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Lee KM, Arriola-Sanchez L, Lumeng JC, Gearhardt A, Tomiyama AJ. Weight Stigma by Association Among Parents of Children With Obesity: A Randomized Trial. Acad Pediatr 2022; 22:754-760. [PMID: 34610460 DOI: 10.1016/j.acap.2021.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/22/2021] [Accepted: 09/25/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To experimentally test weight stigma and weight stigma by association in a parent-child relationship using a large, community-based sample. METHODS We conducted a randomized experiment on Amazon Mechanical Turk using an online survey. Participants were randomly assigned to view a picture of a parent-child dyad, for which the parent and child's gender (male vs. female) and weight status (with obesity vs. without obesity) were manipulated. Participants read identical parenting descriptions that adhered to the American Academy of Pediatrics' parenting recommendations, then rated the parent's perceived effectiveness, helpfulness, and level of caring using a parenting questionnaire based on Barnhart et al (2013). RESULTS Participants (N = 1862; Mage = 36.8 [11.2] years) rated parents of children with obesity as less effective compared to parents of children without obesity (P = .010) and parents with obesity as less effective compared to parents without obesity (P = .033). Participants also rated parents with obesity as less helpful compared to parents without obesity (P = .021). No differences emerged in perceived caring. Parenting evaluations did not differ across daughters versus sons or mothers versus fathers. CONCLUSIONS Parents of children with obesity may experience weight stigma by association, which could have direct consequences for the parents, the children, and the parent-child relationship.
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Affiliation(s)
- Kristen M Lee
- Department of Psychology, University of California, Los Angeles (KM Lee, L Arriola-Sanchez, and AJ Tomiyama)
| | - Lauren Arriola-Sanchez
- Department of Psychology, University of California, Los Angeles (KM Lee, L Arriola-Sanchez, and AJ Tomiyama)
| | - Julie C Lumeng
- Department of Pediatrics, Medical School, and Department of Nutritional Sciences, School of Public Health, University of Michigan (JC Lumeng), Ann Arbor, Mich
| | - Ashley Gearhardt
- Department of Psychology, University of Michigan (A Gearhardt), Ann Arbor, Mich
| | - A Janet Tomiyama
- Department of Psychology, University of California, Los Angeles (KM Lee, L Arriola-Sanchez, and AJ Tomiyama).
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2
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Feiring E, Traina G, Fystro JR, Hofmann B. Avoiding hypersensitive reluctance to address parental responsibility in childhood obesity. JOURNAL OF MEDICAL ETHICS 2022; 48:65-69. [PMID: 32385102 PMCID: PMC8717702 DOI: 10.1136/medethics-2020-106120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/04/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
Childhood obesity is an increasing health problem. Prior empirical research suggests that, although discussing lifestyle behaviours with parents could help prevent childhood obesity and its health-related consequences, physicians are reluctant to address parental responsibility in the clinical setting. Therefore, this paper questions whether parents might be (or might be held) responsible for their children's obesity, and if so, whether parental responsibility ought to be addressed in the physician-patient/parent encounter. We illustrate how different ideal-typical models of the physician-patient/parent interaction emphasise different understandings of patient autonomy and parental responsibility and argue that these models advocate different responses to an appeal for discussing parents' role in childhood obesity. We suggest that responsibility should be attributed to parents because of their parental roles in providing for their children's welfare. We also argue that whether, and how, this responsibility gives rise to a requirement to act depends on the parents' capacities. A deliberative-oriented physician-patient/parent interaction best captures the current ideals of antipaternalism, patient autonomy, and shared and evidence-informed decision-making, and might facilitate parental role development. We conclude that, while not discussing parental responsibility for childhood obesity in the clinical setting can be warranted in particular cases, this cannot be justified as a general rule.
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Affiliation(s)
- Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Gloria Traina
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Joar Røkke Fystro
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Bjorn Hofmann
- Department of Medical Ethics, University of Oslo, Oslo, Norway
- Department of Health Science, Norwegian University of Science and Technology, Gjøvik, Norway
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3
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Cramer RJ, Augustus R, Shield JPH, Giri D. Childhood obesity as a safeguarding issue: positive experiences with the "new home" environment as a treatment for weight management. J Pediatr Endocrinol Metab 2021; 34:1061-1067. [PMID: 33866703 DOI: 10.1515/jpem-2020-0726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Childhood obesity can lead to acute and chronic comorbidities and adult obesity, highlighting the need for prompt intervention. Families and caregivers play a vital role in treatment and when primary interventions fail, this may become a child protection issue. CASE PRESENTATION We present two cases of severe childhood obesity where targeted lifestyle interventions failed to impact weight status. Both cases feature child welfare involvement with patients coming into the care of the local authority (under s20 of the Children Act 1989). Foster placement resulted in significant weight loss and improved BMI achieved through reduced portions, healthier choices, restricted calories to recommended daily intake for age and increased activity. Physical and emotional wellbeing benefits were observed and improvements in obesity related comorbidities. CONCLUSIONS Failure to reduce a child's weight alone does not constitute a child protection issue. In severe cases, where maximum intervention has failed and when the child has obesity related comorbidites or at a higher risk of developing them, home environment change should be considered in the child's best interest as a treatment for severe childhood obesity.
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Affiliation(s)
- Rebecca J Cramer
- Department of Paediatric Endocrinology, Bristol Royal Hospital for Children, Bristol, UK
| | - Rhian Augustus
- Department of Paediatric Endocrinology, Bristol Royal Hospital for Children, Bristol, UK
| | - Julian P H Shield
- Department of Paediatric Endocrinology, Bristol Royal Hospital for Children, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, UK
| | - Dinesh Giri
- Department of Paediatric Endocrinology, Bristol Royal Hospital for Children, Bristol, UK
- Department of Translational Health Sciences, University of Bristol, Bristol, UK
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4
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Shubayr MA, Mattoo KA. Parental neglect of feeding in obese individuals. A review of scientific evidence and its application among Saudi population. Saudi Med J 2021; 41:451-458. [PMID: 32373910 PMCID: PMC7253827 DOI: 10.15537/smj.2020.5.25049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Human beings encountered malnutrition during the twentieth century and obesity in the very next century. This is how the future will look when the present becomes a slice of history. Obesity is threatening the healthy being of many youngsters throughout the world. Environmental influences have indicated to effect even genetically safe subjects among which parental neglect seems to be most alarming. Two extensively and globally investigated variables, the feeding style and the physical activity, provide some hope in its prevention. Despite the high rise of obesity prevalence in Saudi Arabia, there is scant research on these topics. The purpose of this review is to present a comprehensive assessment of these 2-obesity associated parental variables. The composed literature could provide an insight to the dominant surge of obesity in the Arab nations and stimulate research on current parenting practices in the Kingdom.
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Affiliation(s)
- Mosa A Shubayr
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia. E-mail.
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5
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Burford A, Alexander R, Lilly C. Malnutrition and Medical Neglect. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:305-316. [PMID: 33088388 PMCID: PMC7561628 DOI: 10.1007/s40653-019-00282-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Anomalies found during the assessment of nutrition in children are common in pediatric practice, yet few articles address the intersection between malnutrition and medical neglect. The diagnosis of medical neglect requires several components including a) harm, or risk of harm due to lack of recommended health care, b) recommended care provides benefit significantly greater than potential risk, c) caregiver understands the medical recommendations; and d) has access to the recommended care, but fails to utilize it. Through the application of this definition to cases of malnutrition, considerations for diagnosing medical neglect when presented with malnutrition are reviewed. Cases include children with special healthcare needs, children exposed to selective diets, previously well children with severe malnutrition, and treatment-resistant failure to thrive. Obesity is a state of malnutrition, which may also involve neglect; in this instance, the "neglect" involves failure to supervise nutritional intake necessary for optimal functioning. Because many cases involve interactions with medical providers, the subsequent failure to follow medical advice regarding obesity management may also be considered medical neglect. This article reviews the relationship between medical neglect, nutritional deprivation, and over-nutrition to explore when a diagnosis of medical neglect may be applicable.
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Affiliation(s)
- Alexander Burford
- University of Wisconsin School of Medicine and Public Health, Madison, WI USA
- Present Address: Oregon Health & Science University’s Pediatric Residency Program, 3181 SW Sam Jackson Park Rd. L-579, Portland, OR 97239 USA
| | - Randell Alexander
- Division of Child Protection and Forensic Pediatrics, University of Florida, Jacksonville, FL USA
| | - Carol Lilly
- Department of Pediatrics Child Protection Team, University of South Florida, Tampa, FL USA
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6
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Affiliation(s)
- Carole Jenny
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - James B Metz
- Department of Pediatrics, University of Vermont Children's Hospital, Burlington, VT
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7
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Berry EM. The Obesity Pandemic-Whose Responsibility? No Blame, No Shame, Not More of the Same. Front Nutr 2020; 7:2. [PMID: 32118024 PMCID: PMC7025495 DOI: 10.3389/fnut.2020.00002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/10/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Elliot M Berry
- Braun School of Public Health, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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8
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Miller VG. Falling short: When testing is mandated and follow-up is not. Nurs Forum 2020; 55:33-36. [PMID: 31432522 DOI: 10.1111/nuf.12378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/05/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
In 1999, the Texas Legislature mandated acanthosis nigricans (AN) screening in primary schools in designated regions of the state through the passage of House Bill 1860 to identify children at risk for diabetes by identifying the skin condition AN. AN is related to insulin resistance, and, thus, is associated with type 2 diabetes (diabetes mellitus type 2 [DMT2]), a growing concern among school-aged children. Since 1999, millions of children have been screened and hundreds of thousands have been screened positive. No data are available about the effectiveness of the program in identifying DMT2 among the school-aged population because no follow-up is mandated. The current practice is to send a letter to the parents of the child who screens positive, advising the parents to take the child to a health care provider for further assessment. Hence, children within the state may have diabetes or are developing diabetes but have yet to be diagnosed. In light of the presence of a law mandating AN screening, mandating a follow-up to identify those who have diabetes or are developing the condition of diabetes can provide early intervention and decrease costs of care. It is not known why the follow-up of those who screen positive was not included in the initial legislation. It may have been due to the cost of the necessary blood tests that are used to assess an individual for diabetes. Related to this is the reality that blood tests are invasive procedures, whereas screening for a skin disorder is not, thereby possibly explaining the omission of mandated follow-up from the legislation .
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Affiliation(s)
- Virginia G Miller
- School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas
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9
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Regber S, Jormfeldt H. Foster homes for neglected children with severe obesity-Debated but rarely studied. Acta Paediatr 2019; 108:1955-1964. [PMID: 31199006 DOI: 10.1111/apa.14902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 12/26/2022]
Abstract
AIM To explore current research and theoretical articles on foster home placement of children with severe obesity. METHODS An integrative literature review. Literature searches in six electronic databases included theoretical, quantitative and qualitative articles and case reports published in English (2008-2018) on the topic of severe childhood obesity and foster home placement. RESULTS Seventeen selected papers included six theoretical articles, nine quantitative studies, one qualitative study and one case report. Eight of the nine quantitative studies did not specify the grading of obesity in children in foster care. The case report and the qualitative study showed distinct and sustainable body mass index (BMI) reductions after a child had been placed in foster care. Five theoretical articles justified foster care placement when chronic parental neglect led to severe obesity in the child, while one article emphasised the opposite. CONCLUSION Parental and societal neglect of children with severe obesity placed in a foster home is rarely studied or the exclusive aim of research. The views of the children themselves are lacking in research articles, as well as the child's right to health obligations concerning children with severe obesity.
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Affiliation(s)
- Susann Regber
- School of Health and Welfare Halmstad University Halmstad Sweden
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10
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Regber S, Dahlgren J, Janson S. Neglected children with severe obesity have a right to health: Is foster home an alternative?-A qualitative study. CHILD ABUSE & NEGLECT 2018; 83:106-119. [PMID: 30025301 DOI: 10.1016/j.chiabu.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/29/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore key person's perspectives of foster home placement or notification of risk of harm to Social Services of children with severe obesity. METHODS This case study research was performed in the southwest of Sweden and based on interviews with nine informants: a foster home youth, two foster parents, a social worker, two hospital social workers, a pediatric physician, a pediatric nurse, and a psychologist. Content analysis was used for narrative evaluations, within- and cross case analyses and displays. RESULTS Positive health outcomes of the foster home placement were described as a healthy and normalized weight status, a physically and socially active life, and an optimistic outlook on the future. The foster parents made no major changes in their family routines, but applied an authoritative parenting style regarding limit setting about sweets and food portions and supporting physical activity. The professionals described children with severe obesity as having suffered parental as well as societal neglect. Their biological parents lacked the ability to undertake necessary lifestyle changes. Neglected investigations into learning disabilities and neuropsychiatric disorders were seen in the school and healthcare sector, and better collaboration with the Social Services after a report of harm might be a potential for future improvements. Rival discourses were underlying the (in) decision regarding foster home placement. CONCLUSION A child's right to health was a strong discourse for acting when a child was at risk for harm, but parental rights are strong when relocation to a foster home is judged to be necessary.
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Affiliation(s)
- Susann Regber
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.
| | - Jovanna Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Staffan Janson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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11
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Priest M. Are Obese Children Abused Children? Hastings Cent Rep 2018; 48:31-41. [DOI: 10.1002/hast.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Child Abuse and Neglect. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Cathaoir KÓ. Childhood Obesity and the Right to Health. Health Hum Rights 2016; 18:249-262. [PMID: 27781014 PMCID: PMC5070695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Childhood obesity is now a global health epidemic, yet the obligations of states to prevent obesity through fulfillment of the right to health have received limited consideration. This article examines the childhood obesity recommendations of the UN Committee on the Rights of the Child (the committee on the CRC), the Special Rapporteur on the right to health, and the UN High Commissioner on Human Rights. It suggests how their engagement might be strengthened. It concludes that the final report of the World Health Organization's Commission on Ending Childhood Obesity could provide the committee on the CRC with a more systematic basis for advising and assessing preventive measures taken by states. Moreover, while the interim report envisages a central role for states in childhood obesity prevention, it pays inadequate attention to their obligations under international human rights law. It is hoped that this will be remedied in the final report through the adoption of a child-centered approach inspired by the rights to health and play, and the general principles of the Convention on the Rights of the Child (CRC).
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14
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Gray J, Cadieux A, Sweeney B, Beck AR, Edgar S, Eneli I, Getzoff Testa E, Paguio K, Santos M, Ward WL. Medical neglect and pediatric obesity: Insights from tertiary care obesity treatment programs. CHILDRENS HEALTH CARE 2016. [DOI: 10.1080/02739615.2016.1163488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jane Gray
- Dell Children’s Medical Center, Texas Center for the Prevention and Treatment of Childhood Obesity, Austin, TX
- Department of Educational Psychology, The University of Texas at Austin, Austin, TX
| | - Adelle Cadieux
- Healthy Weight Center, Helen DeVos Children’s Hospital, Grand Rapids, MI
| | - Brooke Sweeney
- Weight Management Program, Children’s Mercy Kansas City, Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO
| | - Amy R. Beck
- Weight Management Program, Children’s Mercy Kansas City, Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO
| | - Susan Edgar
- Center for Healthy Weight and Nutrition, Nationwide Children’s Hospital, Columbus, OH
| | - Ihuoma Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children’s Hospital, Columbus, OH
| | - Elizabeth Getzoff Testa
- Department of Psychology, Mt. Washington Pediatric Hospital/Weigh Smart Program, Baltimore, MD
| | - Kristi Paguio
- Healthy Weight Center, Helen DeVos Children’s Hospital, Grand Rapids, MI
- Spectrum Health Medical Group, Grand Rapids, MI
| | - Melissa Santos
- Connecticut Children’s Medical Center, Hartford Hospital, Hartford, CT
- The Institute of Living, University of Connecticut School of Medicine, Hartford, CT
| | - Wendy L. Ward
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
- Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, AR
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15
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Abstract
Pediatric obesity is highly prevalent in developed countries globally (and worsening in developing countries) and threatens to shorten the lifespan of the current generation. At highest risk for weight-related comorbidities including Type 2 diabetes mellitus, non-alcoholic fatty liver disease and dyslipidemia is a sub-set of children with severe obesity, often defined as a body mass index (BMI) percentile ≥99th percentile for age and sex. The pathophysiology of severe obesity in childhood is complex, resulting from the dynamic interplay of a myriad of individual and societal factors including genetic predisposition and health behaviors contributing to energy imbalance. Approximately 4–6% of children have severe obesity, representing a common scenario encountered by providers, and intervention is critical to halt ongoing weight gain and, when possible, reverse the trend. Clinical approaches promoting behavioral weight loss may result in modest, albeit clinically significant, reductions in BMI; however, such changes are often difficult to maintain long-term. Data regarding the impact of targeted pharmacotherapy including agents such as orlistat are limited in the pediatric population and again only suggest modest results. However, increasing evidence suggest that surgical treatment, as an adjunct to ongoing lifestyle changes, may be a promising option in carefully-screened adolescents with severe obesity and weight-related comorbidities who are motivated to adhere to the long-term treatment needs.
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Affiliation(s)
- Edmond P. Wickham
- Departments of Internal Medicine and Pediatrics, Virginia Commonwealth University, Richmond VA 23298
| | - Mark D. DeBoer
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia, Charlottesville, VA 22908,Author to whom correspondence should be addressed: Mark D. DeBoer, MD, MSc., MCR, P.O. Box 800386, Charlottesville, VA 22908, Phone: 434-924-9833, Fax: 434-924-9181,
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16
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van Rijn M, Ahring K, Bélanger-Quintana A, Dokoupil K, Ozel HG, Lammardo AM, Robert M, Rocha JC, MacDonald A. When should social service referral be considered in phenylketonuria? Mol Genet Metab Rep 2015. [PMID: 28649533 PMCID: PMC5471161 DOI: 10.1016/j.ymgmr.2015.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Lifelong low-phenylalanine (Phe) dietary management is the foundation of care in phenylketonuria (PKU). However, strict monitoring of food intake places a burden on patients and their caregivers, and adherence to the required diet frequently decreases in later childhood and adolescence. Rarely, parents of children with PKU refuse to recognise the importance of treatment and follow-up for this chronic condition. Here, two case studies are presented that document consideration of placement of children into foster care or kinship homes as a last resort to improve persistently high Phe concentrations. In the first case, social service referral led to a 3-year-old girl being placed in a kinship home with her grandparents, resulting in excellent Phe control thereafter. In the second case, discussion with the parents of possible placement of a 12-year-old child into foster care was sufficient to have a positive effect on Phe control. A staged approach for managing intractable non-adherence in PKU is proposed.
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Affiliation(s)
- Margreet van Rijn
- Section of Metabolic Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kirsten Ahring
- Department of Clinical Genetics, Copenhagen University Hospital, Kennedy Centre, Glostrup, Denmark
| | | | - Kathi Dokoupil
- Department of Metabolism and Nutrition, Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Hulya Gokmen Ozel
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Hacettepe University, Ankara, Turkey
| | | | - Martine Robert
- Nutrition and Metabolism Unit, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Júlio C Rocha
- Centro de Genética Médica Doutor Jacinto de Magalhães, CHP EPE, Porto, Portugal.,Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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17
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Graff A. Child Abuse and Neglect. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_27-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Medical neglect occurs when children are harmed or placed at significant risk of harm by gaps in their medical care. This is most likely to occur and to be recognized when families lack resources, commonly due to poverty, and when medical demands are high, such as with complex, severe, and chronic illness. A systematic evaluation of the probabilities for harm from gaps in care versus benefits from improved care will define medical neglect. A broad consideration of child, family, community, and medical system contributions to identified gaps will guide management. Special circumstances, such as lapsed immunizations, unremitting obesity, and medically motivated alterations in care, are often challenging for medical providers. Guidance for these specific situations is available from the American Academy of Pediatrics, and from the medical literature.
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Abstract
Medical providers need to monitor growth at every visit. Weight status is influenced by genetics, medical conditions, socioeconomic status, and family environment. Screening for food security and psychosocial risk factors is an integral tool to identify families at risk for nutritional deficits and child maltreatment. Nutritional rehabilitation is best accomplished in an outpatient, multidisciplinary setting. Medical neglect should be considered in failure to thrive and obesity when there is a serious risk of harm from identified medical complications, additional or worsening medical complications occurring despite a multidisciplinary approach, and/or non-adherence with the treatment plan.
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Affiliation(s)
- Nancy S Harper
- Children's Physician Services of South Texas, Driscoll Children's Hospital, 3533 South Alameda, Corpus Christi, TX 78411, USA.
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20
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Merry MS, Voigt K. Risk, harm and intervention: the case of child obesity. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014; 17:191-200. [PMID: 24346516 DOI: 10.1007/s11019-013-9531-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this paper we aim to demonstrate the enormous ethical complexity that is prevalent in child obesity cases. This complexity, we argue, favors a cautious approach. Against those perhaps inclined to blame neglectful parents, we argue that laying the blame for child obesity at the feet of parents is simplistic once the broader context is taken into account. We also show that parents not only enjoy important relational prerogatives worth defending, but that children, too, are beneficiaries of that relationship in ways difficult to match elsewhere. Finally, against the backdrop of growing public concern and pressure to intervene earlier in the life cycle, we examine the perhaps unintended stigmatizing effects that labeling and intervention can have and consider a number of risks and potential harms occasioned by state interventions in these cases.
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Affiliation(s)
- Michael S Merry
- Department of Educational Sciences and Department of Philosophy, University of Amsterdam, Amsterdam, The Netherlands,
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21
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Jones DJ, Gonzalez M, Ward DS, Vaughn A, Emunah J, Miller L, Anton M. Should child obesity be an issue for child protective services? A call for more research on this critical public health issue. TRAUMA, VIOLENCE & ABUSE 2014; 15:113-125. [PMID: 24231942 DOI: 10.1177/1524838013511544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Given the lasting effects on adolescent and adult health, childhood obesity is a major public health issue. The relatively slow progress toward the prevention and treatment of childhood obesity, however, has prompted leaders in both academic and practice sectors to advocate for what may be considered a radical intervention approach, to conceptualize extreme child obesity as an issue of child maltreatment. Advocates of this approach suggest that this conceptualization affords a new angle for intervention-the involvement of child protective services (CPS) in mandating family-focused lifestyle changes aimed at reducing child overweight and, in the most extreme cases, the removal of the obese child from the home. However, surprisingly little research has been conducted to inform policies or practices consistent with this recommendation, which is already being implemented in some states. This article aims to provide an overview of the challenges to the prevention and treatment of childhood obesity that have motivated the call for CPS involvement in extreme cases and to review the existing research related to this approach. Given that relatively little data are currently available to support or refute the merits of CPS involvement, recommendations for future research that would better inform public policy and decision making regarding this and other intervention strategies are also highlighted.
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Affiliation(s)
- Deborah J Jones
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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Hoelscher DM, Kirk S, Ritchie L, Cunningham-Sabo L. Position of the Academy of Nutrition and Dietetics: interventions for the prevention and treatment of pediatric overweight and obesity. J Acad Nutr Diet 2013; 113:1375-94. [PMID: 24054714 DOI: 10.1016/j.jand.2013.08.004] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Indexed: 12/17/2022]
Abstract
It is the position of the Academy of Nutrition and Dietetics that prevention and treatment of pediatric overweight and obesity require systems-level approaches that include the skills of registered dietitians, as well as consistent and integrated messages and environmental support across all sectors of society to achieve sustained dietary and physical-activity behavior change. This position paper provides guidance and recommendations for levels of intervention targeting overweight and obesity prevention and treatment from preschool age through adolescence. Methods included a review of the literature from 2009 to April 2012, including the Academy's 2009 evidence analysis school-based reviews. Multicomponent interventions show the greatest impact for primary prevention; thus, early childhood and school-based interventions should integrate behavioral and environmental approaches that focus on dietary intake and physical activity using a systems-level approach targeting the multilevel structure of the socioecological model as well as interactions and relationships between levels. Secondary prevention and tertiary prevention/treatment should emphasize sustained family-based, developmentally appropriate approaches that include nutrition education, dietary counseling, parenting skills, behavioral strategies, and physical-activity promotion. For obese youth with concomitant serious comorbidities, structured dietary approaches and pharmacologic agents should be considered, and weight-loss surgery can be considered for severely obese adolescents. Policy and environmental interventions are recommended as feasible and sustainable ways to support healthful lifestyles for children and families. The Academy supports commitment of resources for interventions, policies, and research that promote healthful eating and physical-activity behaviors to ensure that all youth have the opportunity to achieve and maintain a weight that is optimal for health.
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Hofmann B. Bariatric surgery for obese children and adolescents: a review of the moral challenges. BMC Med Ethics 2013; 14:18. [PMID: 23631445 PMCID: PMC3655839 DOI: 10.1186/1472-6939-14-18] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 04/22/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Bariatric surgery for children and adolescents is becoming widespread. However, the evidence is still scarce and of poor quality, and many of the patients are too young to consent. This poses a series of moral challenges, which have to be addressed both when considering bariatric surgery introduced as a health care service and when deciding for treatment for young individuals. A question based (Socratic) approach is applied to reveal underlying moral issues that can be relevant to an open and transparent decision making process. DISCUSSION A wide range of moral issues with bariatric surgery for children and adolescents is identified in the literature. There is a moral imperative to help obese minors avoiding serious health problems, but there is little high quality evidence on safety, outcomes, and cost-effectiveness for bariatric surgery in this group. Lack of maturity and family relations poses a series of challenges with autonomy, informed consent, assent, and assessing the best interest of children and adolescents. Social aspects of obesity, such as medicalization, prejudice, and discrimination, raise problems with justice and trust in health professionals. Conceptual issues, such as definition of obesity and treatment end-points, present moral problems. Hidden interests of patients, parents, professionals, industry, and society need to be revealed. SUMMARY Performing bariatric surgery for obese children and adolescents in order to discipline their behavior warrants reflection and caution. More evidence on outcomes is needed to be able to balance benefits and risks, to provide information for a valid consent or assent, and to advise minors and parents.
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Affiliation(s)
- Bjørn Hofmann
- Section for Health, Technology, and Society, University College of Gjøvik, PO Box 191, Gjøvik, N-2802, Norway.
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Winckworth LC, Coren M. Environmental change as an effective treatment of severe childhood obesity. J Paediatr Child Health 2013; 49:E351-2. [PMID: 23574567 DOI: 10.1111/jpc.12140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lucinda C Winckworth
- St Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
| | - Michael Coren
- St Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
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Pratt KJ, Greer AG. Debating Parental Responsibility for Childhood Obesity: Ethical and Legal Considerations. ACTA ACUST UNITED AC 2012. [DOI: 10.1089/bar.2012.9973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Keeley J. Pratt
- Adjunct Graduate Faculty, Department of Child Development and Family Relations, College of Human Ecology, East Carolina University, Greenville, North Carolina
| | - Annette G. Greer
- Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Allen DB, Fost N. Obesity and neglect: it's about the child. J Pediatr 2012; 160:898-9. [PMID: 22504101 DOI: 10.1016/j.jpeds.2012.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 01/31/2012] [Accepted: 02/21/2012] [Indexed: 11/25/2022]
Affiliation(s)
- David B Allen
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Schneiderman JU, Mennen FE, Negriff S, Trickett PK. Overweight and obesity among maltreated young adolescents. CHILD ABUSE & NEGLECT 2012; 36:370-8. [PMID: 22571911 PMCID: PMC3359392 DOI: 10.1016/j.chiabu.2012.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 02/06/2012] [Accepted: 03/27/2012] [Indexed: 05/11/2023]
Abstract
PURPOSE (1) To identify and compare rates of body mass index (BMI)≥ 85% (overweight/obesity) and BMI ≥ 95% (obesity) in maltreated versus comparison young adolescents; (2) to determine whether demographic/psychological characteristics are related to high BMI; (3) to determine whether type of maltreatment is related to high BMI in maltreated young adolescents. METHODS We compared a sample of maltreated young adolescents to a comparison sample of adolescents from the same neighborhood. The maltreated sample (n=303) of young adolescents (ages 9-12) came from referrals from the county child welfare department in Los Angeles, CA from new cases of maltreatment opened in specified zip codes. A comparison sample (n=151) was recruited from the same zip codes. The total sample (both maltreated and comparison) was 77% Black or Hispanic and 23% White or biracial with 53% males and 47% females. A stepwise logistic regression was used to examine predictors of high BMI with demographic/psychological covariates and maltreatment group. The maltreated young adolescents were selected and the logistic model included all covariates as well as an interaction between gender and each maltreatment type (neglect, sexual, and physical abuse). RESULTS Maltreated young adolescents were similar to comparison adolescents in obesity prevalence (27.1% and 34.4%, respectively), although comparison young adolescents were 1.7 times more likely to have overweight/obesity than the maltreated young adolescents (95% CI=1.13-2.76). No demographic variables predicted high BMI. For the comparison young adolescents, depression slightly increased the odds of overweight/obesity (OR=1.08, 95% CI=1.01-1.15). Being neglected reduced the odds of being in the overweight/obesity and obesity group when combining genders. For females, but not males, sexual and physical abuse slightly reduced the odds of obesity. CONCLUSIONS Both the maltreated and comparison young adolescents had a high prevalence of overweight and obesity, which puts them at risk for health problems. Maltreatment reduced the odds of having a high BMI for adolescents in this study, which is opposite to research in adults. Further exploration of the mechanism of how maltreatment is related to weight as adolescents age, with specific emphasis on differences between genders, is needed.
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Affiliation(s)
- Janet U Schneiderman
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA 90089-0411, USA
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Abstract
Today, many medical interventions that begin as treatments for disease often expand into therapies that reduce disability, lessen disadvantage, or even confer advantage. Forces that propel profitable drugs, devices, and procedures dominate over considerations of efficient and equitable distribution of resources. This dominance is fueled by industry-physician collaborations often biased by prior assumptions, reliant on surrogate outcomes, and advantageous to marketing. Interventions are justified by "medicalization" of physiologic variations (e.g. short stature) as defects or disease, and nudged into "standard practice" by key opinion leaders. The story below of recombinant human growth hormone (hGH) treatment of short stature is one vivid example, but others (e.g. expansion of drug treatment to "optimize" cholesterol profiles, bone health, psychological well-being) can be found throughout medicine. In the new obesity era, lessons learned from the hGH era will be needed to keep the field of pediatric endocrinology empowered to make the key clinical decisions, and free of unintended consequences for patients and runaway health care inflation for society.
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Affiliation(s)
- David B Allen
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705, USA.
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Tirosh A, Afek A, Rudich A, Percik R, Gordon B, Ayalon N, Derazne E, Tzur D, Gershnabel D, Grossman E, Karasik A, Shamiss A, Shai I. Progression of normotensive adolescents to hypertensive adults: a study of 26,980 teenagers. Hypertension 2010; 56:203-9. [PMID: 20547973 DOI: 10.1161/hypertensionaha.109.146415] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although prehypertension at adolescence is accepted to indicate increased future risk of hypertension, large-scale/long follow-up studies are required to better understand how adolescent blood pressure (BP) tracks into young adulthood. We studied 23 191 male and 3789 female adolescents from the Metabolic Lifestyle and Nutrition Assessment in Young Adults cohort (mean age: 17.4 years) with BP <140/90 mm Hg at enrollment or categorized by current criteria for pediatric BP and body mass index (BMI) values. Participants were prospectively followed up with repeated BP measurements between ages 25 and 42 years and retrospectively between ages 17 and 25 years for the incidence of hypertension. We identified 3810 new cases of hypertension between ages 17 and 42 years. In survival analyses, the cumulative risk of hypertension between ages 17 and 42 years was 3 to 4 times higher in men than in women. Using Cox regression models adjusted for age, BMI, and stratified by baseline BP, the hazard ratio of hypertension increased gradually across BP groups within the normotensive range at age 17 years, without a discernible threshold effect, reaching a hazard ratio of 2.50 (95% CI: 1.75 to 3.57) for boys and 2.31 (95% CI: 0.71 to 7.60) for girls in the group with BP at 130 to 139/85 to 89 mm Hg. BMI at age 17 years was strongly associated with future risk of hypertension even when adjusted to BP at age 17 years, particularly in boys. Yet, BMI at age 30 years attenuated this association, more evidently in girls. In conclusion, BP at adolescence, even in the low-normotensive range, linearly predicts progression to hypertension in young adulthood. This progression and the apparent interaction between BP at age 17 years and BMI at adolescence and at adulthood are sex dependent.
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Affiliation(s)
- Amir Tirosh
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Sealy YM. Parents' perceptions of food availability: implications for childhood obesity. SOCIAL WORK IN HEALTH CARE 2010; 49:565-580. [PMID: 20640967 DOI: 10.1080/00981381003635353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Childhood obesity is an epidemic in the United States, with children experiencing chronic adult diseases and poor health outcomes. Focus groups were held with parents of children between 6-12 years of age in three different communities in Brooklyn and the Bronx, New York, to explore their attitudes and practices regarding food availability. Poor food quality and discrimination were the key themes affecting parents' food choices and perceptions of food availability in their neighborhoods. Social workers are in a position to decrease obesity prevalence by supporting childhood obesity policy legislation, designing interventions to increase parental awareness of childhood obesity and the importance of making healthy food choices, and working with parents to improve food quality and availability in their neighborhoods.
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Affiliation(s)
- Yvette M Sealy
- Graduate School of Social Service, Fordham University, New York, New York 10023, USA.
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Bariatric surgery in the management of childhood obesity: should there be an age limit? Obes Surg 2009; 20:114-7. [PMID: 19844765 DOI: 10.1007/s11695-009-9996-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 09/30/2009] [Indexed: 10/20/2022]
Abstract
We report a case of a 6-year-old girl suffering from morbid obesity, Blount;s disease, and significant social and functional impairment who underwent a laparoscopic sleeve gastrectomy. One year later, she has shown remarkable improvement in all aspects of her health emphasizing the success of the procedure. A follow-up laparoscopic Roux-en-Y gastric bypass or biliopancreatic diversion (BPD) are options if she regains weight as she gets older. This case is noteworthy for several reasons. The age of the patient is younger than any currently on record who has had this treatment. Additionally, the utilization of a sleeve gastrectomy as a first-step procedure, to be followed by Roux-en-Y gastric bypass or BPD, remains a novel treatment for morbid obesity in a pediatric population.
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