1
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Srikumar G, Schroeder D, McEwan C, MacCormick AD. Development of the national bariatric prioritization tool in Aotearoa New Zealand. ANZ J Surg 2023; 93:2843-2850. [PMID: 37483147 DOI: 10.1111/ans.18623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Bariatric surgery is a proven effective method of reducing obesity and reversing or preventing obesity-related comorbidities. The aim of this study is to describe the development of a tool to assist with the prioritization of patients with obesity for bariatric surgery. The tool would meet the criteria for being evidence-based, fair, implementable and transparent. METHODS The development of the tool involved a validated step-by-step process based on the consensus of clinical judgement of the New Zealand Ministry of Health working party. The process involved elicitation of criteria, clinical ranking of vignettes and creation of weightings using the 1000Minds® tool. The concurrent validity was tested by comparing tool rankings of vignettes to clinical judgement rankings. RESULTS Four major criteria (impact on life, likelihood of achieving maximum benefit with respect to control of diabetes, duration of benefit and surgical risk) are used to characterize the need and potential to benefit. The impact on life criterion has the largest weighting (up to 44.3%). There was good concurrent validity with a correlation coefficient r = 0.67. CONCLUSION The tool as presented is evidence-based, transparent and internally valid. The next step is to assess the predictive validity of the tool using real patient data to evaluate the effectiveness of the tool and determine what modifications may be required.
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Affiliation(s)
- Gajan Srikumar
- Department of General Surgery, Middlemore Hospital, Auckland, New Zealand
| | - David Schroeder
- General and Bariatric Surgery, Waikato Surgery, Hamilton, New Zealand
| | - Christopher McEwan
- Prioritisation, Planned Care, Hospital and Specialist Services, Ministry of Health, Wellington, New Zealand
| | - Andrew D MacCormick
- Department of General Surgery, Middlemore Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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2
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Tung JYL, Poon GWK, Du J, Wong KKY. Obesity in children and adolescents: Overview of the diagnosis and management. Chronic Dis Transl Med 2023. [DOI: 10.1002/cdt3.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Affiliation(s)
- Joanna Y. L. Tung
- Department of Paediatrics and Adolescent Medicine The University of Hong Kong Pokfulam Hong Kong China
- Department of Paediatrics and Adolescent Medicine Hong Kong Children's Hospital Hong Kong China
| | - Grace W. K. Poon
- Department of Paediatrics and Adolescent Medicine The University of Hong Kong Pokfulam Hong Kong China
| | - Juan Du
- Department of Endocrinology Jilin Province People's Hospital Jilin China
- The Paediatric Precision Medicine Centre Children's Hospital of Changchun Jilin China
| | - Kenneth K. Y. Wong
- Department of Surgery The University of Hong Kong Pokfulam Hong Kong China
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3
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Al-Beltagi M, Bediwy AS, Saeed NK. Insulin-resistance in paediatric age: Its magnitude and implications. World J Diabetes 2022; 13:282-307. [PMID: 35582667 PMCID: PMC9052009 DOI: 10.4239/wjd.v13.i4.282] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/12/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Insulin resistance (IR) is insulin failure in normal plasma levels to adequately stimulate glucose uptake by the peripheral tissues. IR is becoming more common in children and adolescents than before. There is a strong association between obesity in children and adolescents, IR, and the metabolic syndrome components. IR shows marked variation among different races, crucial to understanding the possible cardiovascular risk, specifically in high-risk races or ethnic groups. Genetic causes of IR include insulin receptor mutations, mutations that stimulate autoantibody production against insulin receptors, or mutations that induce the formation of abnormal glucose transporter 4 molecules or plasma cell membrane glycoprotein-1 molecules; all induce abnormal energy pathways and end with the development of IR. The parallel increase of IR syndrome with the dramatic increase in the rate of obesity among children in the last few decades indicates the importance of environmental factors in increasing the rate of IR. Most patients with IR do not develop diabetes mellitus (DM) type-II. However, IR is a crucial risk factor to develop DM type-II in children. Diagnostic standards for IR in children are not yet established due to various causes. Direct measures of insulin sensitivity include the hyperinsulinemia euglycemic glucose clamp and the insulin-suppression test. Minimal model analysis of frequently sampled intravenous glucose tolerance test and oral glucose tolerance test provide an indirect estimate of metabolic insulin sensitivity/resistance. The main aim of the treatment of IR in children is to prevent the progression of compensated IR to decompensated IR, enhance insulin sensitivity, and treat possible complications. There are three main lines for treatment: Lifestyle and behavior modification, pharmacotherapy, and surgery. This review will discuss the magnitude, implications, diagnosis, and treatment of IR in children.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Department of Pulmonology, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama 12, Bahrain
- Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Busaiteen 15503, Bahrain
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4
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Giblin J, Santos M, Finck C. Thiamine deficiency in an adolescent following bariatric surgery. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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5
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Westrick A, Liu S, Messiah SE, Koru-Sengul T, Hlaing WM. Hospital Length of Stay after Metabolic and Bariatric Surgery by Race/Ethnicity and Procedure Type among Florida Patients. J Natl Med Assoc 2020; 112:158-166. [DOI: 10.1016/j.jnma.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 02/01/2023]
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Ahn SM. Current Issues in Bariatric Surgery for Adolescents with Severe Obesity: Durability, Complications, and Timing of Intervention. J Obes Metab Syndr 2020; 29:4-11. [PMID: 32183507 PMCID: PMC7118002 DOI: 10.7570/jomes19073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/16/2020] [Accepted: 02/20/2020] [Indexed: 02/06/2023] Open
Abstract
Conventional nonsurgical management of severe obesity in the pediatric population and adolescents has focused on a multidisciplinary approach involving diet, exercise, behavioral modification, and to some extent, pharmaceuticals. Although nonsurgical strategies provide a certain degree of effective weight reduction, most of the severely obese adolescents suffer from a high relapse rate. In recent studies, long-term outcomes of bariatric surgery for severely obese adolescents have shown sustainable effects on weight loss and resolution of related comorbidities, such as hypertension and type 2 diabetes mellitus in this vulnerable age group. Notably, the role and practical benefits of bariatric surgery as a multidisciplinary therapeutic approach to adolescent obesity is gaining attention and acceptance. However, a surgical approach has many obstacles that prevent the timely evaluation and optimal intervention for adolescent obesity and its comorbidities. In the present review, the latest data on long-term outcomes after bariatric surgery for severely obese adolescents in terms of durability, effects on metabolic risk factors, complications, and optimal timing were summarized. The results showed the sustainability of weight loss and comorbidity resolution in adolescents following bariatric surgery. In addition, earlier surgery in patients without an extremely high body mass index increases the likelihood of a healthier life in adulthood. This review can help clarify the beneficial effects of bariatric surgery on weight reduction and resolution of comorbidities in severely obese adolescents and remove the barriers to referral of adolescents for bariatric surgery.
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Affiliation(s)
- Soo Min Ahn
- Department of Surgery, Bariatric and Metabolic Surgery Center, Pediatric Specialized Center, Hallym University Sacred Heart Hospital, Anyang, Korea
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7
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Sarno LA, Lipshultz SE, Harmon C, De La Cruz-Munoz NF, Balakrishnan PL. Short- and long-term safety and efficacy of bariatric surgery for severely obese adolescents: a narrative review. Pediatr Res 2020; 87:202-209. [PMID: 31401646 DOI: 10.1038/s41390-019-0532-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/16/2019] [Accepted: 07/25/2019] [Indexed: 12/27/2022]
Abstract
The selection criteria, safety, and efficacy of bariatric surgery are well established in adults but are less well defined for severely obese adolescents. The number of severely obese adolescents who could benefit from weight loss surgery is increasing, although referral rates have plateaued. Surgical options for these adolescents are controversial and raise several questions. Recent studies, including the prospective Teen-Longitudinal Assessment of Bariatric Surgery Study and the Adolescent Morbid Obesity Surgery Study, help answer these questions. Early bariatric surgical intervention improves body mass index but, more importantly, improves cardiovascular and metabolic co-morbidities of severe obesity. A review of the medical, psychosocial, and economic risks and benefits of bariatric surgery in severely obese adolescents is a step toward improving the management of a challenging and increasing population. We describe the current knowledge of eligibility criteria, preoperative evaluation, surgical options, outcomes, and referral barriers of adolescents for bariatric surgery.
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Affiliation(s)
- Lauren A Sarno
- Division of Pediatric Cardiology, East Carolina University, Brody School of Medicine, Greenville, NC, USA.
| | - Steven E Lipshultz
- Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Carroll Harmon
- Division of Pediatric Surgery, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Preetha L Balakrishnan
- Division of Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
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8
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Bishop-Freeman SC, Skirnick O, Noble CN, Eagerton DH, Winecker RE. Effects of Bariatric Surgery Observed in Postmortem Toxicology Casework. J Anal Toxicol 2019; 43:651-659. [PMID: 31424074 DOI: 10.1093/jat/bkz062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
Bariatric surgery has been on the rise and patients often have multiple indications for pre- and post-operative pharmacotherapy. Procedures target the stomach and/or small intestine and affect weight loss through restriction, malabsorption, or a combination of the two. The absorption and/or metabolism of drugs via the gastrointestinal tract could be altered by different mechanisms. Several cases at the North Carolina Office of the Chief Medical Examiner's Toxicology Laboratory (NCOCME) have raised questions about the potential impact of these procedures on the disposition of drugs in the body and how that altered disposition may affect cause and manner of death. Overmedication and postmortem redistribution are not enough to explain the phenomena seen in some NCOCME bariatric surgery-related casework. Case examples include a 46-year-old female with a history of Roux-en-Y gastric bypass (RYGB) who suffered a witnessed collapse. Toxicological findings included elevated concentrations of oxymorphone at 0.49 mg/L in vena cava blood. A 67-year-old female, who died from vomiting and bacterial gastritis one day after placement of two intragastric weight-loss balloons, had elevated concentrations of duloxetine at 1.4 mg/L in the iliac vein blood and 9.3 mg/kg in the liver. Her medication was strictly controlled by her sister and gastric contents were without intact tablets or residue at autopsy.
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Affiliation(s)
| | - Olivia Skirnick
- North Carolina Office of the Chief Medical Examiner, Raleigh, NC, USA
| | | | - David H Eagerton
- Campbell University, College of Pharmacy and Health Sciences, Buies Creek, NC, USA
| | - Ruth E Winecker
- Center for Forensic Sciences, RTI International, Research Triangle Park, NC, USA
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9
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Hornack SE, Nadler EP, Wang J, Hansen A, Mackey ER. Sleeve Gastrectomy for Youth With Cognitive Impairment or Developmental Disability. Pediatrics 2019; 143:peds.2018-2908. [PMID: 30988024 DOI: 10.1542/peds.2018-2908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Youth with cognitive impairment or developmental disability (CI/DD) face higher rates of obesity and secondary medical issues. Bariatric surgery may be a helpful tool for health improvement because it has been shown efficacious for adolescents. We aim to contribute to literature regarding bariatric surgery for adolescents with CI/DD and explore the association between cognitive functioning and weight loss outcomes. METHODS Adolescents (N = 64) received a preoperative psychological evaluation, including cognitive assessment, and bariatric surgery at 1 weight loss program between 2010 and 2017. For these adolescents with measured cognitive performance, CI/DD was defined by an IQ <80 or previous diagnosis. In analyses, we compared adolescents with and without CI/DD. Structural equation modeling was used to assess the impact of cognitive functioning on weight loss 3 to 24 months postsurgery. RESULTS There were no significant differences between adolescents with or without CI/DD in terms of preoperative BMI, age, and sex. Having CI/DD did not significantly impact weight loss or weight loss trajectory in the 2 years after surgery, although modeling revealed a trend toward individuals with CI/DD losing more weight over time. Similarly, intelligence scores did not predict weight loss after surgery. CONCLUSIONS Bariatric surgery may be a helpful tool for adolescents with severe obesity and CI/DD. They could benefit from the surgery as much as those with typical development, and having CI/DD should not be used as a criterion to deny surgery. Continuing research with this population can be used to determine long-term outcomes in addition to defining best practices.
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Affiliation(s)
- Sarah E Hornack
- Center for Translational Research, Children's National Health System, Washington, District of Columbia; .,School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
| | - Evan P Nadler
- Center for Translational Research, Children's National Health System, Washington, District of Columbia.,School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
| | - Jichuan Wang
- Center for Translational Research, Children's National Health System, Washington, District of Columbia.,School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
| | - Amysue Hansen
- Department of Psychology, George Mason University, Fairfax, Virginia
| | - Eleanor R Mackey
- Center for Translational Research, Children's National Health System, Washington, District of Columbia.,School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
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10
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Al-Hamad D, Raman V. Metabolic syndrome in children and adolescents. Transl Pediatr 2017; 6:397-407. [PMID: 29184820 PMCID: PMC5682379 DOI: 10.21037/tp.2017.10.02] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/26/2017] [Indexed: 01/19/2023] Open
Abstract
Prevalence of metabolic syndrome in children and adolescents is increasing, in parallel with the increasing trends in obesity rates. Varying definitions of this syndrome have hindered the development of a consensus for the diagnostic criteria in the pediatric population. While pathogenesis of metabolic syndrome is not completely understood, insulin resistance and subsequent inflammation are thought to be among its main mechanistic underpinnings. Overweight and obesity are cardinal features, along with abnormal glucose metabolism, dyslipidemia, and hypertension. Other disorders associated with metabolic syndrome include fatty liver, polycystic ovarian syndrome (PCOS), and pro-inflammatory states. Prevention and management of this condition can be accomplished with lifestyle modifications, behavioral interventions, pharmacological and surgical interventions as needed.
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Affiliation(s)
- Dania Al-Hamad
- Division of Pediatric Endocrinology and Diabetes, University of Utah, Salt Lake City, UT, USA
| | - Vandana Raman
- Division of Pediatric Endocrinology and Diabetes, University of Utah, Salt Lake City, UT, USA
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Mühlig Y, Scherag A, Bickenbach A, Giesen U, Holl R, Holle R, Kiess W, Lennerz B, Brintrup DL, Moss A, Neef M, Ose C, Reinehr T, Teuner CM, Wiegand S, Wolters B, Wabitsch M, Hebebrand J. A Structured, Manual-Based Low-Level Intervention vs. Treatment as Usual Evaluated in a Randomized Controlled Trial for Adolescents with Extreme Obesity - the STEREO Trial. Obes Facts 2017; 10:341-352. [PMID: 28787738 PMCID: PMC5644941 DOI: 10.1159/000475717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/03/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To compare efficacy and safety of a manual-based low-level psychological intervention with treatment as usual (weight loss treatment). METHODS A two-armed randomized controlled trial without blinding and computer-based stratified block randomization included adolescents and young adults (14.0-24.9 years) with a BMI ≥ 30 kg/m2 at five German university hospitals. Primary outcomes were adherence (participation rate ≥ 5/6 sessions) and quality of life (DISABKIDS-37) 6 months after randomization. Secondary outcomes included depression, self-esteem, and perceived stress scores. RESULTS Of 397 screened adolescents, 119 (mean BMI 40.4 ± 7.0 kg/m2, 49.6% female) were randomized to the manual-based low-level intervention (n = 59) or treatment as usual (n = 60). We observed no group difference for adherence (absolute risk reduction 0.4%, 95% CI -14.7% to 15.5%; p = 1.0) or health-related quality of life (score difference 8.1, 95% CI -2.1 to 18.3; p = 0.11). Among all secondary outcomes, we detected explorative evidence for an effect on the DISABKIDS-37 'social exclusion' subscale (score difference 15.5; 95% CI 1.6-29.4; p = 0.03). 18/19 adverse events occurred in 26 participants, none were classified as serious. CONCLUSION Adherence to a coping-oriented intervention was comparable to weight loss treatment, although it was weak in both interventions. Psychological interventions may help to overcome social isolation; further confirmation is required.
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Affiliation(s)
- Yvonne Mühlig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - André Scherag
- Research Group Clinical Epidemiology, Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Annika Bickenbach
- Ambulatory Obesity Center, Charité - University Hospital Berlin, Berlin, Germany
| | - Ulrike Giesen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Reinhard Holl
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, Munich, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, Department of Women and Child Health, University of Leipzig, Leipzig, Germany
| | - Belinda Lennerz
- Division of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, Department of Pediatrics and Adolescent Medicine, University of Ulm, Ulm, Germany
| | - Diana Lütke Brintrup
- Institute for Medical Informatics, Biometry and Epidemiology and Center for Clinical Trials Essen (ZKSE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anja Moss
- Division of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, Department of Pediatrics and Adolescent Medicine, University of Ulm, Ulm, Germany
| | - Madlen Neef
- Hospital for Children and Adolescents, Department of Women and Child Health, University of Leipzig, Leipzig, Germany
| | - Claudia Ose
- Institute for Medical Informatics, Biometry and Epidemiology and Center for Clinical Trials Essen (ZKSE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thomas Reinehr
- Vestische Childrens Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Christina M. Teuner
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, Munich, Germany
| | - Susanna Wiegand
- Ambulatory Obesity Center, Charité - University Hospital Berlin, Berlin, Germany
| | - Barbara Wolters
- Vestische Childrens Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, Department of Pediatrics and Adolescent Medicine, University of Ulm, Ulm, Germany
| | - Johannes Hebebrand
- Institute for Medical Informatics, Biometry and Epidemiology and Center for Clinical Trials Essen (ZKSE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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12
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Weiss AL, Mooney A, Gonzalvo JP. Bariatric Surgery: The Future of Obesity Management in Adolescents. Adv Pediatr 2017; 64:269-283. [PMID: 28688592 DOI: 10.1016/j.yapd.2017.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Amy L Weiss
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA.
| | - Ashley Mooney
- Department of Surgery, Morsani College of Medicine, University of South Florida, 5 Tampa General Circle, Suite 410, Tampa, FL 33606, USA
| | - John Paul Gonzalvo
- Department of Surgery, Morsani College of Medicine, University of South Florida, 5 Tampa General Circle, Suite 410, Tampa, FL 33606, USA
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13
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Affiliation(s)
- Amy L. Christison
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Sandeep K. Gupta
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
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14
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Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, Yanovski JA. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102:709-757. [PMID: 28359099 PMCID: PMC6283429 DOI: 10.1210/jc.2016-2573] [Citation(s) in RCA: 620] [Impact Index Per Article: 88.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/10/2016] [Indexed: 02/06/2023]
Abstract
COSPONSORING ASSOCIATIONS The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society. OBJECTIVE To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity. PARTICIPANTS The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer. EVIDENCE This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline. CONCLUSION Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.
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Affiliation(s)
- Dennis M Styne
- University of California Davis, Sacramento, California 95817
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15
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Meehan C, Silverstein J. Treatment Options for Type 2 Diabetes in Youth Remain Limited. J Pediatr 2016; 170:20-7. [PMID: 26681477 DOI: 10.1016/j.jpeds.2015.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/07/2015] [Accepted: 11/05/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Colette Meehan
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL
| | - Janet Silverstein
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL.
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17
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Tsamis D, Plastiras A, Natoudi M, Oikonomou E, Zografos G, Leandros E, Albanopoulos K. Impact of Laparoscopic Sleeve Gastrectomy on Weight Loss and Associated Comorbidities in Adolescents and Young Adults. J Laparoendosc Adv Surg Tech A 2015; 25:971-5. [DOI: 10.1089/lap.2015.0426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dimitrios Tsamis
- Laparoscopic Unit of 1st Propaideutic Surgical Clinic of University of Athens, Hippokration Hospital of Athens, Athens, Greece
| | - Aris Plastiras
- Laparoscopic Unit of 1st Propaideutic Surgical Clinic of University of Athens, Hippokration Hospital of Athens, Athens, Greece
| | - Maria Natoudi
- Laparoscopic Unit of 1st Propaideutic Surgical Clinic of University of Athens, Hippokration Hospital of Athens, Athens, Greece
| | - Evangelos Oikonomou
- Laparoscopic Unit of 1st Propaideutic Surgical Clinic of University of Athens, Hippokration Hospital of Athens, Athens, Greece
| | - Georgios Zografos
- Laparoscopic Unit of 1st Propaideutic Surgical Clinic of University of Athens, Hippokration Hospital of Athens, Athens, Greece
| | - Emmanouil Leandros
- Laparoscopic Unit of 1st Propaideutic Surgical Clinic of University of Athens, Hippokration Hospital of Athens, Athens, Greece
| | - Konstantinos Albanopoulos
- Laparoscopic Unit of 1st Propaideutic Surgical Clinic of University of Athens, Hippokration Hospital of Athens, Athens, Greece
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