, Kansas, USA
| | - Brooke R Sweeney
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, USA
- Division of Weight Management, Children's Mercy Kansas City, MO, Kansas, USA
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9
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Williams L, Baker-Smith CM, Bolick J, Carter J, Kirkpatrick C, Ley SL, Peterson AL, Shah AS, Sikand G, Ware AL, Wilson DP. Nutrition interventions for youth with dyslipidemia an national lipid association clinical perspective. J Clin Lipidol 2022; 16:776-796. [DOI: 10.1016/j.jacl.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022]
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Roberts KJ, Hafez SA, Snethen J, Binns HJ, Knafl KA. Perceptions of Weight Management: Interviews with Adolescents with Severe Obesity and Their Mothers. Child Obes 2022; 18:219-227. [PMID: 34762511 DOI: 10.1089/chi.2021.0181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Adolescence is a challenging time for families, which is intensified when managing a chronic health condition. In adolescents with severe obesity, little is known about how adolescent/mother dyads approach management. Our study aims to (1) explore similarities/differences in adolescent/mother dyads' perceptions of weight management behaviors and (2) describe their experiences with successes and challenges related to weight management. Methods: This was a qualitative descriptive analysis of interviews from 21 adolescent/mother dyads. Conventional content analysis was used to identify themes characterizing dyads' weight management efforts. Results: Two patterns of perceptions were identified across the dyads specific to weight management behaviors: collaborative (dyads agreed) and conflicting (dyads disagreed). Weight management themes with collaborative perceptions were food preferences; food and emotion; the adolescent is active; exercise is not enjoyable; the family is active together; and stopping medications. Weight management themes with conflicting perceptions were responsibility for initiating and maintaining exercise, motivation and willingness to exercise, and responsibility for medications. Dyads had collaborative pattern responses on perceptions of success and challenges. Themes related to successes were weight loss and supportive relationships. Themes related to challenges were inconsistent daily routines and schedules, and unsupportive relationships. Conclusions: Dyads responded with collaborative or conflicting perceptions to weight management behaviors and with collaborative responses to success and challenges. Sustaining healthy habits was difficult from the perspectives of dyads. For youth with severe obesity, providing care that recognizes and addressees issues youth and their families experience may require improved and innovative interventions.
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Affiliation(s)
- Karyn J Roberts
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.,Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shahad Amr Hafez
- Batterjee Medical College for Sciences and Technology, Jeddah, Saudi Arabia
| | - Julia Snethen
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Helen J Binns
- Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kathleen A Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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11
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Roberts KJ, Ariza AJ, Selvaraj K, Quadri M, Mangarelli C, Neault S, Davis EE, Binns HJ. Testing for rare genetic causes of obesity: findings and experiences from a pediatric weight management program. Int J Obes (Lond) 2022; 46:1493-1501. [PMID: 35562395 PMCID: PMC9105591 DOI: 10.1038/s41366-022-01139-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Genetic screening for youth with obesity in the absence of syndromic findings has not been part of obesity management. For children with early onset obesity, genetic screening is recommended for those having clinical features of genetic obesity syndromes (including hyperphagia). OBJECTIVES The overarching goal of this work is to report the findings and experiences from one pediatric weight management program that implemented targeted sequencing analysis for genes known to cause rare genetic disorders of obesity. SUBJECTS/METHODS This exploratory study evaluated youth tested over an 18-month period using a panel of 40-genes in the melanocortin 4 receptor pathway. Medical records were reviewed for demographic and visit information, including body mass index (BMI) percent of 95th percentile (%BMIp95) and two eating behaviors. RESULTS Of 117 subjects: 51.3% were male; 53.8% Hispanic; mean age 10.2 years (SD 3.8); mean %BMIp95 157% (SD 29%). Most subjects were self- or caregiver-reported to have overeating to excess or binge eating (80.3%) and sneaking food or eating in secret (59.0%). Among analyzed genes, 72 subjects (61.5%) had at least one variant reported; 50 (42.7%) had a single variant reported; 22 (18.8%) had 2-4 variants reported; most variants were rare (<0.05% minor allele frequency [MAF]), and of uncertain significance; all variants were heterozygous. Nine subjects (7.7%) had a variant reported as PSCK1 "risk" or MC4R "likely pathogenic"; 39 (33.3%) had a Bardet-Biedl Syndrome (BBS) gene variant (4 with "pathogenic" or "likely pathogenic" variants). Therefore, 9 youth (7.7%) had gene variants previously identified as increasing risk for obesity and 4 youth (3.4%) had BBS carrier status. CONCLUSIONS Panel testing identified rare variants of uncertain significance in most youth tested, and infrequently identified variants previously reported to increase the risk for obesity. Further research in larger cohorts is needed to understand how genetic variants influence the expression of non-syndromic obesity.
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Affiliation(s)
- Karyn J Roberts
- College of Nursing, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI, 53201-0413, USA. .,Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Adolfo J Ariza
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kavitha Selvaraj
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Maheen Quadri
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Caren Mangarelli
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sarah Neault
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Erica E Davis
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Helen J Binns
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.,Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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12
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Impact of Telehealth Implementation on an Adolescent Metabolic and Bariatric Surgery Program. Surg Obes Relat Dis 2022; 18:1161-1166. [DOI: 10.1016/j.soard.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/25/2022] [Accepted: 05/08/2022] [Indexed: 01/19/2023]
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13
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Bomberg EM, Palzer EF, Rudser KD, Kelly AS, Bramante CT, Seligman HK, Noni F, Fox CK. Anti-obesity medication prescriptions by race/ethnicity and use of an interpreter in a pediatric weight management clinic. Ther Adv Endocrinol Metab 2022; 13:20420188221090009. [PMID: 35432917 PMCID: PMC9005816 DOI: 10.1177/20420188221090009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background Race/ethnicity and low English proficiency healthcare disparities are well established in the United States. We sought to determine if there are race/ethnicity differences in anti-obesity medication (AOM) prescription rates among youth with severe obesity treated in a pediatric weight management clinic and if, among youth from non-primary English speaking families, there are differences in prescriptions between those using interpreters during visits versus not. Methods We reviewed electronic health records of 2- to 18-year-olds with severe obesity seen from 2012 to 2021. Race/ethnicity was self-report, and AOMs included topiramate, stimulants (e.g. phentermine, lisdexamfetamine), naltrexone (±bupropion), glucagon-like peptide-1 agonists, and orlistat. We used general linear regression models with log-link to compare incidence rate ratios (IRRs) within the first 1 and 3 years of being followed, controlling for age, percent of the 95th BMI percentile (%BMIp95), number of obesity-related comorbidities (e.g. insulin resistance, hypertension), median household income, and interpreter use. We repeated similar analyses among youth from non-primary English speaking families, comparing those using interpreters versus not. Results 1,725 youth (mean age 11.5 years; %BMIp95 142%; 53% non-Hispanic White, 20% Hispanic/Latino, 16% non-Hispanic black; 6% used interpreters) were seen, of which 15% were prescribed AOMs within 1 year. The IRR for prescriptions was lower among Hispanic/Latino compared to non-Hispanic White youth at one (IRR 0.70; CI: 0.49-1.00; p = 0.047) but not 3 years. No other statistically significant differences by race/ethnicity were found. Among non-primary English speaking families, the IRR for prescriptions was higher at 1 year (IRR 2.49; CI: 1.32-4.70; p = 0.005) in those using interpreters versus not. Conclusions Among youth seen in a pediatric weight management clinic, AOM prescription incidence rates were lower in Hispanics/Latinos compared to non-Hispanic Whites. Interpreter use was associated with higher prescription incidence rates among non-primary English speakers. Interventions to achieve equity in AOM prescriptions may help mitigate disparities in pediatric obesity.
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Affiliation(s)
- Eric M. Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, 717 Delaware Street SE, Room 370, Minneapolis, MN 55414, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Elise F. Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kyle D. Rudser
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Carolyn T. Bramante
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Hilary K. Seligman
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Favour Noni
- University of Minnesota, Minneapolis, MN, USA
| | - Claudia K. Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
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14
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Sagi-Dain L, Echar M, Paska-Davis N. How to talk with patients about weight? Viewpoints of 1697 individuals with overweight and obesity. PATIENT EDUCATION AND COUNSELING 2022; 105:497-501. [PMID: 34620519 DOI: 10.1016/j.pec.2021.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/09/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To evaluate the preferences of individuals with overweight and obesity regarding the optimal approach for discussing the excess weight during medical appointments. METHODS The cross-sectional study was conducted by distribution of an anonymous questionnaire in social media platforms during September 2020, aiming for respondents with body mass index over 25 kg/m2. RESULTS The questionnaire was completed by 1697 participants, mostly female. Only 14.5% agreed that the weight issue should be brought up at medical appointments, while 69.3% preferred health practitioners to ask for a preliminary agreement to talk about the excess weight. The participants were frequently advised to lose weight without them wanting to talk about this (65.0%), when the reason for their appointment was irrelevant to the excess weight (60.4%), and without receiving any effective and practical tools on losing weight (60.1%). CONCLUSIONS Health practitioners should ask the patient for a preliminary permission to discuss the issue of excess weight during medical appointments. PRACTICE IMPLICATIONS Discussing the subject of weight during medical appointments should be done in a sensitive and respectful manner. Health practitioners should learn more about the numerous reasons for obesity, the adverse effects of weight stigmatization, and the practical tools to lose weight.
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Affiliation(s)
- Lena Sagi-Dain
- Genetics Institute, Carmel Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Moran Echar
- Genetics Institute, Carmel Medical Center, Haifa, Israel
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15
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Herdes RE, Tsao DD, Pratt JSA. Why earlier may be better: a look at the use of metabolic and bariatric surgery in the treatment of severe childhood obesity. Surg Obes Relat Dis 2021; 17:2107-2110. [PMID: 34565685 DOI: 10.1016/j.soard.2021.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/15/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Rachel E Herdes
- Stanford University School of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Palo Alto, California.
| | - Deborah D Tsao
- Stanford University School of Medicine, Department of General Surgery, Adolescent Bariatric Surgery, Palo Alto, California
| | - Janey S A Pratt
- Stanford University School of Medicine, Department of General Surgery, Adolescent Bariatric Surgery, Palo Alto, California
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16
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Roberts KJ, Polfuss ML, Marston EC, Davis RL. Experiences of weight stigma in adolescents with severe obesity and their families. J Adv Nurs 2021; 77:4184-4194. [PMID: 34435701 DOI: 10.1111/jan.15012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/05/2021] [Accepted: 07/29/2021] [Indexed: 01/25/2023]
Abstract
AIM To describe the experiences of weight stigma in adolescents with severe obesity and their parents. DESIGN Qualitative descriptive secondary analysis. METHODS A secondary analysis on 31 transcripts from a larger study of 46 transcripts conducted between February 2019 and June 2020. Semi-structured interviews were conducted with 19 parents (n = 17 mothers, n = 2 fathers) and 12 adolescents (n = 7 male, n = 5 female). Interviews were digitally audio recorded, transcribed and analysed using conventional content analysis. RESULTS Four common themes were identified reflecting experiences of weight stigma: weight-based teasing and bullying, interactions with healthcare providers (HCPs), family interactions and blame. Subthemes were fairness and impact on mental health. CONCLUSION This secondary analysis adds to the sparse literature documenting the experiences of weight stigma from adolescents with severe obesity and their families. It is important to understand the experiences of weight stigma from the adolescent and parent perspective as it can inform healthcare, education and policies across communities and facilitate holistic health for this vulnerable population. IMPACT The need for research to better understand how experiences of weight stigma correlate with physiological and psychological outcomes and inform innovative interventions are critical to improve treatment of severe obesity. Healthcare providers across disciplines are in a strategic position to change the paradigm through which we provide care to youth with severe obesity and guide families in supporting their children's weight management efforts without contributing to weight stigma.
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Affiliation(s)
- Karyn J Roberts
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, Wisconsin, USA
| | - Michele L Polfuss
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, Wisconsin, USA
| | - Emma C Marston
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, Wisconsin, USA
| | - Renée L Davis
- Saint Louis University Trudy Busch Valentine School of Nursing, Saint Louis, Missouri, USA
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17
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San Giovanni CB, Sweeney B, Skelton JA, Kelsey MM, Kelly AS. Aversion to Off-label Prescribing in Clinical Pediatric Weight Management: The Quintessential Double Standard. J Clin Endocrinol Metab 2021; 106:2103-2113. [PMID: 33901290 PMCID: PMC8600003 DOI: 10.1210/clinem/dgab276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Pediatric obesity is now recognized as a chronic disease; yet few treatment options exist besides lifestyle modification therapy and bariatric surgery. We describe the limited availability of United States Food and Drug Administration (FDA)-approved antiobesity medications for adolescents and compare this to what is available for adults. We offer a rationale for off-label prescribing to assist with lifestyle modification therapy. We also highlight the need for more pharmacotherapy options and additional research into novel treatments for pediatric obesity. CASE DESCRIPTION We describe a patient who is struggling with managing her weight and starting to develop complications of obesity. We offer a framework in which off-label prescribing may be beneficial to patients who have been engaging in lifestyle modification therapy yet fail to see improvement. CONCLUSION Lifestyle modification therapy is necessary but often insufficient in stimulating clinically meaningful weight loss when used alone in children and adolescents who struggle with weight management. Until more FDA-approved antiobesity medications are available, pediatricians may be able to help more patients achieve weight reduction goals by familiarizing themselves with the responsible use of off-label medications and implementing these tools to improve clinical outcomes. There is a critical need for more pharmacotherapy options to help pediatric patients in managing their weight and preventing or improving the insidious complications resulting from untreated obesity.
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Affiliation(s)
| | - Brooke Sweeney
- Department of Pediatrics, University of Missouri, Kansas City, MO 65211, USA
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Megan M Kelsey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Aaron S Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN 55812, USA
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18
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Herdes RE, El Haija MA, Johnson K, Shepard WE, Zak Y, Bruzoni M, Pratt JSA. Experience With Vertical Sleeve Gastrectomy in Adolescent and Young Adult Ehlers-Danlos Syndrome Patients: a Case Series and Review of the Literature. Obes Surg 2021; 31:4168-4173. [PMID: 33948912 DOI: 10.1007/s11695-021-05453-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Rachel E Herdes
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stanford University School of Medicine, 750 Welch Road Suite 116, Palo Alto, CA, 94304, USA.
| | - Marwa Abu El Haija
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stanford University School of Medicine, 750 Welch Road Suite 116, Palo Alto, CA, 94304, USA
| | - Kate Johnson
- Department of General Surgery, Adolescent Bariatric Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - W Elizabeth Shepard
- Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Yulia Zak
- Department of General Surgery, Adult Bariatric Program, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Matias Bruzoni
- Department of General Surgery, Adolescent Bariatric Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Janey S A Pratt
- Department of General Surgery, Adolescent Bariatric Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
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19
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Tashlizky Madar R, Zion Yohay N, Grinstein Cohen O, Cohen L, Newman-Heiman N, Dvori Y. Post-Bariatric Surgery Care in Israeli Adolescents: A Qualitative Study. Clin Nurs Res 2021; 30:1281-1289. [PMID: 33754874 DOI: 10.1177/10547738211000064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Undergoing bariatric surgery is a life-changing experience for adolescents. However, little is known about post-bariatric surgery management among Israeli adolescents. We aimed to identify the post-operative needs and support from a qualitative aspect. Seventeen adolescents who underwent bariatric surgery were interviewed by semi-structure telephone interview. The interview guide was validated by 10 content experts from different hospitals across the country. Data were collected in 2018. Analysis of the interviews revealed three major themes: "multi-disciplinary team management," "patient satisfaction," and "follow-up." The "multi-disciplinary team management" theme was further divided into three major categories: "pain management," "physiotherapy," and "nutrition." "Patient satisfaction" was further divided into "guidance" and "team handling" categories. The "follow-up" theme included recommendations for improvement. The analysis provides novel information about adolescents' needs after bariatric surgery. Healthcare professionals' awareness of the adolescents' perspective could contribute to providing optimal post-operative care to this population.
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Affiliation(s)
| | | | - Orli Grinstein Cohen
- Soroka University Medical Center, Beer Sheva, Israel.,Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Lea Cohen
- Soroka University Medical Center, Beer Sheva, Israel
| | | | - Yael Dvori
- Soroka University Medical Center, Beer Sheva, Israel
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20
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Roberts KJ, Binns HJ, Vincent C, Koenig MD. A Scoping Review: Family and Child Perspectives of Clinic-Based Obesity Treatment. J Pediatr Nurs 2021; 57:56-72. [PMID: 33271477 PMCID: PMC7946710 DOI: 10.1016/j.pedn.2020.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 10/22/2022]
Abstract
PROBLEM Interventions for children with obesity lead to only modest improvements in BMI and long-term outcomes, and data are limited on the perspectives of families of children with obesity in clinic-based treatment. This scoping review seeks to answer the question: What is known about the perspectives of families and children who receive care in clinic-based child obesity treatment? ELIGIBILITY CRITERIA Studies were eligible for inclusion in this review that 1) reported parent, family or child perspectives of obesity treatment; 2) addressed concepts identified in the obesity literature as barriers or facilitators to success in obesity treatment from the perspective of the parent/family/child, including reasons for failure to return to clinic and satisfaction with care. SAMPLE Twelve studies qualified for final inclusion in this scoping review RESULTS: Families report a lack of interventions tailored to their unique needs and resources. Barriers and facilitators encompass 1) structural issues (e.g., clinic location and scheduling); 2) financial issues; 3) patient and family issues; and 4) personal behaviors, motivation, and expectations. CONCLUSION Data are lacking on the clinic-based treatment of children with severe obesity, and few studies report on non-maternal perspectives. IMPLICATIONS Clinical practice must be tailored to individual family needs. Future research should concentrate on identifying missing variables which impact successful treatment outcomes through more rigorous qualitative studies, standardized outcome measures, focus on children with severe obesity, and fathers' and siblings' perspectives.
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Affiliation(s)
- Karyn J Roberts
- University of Wisconsin-Milwaukee, College of Nursing, WI, USA.
| | - Helen J Binns
- Ann and Robert H. Lurie Children's Hospital, IL, USA; Feinberg School of Medicine, Northwestern University, IL, USA
| | | | - Mary Dawn Koenig
- The University of Illinois at Chicago College of Nursing, IL, USA
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21
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Abstract
PURPOSE OF REVIEW This review describes clinical management of early-onset severe obesity, defined here as severe obesity in children ≤ 5 years old. It summarizes current information regarding (1) assessment, specifically growth, genetics, cardiometabolic risk, health behaviors, developmental considerations, and psychosocial factors, and (2) treatment, focusing on lifestyle modification including parent training and a brief summary of pharmacotherapy. RECENT FINDINGS Prevalence of severe obesity in young children has remained stable yet most of these children will become adults with obesity. Interventions that address multiple health domains, such as eating habits, physical activity, and parenting skills, are necessary for addressing early-onset severe obesity. Research into pharmacotherapy remains limited but may provide future strategies for management. Early-onset severe obesity significantly influences children's long-term health and management should focus on intervention to promote BMI reduction. Further research into effective strategies is necessary to address the needs of this high-risk population.
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Affiliation(s)
- Sarah Raatz
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, USA
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, USA
| | - Amy C Gross
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, USA.
- Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, USA.
- , Minneapolis, USA.
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22
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Vidmar AP, Goran MI, Naguib M, Fink C, Wee CP, Hegedus E, Lopez K, Gonzalez J, Raymond JK. Time limited eating in adolescents with obesity (time LEAd): Study protocol. Contemp Clin Trials 2020; 95:106082. [PMID: 32682994 DOI: 10.1016/j.cct.2020.106082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Time limited eating (TLE) has been shown to be effective for weight loss and improvement of glycemic control in adults with obesity and type 2 diabetes (T2D), but has not been well studied in adolescents. TLE may be a more feasible, flexible and effective dietary intervention for adolescents because it removes the need for intensive counting of calories or macronutrients, and emphasizes eating during a specified time period. OBJECTIVES The aim of this study is to assess the feasibility of a TLE approach in adolescents with obesity using a continuous glucose monitor (CGM) to promote adherence to the intervention. METHODS We propose a prospective, randomized controlled trial, in 60 adolescents (ages 14-18) with obesity (BMI% ≥ 95th percentile). Youth will be randomized to one of three treatment groups for a 12-week intervention: Group 1) Low sugar and carbohydrate education (LSC, 5% of total daily calories from sugar (<35 g)/day; <90 g carbohydrate (CHO)/day) + blinded CGM (used to monitor adherence and glycemic outcomes without real time feedback), Group 2) LSC + TLE (16-h fast/8-h feed for 5 days per week) + blinded CGM, and Group 3) LSC + TLE+ real time feedback via CGM (to evaluate effect of providing CGM data on intervention efficacy). Outcomes will include change in total body fat (TBF) percentage measured on DEXA scan, BMI status and fasting blood glucose at 12 weeks compared to baseline. CONCLUSIONS TLE is a potentially powerful lifestyle intervention that could be readily integrated into pediatric weight management programs to optimize their impact and accelerate healthy changes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03954223.
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Affiliation(s)
- Alaina P Vidmar
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America.
| | - Michael I Goran
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Monica Naguib
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Cassandra Fink
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Choo Phei Wee
- CTSI Biostatics Core, Saban Research Institute, Los Angeles, CA, United States of America
| | - Elizabeth Hegedus
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Kelleen Lopez
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Janelle Gonzalez
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
| | - Jennifer K Raymond
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, CA, United States of America
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23
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Hagman E, Danielsson P, Lindberg L, Marcus C. Paediatric obesity treatment during 14 years in Sweden: Lessons from the Swedish Childhood Obesity Treatment Register-BORIS. Pediatr Obes 2020; 15:e12626. [PMID: 32074662 DOI: 10.1111/ijpo.12626] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Treatment of paediatric obesity has been offered customarily and free of charge for more than 15 years in Sweden. The Swedish Childhood Obesity Treatment Register (BORIS) is a prospective register of children and adolescents undergoing obesity treatment. OBJECTIVES To investigate how patient characteristics and treatment efficacy has changed over 14 years on a national scale. METHODS All subjects in BORIS with data from 2004 until 2017 were included, n = 21 499. Outcomes were age and BMI SDS at treatment initiation, dropout rates and treatment outcome up to 3 years after treatment initiation. RESULTS Age and BMI SDS at treatment initiation have decreased during the years (both P < .0001). Of the patients who started treatment before 2009, more than 80% had at least 1-year follow-up. This number has decreased to about 60% in 2017. Since 2004, no trend in improvement of treatment results was observed when evaluating change in either BMI SDS or proportion of obesity remission. There was no difference between the sexes. CONCLUSION Although children in Sweden receive treatment at an earlier age, which is a major determinant of treatment success, and at a lower degree of obesity at treatment initiation, the effect of childhood obesity treatment on standard anthropometric measures has not improved over the investigated years.
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Affiliation(s)
- Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Danielsson
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Louise Lindberg
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Thaker VV, Osganian SK, deFerranti SD, Sonneville KR, Cheng JK, Feldman HA, Richmond TK. Psychosocial, behavioral and clinical correlates of children with overweight and obesity. BMC Pediatr 2020; 20:291. [PMID: 32522176 PMCID: PMC7285533 DOI: 10.1186/s12887-020-02145-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 05/14/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Psychological and behavioral correlates are considered important in the development and persistence of obesity in both adults and youth. This study aimed to identify such features in youth with severe obesity (BMI ≥ 120% of 95thpercentile of sex-specific BMI-for-age) compared to those with overweight or non-severe obesity. METHODS Youth with BMI ≥ 85th percentile were invited to participate in a prospective research registry where data was collected on attributes such as family characteristics, eating behaviors, dietary intake, physical activity, perception of health and mental well-being, and cardiometabolic parameters. RESULTS In a racially/ethnically diverse cohort of 105 youth (65% female, median age 16.1 years, range 4.62-25.5), 51% had severe obesity. The body fat percent increased with the higher levels of obesity. There were no differences in the self-reported frequency of intake of sugar sweetened beverages or fresh produce across the weight categories. However, the participants with severe obesity reported higher levels of emotional eating and eating when bored (p = 0.022), levels of stress (p = 0.013), engaged in fewer sports or organized activities (p = 0.044), and had suboptimal perception of health (p = 0.053). Asthma, depression and obstructive sleep apnea were more frequently reported in youth with severe obesity. The presence of abnormal HDL-C, HOMA-IR, hs-CRP and multiple cardiometabolic risk factors were more common among youth with severe obesity. CONCLUSIONS Youth with severe obesity have identifiable differences in psychosocial and behavioral attributes that can be used to develop targeted intervention strategies to improve their health.
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Affiliation(s)
- Vidhu V Thaker
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Irving Medical Center, 1150, St. Nicholas Avenue, New York, NY, 10032, USA.
| | - Stavroula K Osganian
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sarah D deFerranti
- Division of Ambulatory Cardiology, Deparment of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | | | - Jennifer K Cheng
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
- Division of Primary Care, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Henry A Feldman
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Tracy K Richmond
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, 02115, USA
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Boles RE, Moore JM, Glover JJ. The role of ethics consultation in decision making for bariatric surgery in pediatrics. Semin Pediatr Surg 2020; 29:150884. [PMID: 32238293 PMCID: PMC8607297 DOI: 10.1016/j.sempedsurg.2020.150884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The decision to pursue metabolic and bariatric surgery (MBS) for pediatric patients has become increasingly accepted by patients and their families and by health care professionals. The advancement of pre- and post-operative MBS guidelines, based on accumulating evidence for safety, efficacy, and cost-effectiveness help to map the clinical pathway for MBS consideration. Ethical issues remain possible for each case, however, and consultation with ethical experts can provide clarity in the consideration of MBS. Specifically, ethical issues related to principles of autonomy, justice, beneficence, and non-maleficence may need to be resolved based on patient characteristics, including preadolescent patients and those who present with intellectual disabilities. Institutions that offer MBS for pediatric patients will benefit from collaborating with ethics consultants to develop a structured approach that helps ensure that ethical principles have been adequately addressed for patients presenting for MBS.
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Affiliation(s)
- Richard E. Boles
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, CO 80045, United States,Corresponding author. (R.E. Boles)
| | - Jaime M. Moore
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, CO 80045, United States
| | - Jacqueline J. Glover
- University of Colorado Anschutz Medical Campus, Department of Pediatrics and Center for Bioethics and Humanities, Aurora, CO 80045, United States
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Messiah SE, Sacher PM, Yudkin J, Qureshi FG, Hoelscher DM, Barlow SE. Partnering Support Interventions with Bariatric Surgery to Maximize Health Outcomes in Adolescents with Severe Obesity. Obesity (Silver Spring) 2019; 27:1784-1795. [PMID: 31562699 DOI: 10.1002/oby.22612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/19/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Rates of adolescents with severe obesity continue to rise worldwide, with concurrent increases in metabolic and bariatric surgery (MBS) uptake. The gap between support (lifestyle, pharmacotherapy) interventions and MBS as treatment options for adolescents has been understudied. This review, couched in a socio-ecological framework, investigates how support interventions for adolescents with severe obesity could be combined or sequenced with MBS to optimize health outcomes. METHODS A comprehensive search revealed 36 published articles between 1995 and 2019 that included the combination of support interventions and MBS among adolescents. RESULTS There were no studies that specifically reported outcomes or effect sizes for the combination of lifestyle intervention with MBS. Previous studies have reported individual results for either lifestyle intervention or MBS but not for their compound effect. CONCLUSIONS As rates of adolescents with severe obesity are on the rise globally, future research should focus on how partnering support interventions with MBS can amplify positive short- and long-term health outcomes and within a socio-ecological framework. Understanding the sequence of these approaches will be of particular importance. High-risk and vulnerable populations such as ethnic minorities who have suffered a disproportionate burden of the obesity epidemic must be included in rigorously tested future trials of combination interventions to maximize health outcomes worldwide.
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Affiliation(s)
- Sarah E Messiah
- University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas, USA
| | - Paul M Sacher
- Childhood Nutrition Research Centre, University College London, London, UK
| | - Joshua Yudkin
- University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas, USA
| | - Faisal G Qureshi
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Deanna M Hoelscher
- University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas, USA
- Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston, Austin, Texas, USA
| | - Sarah E Barlow
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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