# Obesity — GCMD Library living collection Everything in the library about obesity — built automatically from dossiers that name it. Updated: n/a · 30 episodes · 646 cited statements ## Episodes ### Fundamentals - [Weight Bias: Child & Adolescent Obesity 2015](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863) — video · 34:43 · [machine version](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863.md) - [Everyday Stress: Child & Adolescent Obesity 2015](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864) — video · 27:59 · [machine version](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864.md) ### Diagnosis & Workup - [Making the Assessment, Management and Treatment of Obesity Come Alive in Your...](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865) — video · 46:57 · [machine version](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865.md) - [Identifying & Managing Eating Disorders in Pediatric Obesity Treatment: Current Practices in Weight](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885) — video · 0:53 · [machine version](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885.md) - [Identifying & Managing Eating Disorders in Pediatric Obesity Treatment: Current Practices in Weight](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886) — video · 0:53 · [machine version](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886.md) ### Medical Management - [The Right Tool for the Job: Child & Adolescent Obesity 2015](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870) — video · 42:40 · [machine version](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870.md) - [Stephanie Walsh, MD - 2024 Pediatric Bariatric Surgery Update Course](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963) — video · 16:14 · [machine version](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963.md) ### Surgical Management - [AAP Policy for Adolescent Bariatric Surgery: Pediatric Obesity 2017](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372) — video · 27:22 · [machine version](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372.md) - [Bariatric Surgery in the Pediatric Patient](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388) — podcast · 49:29 · [machine version](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388.md) - [Bariatric Partial Gastrectomy Technique: Adolescent Obesity 2013](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429) — video · 39:40 · [machine version](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429.md) - [Obesity: Advanced Practice Providers](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047) — video · 36:49 · [machine version](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047.md) - [Preoperative Optimization and Management - Caren Mangarelli, MD - 2024 Pediatric Bariatric Surgery Update Course](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957) — video · 26:30 · [machine version](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957.md) - [Marc Michalsky, MD - 2024 Pediatric Bariatric Surgery Update Course](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959) — video · 14:54 · [machine version](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959.md) - [Guillermo Ares, MD and Mark Wulkan, MD - 2024 Pediatric Bariatric Surgery Update Course](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961) — video · 16:42 · [machine version](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961.md) - [Janey Pratt, MD and David Lanning, MD - 2024 Pediatric Bariatric Surgery Update Course](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964) — video · 15:54 · [machine version](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964.md) ### Evidence & Research - [Public Policies to Address Obesity: Pediatric Obesity 2017](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365) — video · 46:10 · [machine version](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365.md) - [Bariatric Rapid Fire Sessions: Latest Evidence and Trends in Pediatric...](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869) — video · 22:06 · [machine version](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869.md) - [Bariatric surgery has improved remission of DMII and HTN when performed...](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628) — video · [machine version](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628.md) - [BOB Ped Surg 2023 - Wendy Jo Svetanoff, IPEG - Presentation](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360) — video · [machine version](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360.md) - [Justin Ryder, MD- 2024 Pediatric Bariatric Surgery Update Course](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967) — video · 12:26 · [machine version](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967.md) - [Clinical Research Facilitators, Barriers, and Preferences of Parents of Children With Overweight...](https://origin-library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884) — video · 0:41 · [machine version](https://origin-library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884.md) ### Case-Based Learning - [Rapid Fire and Conclusion: Pediatric Obesity 2017](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373) — video · 23:37 · [machine version](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373.md) - [PDC 2020 Practice Gaps](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998) — video · 1:23:26 · [machine version](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998.md) ### In-Depth Reviews - [StayCurrent Forums - Obesity in Children](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280) — video · [machine version](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280.md) - [Pediatric Obesity Is a Disease: Treatment, Medications, Surgery & Equity in Care with Dr. Justin Ryder](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602) — video · 6:48 · [machine version](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602.md) ### Emerging & Future Directions - [Evan Nadler, MD - 2024 Pediatric Bariatric Surgery Update Course](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966) — video · 29:40 · [machine version](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966.md) - [Wrap Up Discussions - 2024 Pediatric Bariatric Surgery Update Course](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968) — video · 13:52 · [machine version](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968.md) ### Patient & Family Education - [Taking the Battle Out of Getting Kids to Eat Healthier and Move More: Child &...](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862) — video · 1:09:36 · [machine version](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862.md) - [Manish Raiji, MD - 2024 Pediatric Bariatric Surgery Update Course](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965) — video · 15:17 · [machine version](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965.md) ### Long-Term Care - [Traci Williams, MD - 2024 Pediatric Bariatric Surgery Update Course](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960) — video · 19:59 · [machine version](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960.md) ## Chapters - [0:00](https://origin-library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=0) Barriers to Childhood Obesity Research Enrollment (Ep 28) - [0:00](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=0) Eating Disorder Screening Gaps in Pediatric Weight Management (Ep 29) - [0:00](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=0) Eating Disorder Screening Gaps in Pediatric Weight Management (Ep 30) - [0:00](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=0) Optimal BMI for Bariatric Surgery Intervention and Surgery vs. Medication Decision-Making (Ep 3) - [8:18](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=498) Pharmacotherapy Use Patterns in Clinical Practice (Ep 3) - [10:42](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=642) Financial Viability of Nutrition Services (Ep 3) - [14:22](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=862) Sugar Tax Policy Debate (Ep 3) - [16:47](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1007) Eating Disorders in Obesity Treatment (Ep 3) - [22:37](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1357) Closing Remarks (Ep 3) - [0:12](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=12) Introduction and Obstructive Sleep Apnea in Obese Surgical Patients (Ep 14) - [7:54](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=474) Long-term Surveillance After Esophageal Atresia Repair (Ep 14) - [13:22](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=802) Gas Embolism During Neonatal Laparoscopy (Ep 14) - [24:24](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=1464) Thromboelastography in Pediatric Trauma (Ep 14) - [29:00](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=1740) CDH Readiness Criteria and Pulmonary Hypertension Management (Ep 14) - [41:00](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=2460) Conservative Management of Spontaneous Pneumothorax (Ep 14) - [51:38](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3098) Balanced Resuscitation in Pediatric Trauma (Ep 14) - [60:01](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3601) Peritoneal Dialysis Catheter Placement Guidelines (Ep 14) - [68:21](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=4101) Hemodialysis Access: Fistula versus Catheter (Ep 14) - [75:42](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=4542) Newer Biologic Agents for Inflammatory Bowel Disease and Androgen Insensitivity Management (Ep 14) - [0:01](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=1) Introduction and Obesity as a Multifactorial Disease (Ep 27) - [1:00](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=60) Paradigm Shift in AAP Guidelines: From Prevention to Treatment (Ep 27) - [1:37](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=97) Treatment Continuum: Lifestyle, Pharmacotherapy, and Surgery (Ep 27) - [3:35](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=215) Weight Regain Mechanisms and Challenges (Ep 27) - [4:22](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=262) MASLD Prevalence and Risk in Pediatric Obesity (Ep 27) - [5:00](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=300) Advocacy for Treatment Access and Health Equity (Ep 27) - [0:00](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=0) Introduction of Dr. Kelly Brownell (Ep 1) - [1:16](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=76) Conceptual Framework: Individual vs. Environmental Approaches (Ep 1) - [7:00](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=420) The Power of Defaults: Pension Plans and Organ Donation (Ep 1) - [15:00](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=900) Toxic Food Defaults and Personal Responsibility (Ep 1) - [20:00](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=1200) Bridging Research and Policy: The Dropped Baton Problem (Ep 1) - [25:00](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=1500) Sugar-Sweetened Beverage Taxes: Case Study and Implementation (Ep 1) - [32:58](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=1978) Q&A: Tax Revenue, Food Subsidies, and School Nutrition (Ep 1) - [38:28](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2308) Q&A: SNAP Benefits, Small Business Concerns, and Closing (Ep 1) - [0:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=0) Introduction of Speaker and Topic (Ep 2) - [0:50](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=50) Rationale for Policy Development and Obesity Prevalence (Ep 2) - [7:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=420) Evolution of Evidence Base (Ep 2) - [10:40](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=640) Consensus Guidelines Development History (Ep 2) - [15:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=900) National Accreditation Standards (Ep 2) - [18:20](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1100) Insurance Authorization Barriers (Ep 2) - [22:30](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1350) Physician Attitudes and Procedural Prevalence (Ep 2) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - BMIs in the 40s will predictably achieve post-surgical BMIs less than 30 (clinical) [Ep 3 · 0:56](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=56) - Earlier intervention in bariatric surgery improves quality of life for patients (clinical) [Ep 3 · 1:49](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=109) - Once BMI crosses 50 threshold, probability of mitigating risks associated with BMI 35+ becomes challenging (clinical) [Ep 3 · 3:32](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=212) - Conversation about bariatric surgery should begin when BMI reaches mid-30s, especially with comorbidities (opinion) [Ep 3 · 3:59](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=239) - At BMI 49, surgery may fail to get patients out of the severely obese category (clinical) [Ep 3 · 5:34](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=334) - Topiramate and phentermine can be used as bridge therapy to buy time for patient maturity before surgery (clinical) [Ep 3 · 6:27](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=387) - Medications can serve as bridge to surgery, primary therapeutic intervention, or post-surgical adjunct depending on patient needs (clinical) [Ep 3 · 7:06](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=426) - Obesity is a heterogeneous disease requiring continuous treatment escalation based on individual patient response (clinical) [Ep 3 · 7:56](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=476) - Medications should be initiated after 3-6 months in program when healthy living alone is insufficient to control disease (guideline) [Ep 3 · 8:31](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=511) - Dexamphetamine has evidence base for hypothalamic obesity patients and may be needed pre- and post-surgery (clinical) [Ep 3 · 9:15](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=555) - Hypothalamic obesity patients have biological drive to gain weight that defeats surgery, profoundly different from patients without brain injury (clinical) [Ep 3 · 9:32](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=572) - Private insurers are limiting dietitian visits to 3 per year, inadequate for chronic disease management (clinical) [Ep 3 · 13:36](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=816) - Taxing specific products like sugar will not have desired impact because obesity is not caused by sugar per se (opinion) [Ep 3 · 15:08](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=908) - Most obese patients meet objective criteria for binge eating disorder when assessed with questionnaires, even without formal diagnosis (epidemiological) [Ep 3 · 19:53](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1193) - Surgery is effective at extinguishing binge eating behaviors (clinical) [Ep 3 · 20:49](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1249) - Prior binge eating disorder diagnosis may pose higher risk for relapse or weight regain long-term after surgery (clinical) [Ep 3 · 21:03](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1263) - Rate of true diagnosable binge eating disorder in obese pediatric patients is under 5% when screened with diagnostic criteria (epidemiological) [Ep 3 · 21:33](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1293) - Disordered eating (restricting during day, overeating in evening) is present in many obese patients even without formal eating disorder diagnosis (clinical) [Ep 3 · 21:18](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1278) - Patients who develop fear of eating and severe restriction should be referred to eating disorders programs (guideline) [Ep 3 · 21:51](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1311) - Disordered eating applies to nearly every obese patient, involving feelings and emotions around eating, food, and restricting, even without meeting DSM criteria (clinical) [Ep 3 · 22:20](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1340) - In the last 40 years, the prevalence of obesity has gone to over 18% of children worldwide — Liz Byerly (epidemiological) [Ep 14 · 6:39](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=399) - Kids who are obese and receiving therapy for DVT require closer monitoring of their enoxaparin levels because they can have altered drug metabolism due to obesity — Liz Byerly (clinical) [Ep 14 · 7:24](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=444) - A significant number of children with repaired esophageal atresia will have esophageal metaplasia or Barrett's esophagus, and symptoms often do not correlate with pathology — Liz Byerly (clinical) [Ep 14 · 11:22](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=682) - The most likely cause of cardiac arrest during laparoscopy in neonates is pneumopericardium from extraperitoneal insufflation — Liz Byerly (clinical) [Ep 14 · 16:22](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=982) - The problem occurs because insufflation tubing contains air with nitrogen, which is not soluble in blood, unlike carbon dioxide. It's like the baby gets the bends when you insufflate all that air — Liz Byerly (clinical) [Ep 14 · 17:52](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=1072) - End-tidal CO2 is the most sensitive detector of a gas embolism during laparoscopic surgery — Liz Byerly (clinical) [Ep 14 · 17:14](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=1034) - Prevention strategies include turning gas on and flushing tubing of air before connecting it to the patient, which decreases the amount of nitrogen and air delivered — Liz Byerly (clinical) [Ep 14 · 19:09](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=1149) - On thromboelastography, if R time is abnormal, the patient needs FFP. If alpha angle is abnormal, administer cryoprecipitate. If maximum amplitude is abnormal, give platelets. If LY30 shows excessive fibrinolysis, give aminocaproic acid or tranexamic acid — Liz Byerly (clinical) [Ep 14 · 27:03](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=1623) - Surgery is a stressor on the pulmonary vascular bed in CDH patients, so we want to see pulmonary artery pressures trending down and less than systemic pressures before operating — Eric Skarsgard (clinical) [Ep 14 · 38:20](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=2300) - For CDH patients with predominantly right ventricular dysfunction on echo, treatment options are nitric oxide, sildenafil, and increasingly PGE1, which maintains the ductus open and allows a pop-off vent for the right ventricle — Eric Skarsgard (clinical) [Ep 14 · 39:47](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=2387) - Giving excessive crystalloid worsens dilutional coagulopathy and increases metabolic acidosis in trauma patients — Eric Skarsgard (clinical) [Ep 14 · 56:37](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3397) - There is no evidence supporting intentional hypotensive resuscitation as a strategy in pediatric trauma — Eric Skarsgard (opinion) [Ep 14 · 58:51](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3531) - Half-life of even a living donor kidney is only about 23-24 years, so a 5-year-old receiving a transplant will face retransplant at age 27-28 — Eric Skarsgard (clinical) [Ep 14 · 69:16](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=4156) - Obesity is a disease impacted by behavior and represents a multifactorial disease impacted by a robust gene-environment interaction. — Justin Ryder (clinical) [Ep 27 · 0:32](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=32) - Obesity is influenced by numerous factors including genetics, epigenetics, appetite and satiety hormone dysregulation, stress, economics, adverse life experiences, and environmental factors like calorically dense foods and sedentary lifestyles. — Justin Ryder (clinical) [Ep 27 · 0:44](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=44) - Historically, about 90% of efforts over the past 50 years have been on prevention of childhood obesity. — Justin Ryder (epidemiological) [Ep 27 · 1:08](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=68) - The new AAP clinical practice guidelines clearly state that obesity is a disease. — Justin Ryder (guideline) [Ep 27 · 1:15](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=75) - Treatment should be offered to all children above the 85th percentile, and there should be no more watchful waiting. — Justin Ryder (guideline) [Ep 27 · 1:25](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=85) - The guidelines describe a non-linear continuum of care starting with intensive health, behavior, and lifestyle treatment involving more than 26 contact hours over a 3 to 12-month period. — Justin Ryder (guideline) [Ep 27 · 1:41](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=101) - Pharmacotherapy is FDA labeled for adolescents above the age of 12. — Justin Ryder (guideline) [Ep 27 · 1:55](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=115) - Currently, there are 5 medications that are FDA approved for the treatment of adolescents with obesity. — Justin Ryder (clinical) [Ep 27 · 2:02](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=122) - Bariatric surgery should be considered for those over the age of 13 years old with a BMI 1.2 times the 95th percentile. — Justin Ryder (guideline) [Ep 27 · 2:08](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=128) - Wegovy, a GLP-1 receptor agonist, causes about 17% weight loss and is FDA approved in adolescents. — Justin Ryder (clinical) [Ep 27 · 2:29](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=149) - Data in adults on tirzepatide shows significant change in body weight compared to placebo. — Justin Ryder (clinical) [Ep 27 · 2:44](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=164) - Oral GLP-1 medications are on the way in a few short years. — Justin Ryder (clinical) [Ep 27 · 2:51](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=171) - Bariatric surgery studies show sustained weight loss in both adults and adolescent cohorts over several years. — Justin Ryder (clinical) [Ep 27 · 2:51](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=171) - There is no difference between Roux-en-Y gastric bypass and vertical sleeve gastrectomy in terms of percent BMI change from baseline over a 10-year period. — Justin Ryder (clinical) [Ep 27 · 3:03](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=183) - There is significant heterogeneity in response to bariatric surgery, and weight regain is a significant problem. — Justin Ryder (clinical) [Ep 27 · 3:18](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=198) - Bariatric surgery produces substantial improvements in conditions that commonly occur with obesity, like hypertension, diabetes, and high lipids. — Justin Ryder (clinical) [Ep 27 · 3:24](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=204) - Weight regain is driven by a complex interplay between behaviors like physical activity and energy intake, and biological factors like energy expenditure and appetite and satiety hormones that regulate how full you feel. — Justin Ryder (clinical) [Ep 27 · 3:40](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=220) - Weight regain factors are all influenced by genetics and the environment, including puberty, race, and socioeconomic status. — Justin Ryder (clinical) [Ep 27 · 3:56](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=236) - It is much easier to lose weight than to keep it off, which is demonstrated across many studies. — Justin Ryder (clinical) [Ep 27 · 4:03](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=243) - Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent pediatric liver disease. — Justin Ryder (epidemiological) [Ep 27 · 4:22](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=262) - Obesity is a significant risk factor for MASLD. — Justin Ryder (clinical) [Ep 27 · 4:31](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=271) - About 20% of youth in the United States have obesity, which is roughly 15 million children. — Justin Ryder (epidemiological) [Ep 27 · 4:34](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=274) - Approximately 5 million children have both obesity and MASLD. — Justin Ryder (epidemiological) [Ep 27 · 4:40](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=280) - Between 250,000 and 1 million children with obesity and MASLD will progress to cirrhosis and needing a liver transplant or having hepatocellular carcinoma. — Justin Ryder (epidemiological) [Ep 27 · 4:45](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=285) - There are racial and ethnic differences in MASLD prevalence. — Justin Ryder (epidemiological) [Ep 27 · 4:56](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=296) - Obesity affects at least 35% of adults and 20% of children in Illinois alone. — Justin Ryder (epidemiological) [Ep 27 · 5:09](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=309) - The rates of severe forms of obesity are only increasing. — Justin Ryder (epidemiological) [Ep 27 · 5:09](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=309) - Obesity significantly increases the risk of long-term health problems and early death. — Justin Ryder (clinical) [Ep 27 · 5:19](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=319) - The economic impact of obesity is substantial, with reductions in GDP and increases in state spending. — Justin Ryder (epidemiological) [Ep 27 · 5:23](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=323) - Obesity is a disease driven by biology and it is no one's fault. — Justin Ryder (opinion) [Ep 27 · 5:30](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=330) - Access to effective obesity medications is a health equity issue. — Justin Ryder (opinion) [Ep 27 · 5:37](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=337) - Obesity disproportionately affects people of color and those living in poverty. — Justin Ryder (epidemiological) [Ep 27 · 5:41](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=341) - Organizations like the Stop Obesity Alliance are working to analyze how states are covering obesity medications in Medicaid programs, and there is significant variation across the country. — Justin Ryder (clinical) [Ep 27 · 5:49](https://origin-library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-11602?t=349) - When people consume calories in liquid form, they tend not to feel as full and tend to overconsume compared to consuming the same number of calories in solid form. — Kelly Brownell (clinical) [Ep 1 · 25:00](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=1500) - With pension plans, when employees must opt in (default is not enrolled), about 50% enroll; when employees are enrolled by default but can opt out, enrollment approaches 100%. — Kelly Brownell (epidemiological) [Ep 1 · 9:00](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=540) - In countries using opt-out organ donation (default is donor status), consent rates reach 99.98%; in countries using opt-in systems like the US, rates are much lower. — Kelly Brownell (epidemiological) [Ep 1 · 10:00](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=600) - A tax of about 1 penny per ounce increases beverage price by about 15% and is expected to reduce consumption of sugar-sweetened beverages by about 15%. — Kelly Brownell (epidemiological) [Ep 1 · 34:01](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2041) - Evaluations in Mexico and Berkeley show that sugar-sweetened beverage taxes are being passed along to consumers and affecting behavior; in Mexico, there has been an increase in water consumption. — Kelly Brownell (epidemiological) [Ep 1 · 34:01](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2041) - Tobacco taxes have an especially powerful effect on youth because youth tend to have less expendable resources than adults and are therefore particularly price sensitive. — Kelly Brownell (epidemiological) [Ep 1 · 34:01](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2041) - The US government spends $4 billion worth of SNAP benefits on soda every year. — Kelly Brownell (epidemiological) [Ep 1 · 39:51](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2391) - Heavy subsidies for commodity crops like corn and soybeans began in the Nixon administration, leading to low-cost ingredients that the food industry processed into snack foods, salty foods, beverages, and high fructose corn syrup. — Kelly Brownell (epidemiological) [Ep 1 · 35:11](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2111) - Research on changes in school nutrition standards has been very positive; kids not only eat healthier foods in school but also tend to eat somewhat healthier at home. — Kelly Brownell (epidemiological) [Ep 1 · 36:54](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2214) - Anecdotal cases of kids not liking healthier school foods and throwing them away tend to be temporary, especially with younger kids developing eating habits. — Kelly Brownell (clinical) [Ep 1 · 36:54](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2214) - Economists in Chicago found that soda taxes would probably lead to a little bit of job improvement rather than job loss because jobs would be created in other sectors. — Kelly Brownell (epidemiological) [Ep 1 · 43:51](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2631) - Philadelphia's sugar-sweetened beverage tax is 1.5 cents per ounce, which is 50% higher than the penny-per-ounce tax used in Berkeley. — Kelly Brownell (epidemiological) [Ep 1 · 34:01](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2041) - Using a tax calculator algorithm, the state of California would generate more than a billion dollars per year from a 1-cent-per-ounce sugar-sweetened beverage tax. — Kelly Brownell (epidemiological) [Ep 1 · 28:20](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=1700) - Mayor Nutter of Philadelphia introduced a soda tax focused on health benefits and came very close to passage but did not succeed; Mayor Kenny later succeeded by framing it around funding early childhood education. — Kelly Brownell (epidemiological) [Ep 1 · 30:00](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=1800) - In the 280 schools in Maine's 5210 program, when healthy foods are put in front of kids in a positive way, they eat them; adults and teachers have a harder time adjusting. — Tory (clinical) [Ep 1 · 38:28](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2308) - The obesity public health community and hunger advocacy community are at an impasse over restricting sugar-sweetened beverages in SNAP benefits, with both sides having dug in their heels. — Kelly Brownell (opinion) [Ep 1 · 39:51](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2391) - New York City proposed a pilot study to test adjusted SNAP benefits excluding sugar-sweetened beverages, but USDA declined, saying New York was too big for a pilot study. — Kelly Brownell (epidemiological) [Ep 1 · 40:50](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2450) - The next revision of the food label is expected to include added sugar on the nutrition facts panel, similar to how trans fats were added before being banned. — Kelly Brownell (guideline) [Ep 1 · 36:40](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2200) - National legislation is expected to require calorie labeling on menus of all chain restaurants around the country. — Kelly Brownell (guideline) [Ep 1 · 36:40](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2200) - Severe obesity estimates in the adolescent population range up to approximately 2 million patients who have physiologic or anthropomorphic qualifications to consider bariatric surgery. — Mark (epidemiological) [Ep 2 · 3:30](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=210) - Data from a decade ago consisted mostly of single institutional, relatively small cohort, retrospective, non-uniform studies. — Mark (clinical) [Ep 2 · 5:50](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=350) - Recent studies (Teen Labs, FAS-5, AMOS) are high-level prospective studies using uniform data reporting methodology, which is the type of data needed to develop paradigm shifts and widespread clinical application. — Mark (clinical) [Ep 2 · 7:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=420) - These prospective studies serve as the foundation for making best practice guidelines and widely accepted recommendations on treatment paradigms. — Mark (opinion) [Ep 2 · 8:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=480) - The 2004 consensus paper in Pediatrics continues to hold significant influence in the insurance industry regarding access to care for adolescent bariatric surgery. — Mark (clinical) [Ep 2 · 10:40](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=640) - BMI recommendations for eligibility were higher in the 2004 paper than in current recommendations. — Mark (guideline) [Ep 2 · 11:10](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=670) - Current BMI eligibility guidelines target around 40 kg/m² or higher, though in certain individual cases below 40 is considered reasonable. — Mark (guideline) [Ep 2 · 13:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=780) - Updated guidelines from ASMBS pediatric committee are expected within the next 12 to 18 months. — Mark (clinical) [Ep 2 · 14:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=840) - Prior to 2014, ASMBS had no specific pediatric standards in their centers of excellence designation. — Mark (clinical) [Ep 2 · 15:20](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=920) - MBSAQIP (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program) was formed around 2012, combining ASMBS and American College of Surgeons accreditation, and included for the first time a separate designation for centers offering bariatric surgery to individuals under age 18. — Mark (clinical) [Ep 2 · 16:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=960) - The first MBSAQIP pediatric standards were rolled out in 2014 and updated in 2016. — Mark (clinical) [Ep 2 · 17:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1020) - In a 2014 study of Teen Labs centers, 47% of adolescents achieved initial insurance authorization at original request for surgery, compared to approximately 85% in the adult population. — Mark (epidemiological) [Ep 2 · 19:10](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1150) - 80% of insurance denials were approved after appeals, but required as many as 5 appeals. — Mark (epidemiological) [Ep 2 · 19:50](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1190) - 11% of adolescents in the Teen Labs centers study were ultimately unable to obtain insurance authorization for bariatric surgery. — Mark (epidemiological) [Ep 2 · 20:40](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1240) - The most cited reason for insurance denial was age less than 18 years. — Mark (epidemiological) [Ep 2 · 21:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1260) - The most recent AHRQ report developed by Kaiser on management for obese and severely obese children makes only scant reference to bariatric surgery and largely ignores it as a consideration for this population. — Mark (clinical) [Ep 2 · 26:20](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1580) - In 2016, the AAP Section on Obesity and Section on Surgery executive committees agreed to sponsor joint policy statements on adolescent bariatric surgery. — Mark (clinical) [Ep 2 · 28:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1680) - The AAP policy statement is currently in draft in committee as of first quarter 2017, with peer review planned for Q1 2017 and proposed publication by end of 2017 or early 2018. — Mark (clinical) [Ep 2 · 27:22](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1642) - The AAP policy statement will be released around the same time as revised ASMBS best practice guidelines. — Mark (clinical) [Ep 2 · 27:22](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1642) - Procedural prevalence for adolescent bariatric surgery remains stable despite favorable outcomes and standardization of care. — Mark (clinical) [Ep 2 · 27:22](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1642) - Type 2 diabetes, previously called adult-onset diabetes, is now seen in children and teenagers as a complication of obesity. — Marc Harmon (epidemiological) [Ep 4 · 1:44](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=104) - Obstructive sleep apnea, hypertension, dyslipidemias, and cardiovascular risk factors are comorbidities now appearing in obese children. — Marc Harmon (clinical) [Ep 4 · 1:44](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=104) - About half of teenagers presenting for bariatric surgery have had a parent who underwent weight loss surgery. — Thomas Inge (epidemiological) [Ep 4 · 2:20](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=140) - The success rate of non-operative weight loss falls dramatically and linearly from age 6 to 16; a severely obese teenager may have only a 1% chance of losing significant weight with lifestyle interventions. — Todd Ponsky (epidemiological) [Ep 4 · 3:15](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=195) - Lifestyle management research defines success as 5–10% total body weight loss, whereas bariatric surgery in teens achieves about 30% weight loss at 3–5 years. — Marc Harmon (clinical) [Ep 4 · 4:34](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=274) - Caloric restriction is the primary mechanism for weight loss; exercise is more effective for maintaining weight loss once achieved. — Todd Ponsky (clinical) [Ep 4 · 5:15](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=315) - Orlistat is the only FDA-approved weight-loss drug for pediatrics, causing greasy stools and achieving only about 2% weight loss. — Todd Ponsky (clinical) [Ep 4 · 6:21](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=381) - Topiramate and phentermine, approved for adults, affect appetite and satiety pathways in teenagers identically to adults and are used off-label. — Todd Ponsky (clinical) [Ep 4 · 6:21](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=381) - Most U.S. bariatric surgeons limit surgery to teenagers (youngest reported case age 13) to ensure physiologic maturity and avoid harm to development. — Marc Harmon (guideline) [Ep 4 · 7:13](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=433) - A colleague in Saudi Arabia has performed weight loss surgery on children as young as 6–7 with reported good long-term results. — Marc Harmon (clinical) [Ep 4 · 7:13](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=433) - Surgery can prevent diabetes in adolescents with elevated blood sugar who are not yet diabetic. — Todd Ponsky (clinical) [Ep 4 · 8:25](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=505) - Adult bariatric studies show a longevity benefit for surgery in morbid obesity. — Todd Ponsky (clinical) [Ep 4 · 8:25](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=505) - Most insurance plans covering bariatric surgery require a 6-month period of medically supervised weight loss before surgery. — Todd Ponsky (guideline) [Ep 4 · 10:08](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=608) - Patients are put through 'surgery school' during the 6-month preoperative period to teach them about the surgery, nutrition, risks, and benefits, ensuring informed, non-coerced consent. — Todd Ponsky (guideline) [Ep 4 · 10:08](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=608) - A multidisciplinary team for adolescent bariatric surgery includes pediatric endocrinology, gastroenterology, psychology (2), exercise physiology (2), nutrition (2), and surgery. — Marc Harmon (guideline) [Ep 4 · 12:12](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=732) - Patients may be in a medical obesity program for 3 years before considering surgery, allowing the surgical team to build longitudinal relationships with families. — Marc Harmon (guideline) [Ep 4 · 12:12](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=732) - Many patients who need bariatric surgery lack insurance coverage due to policy exclusions, even when surgery is medically indicated. — Todd Ponsky (epidemiological) [Ep 4 · 16:09](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=969) - Surgeons advocate for patients when insurance denies coverage but it is not an absolute exclusion. — Todd Ponsky (guideline) [Ep 4 · 16:09](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=969) - Teens with chaotic lives, uncontrolled medical problems, or untreated psychiatric illness may not be ready for surgery and require preparation by the multidisciplinary team. — Todd Ponsky (clinical) [Ep 4 · 17:52](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1072) - Syndromic obesity and monogenic obesity (single-gene mutations driving appetite) account for 6–7% of severely obese children by age 10; outcomes with bariatric surgery in this group are mixed and require further study. — Marc Harmon (clinical) [Ep 4 · 19:11](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1151) - Roux-en-Y gastric bypass has the longest track record in adults and teenagers. — Marc Harmon (clinical) [Ep 4 · 19:57](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1197) - Adjustable gastric band has a high reoperation rate in teenagers and adults and is no longer widely offered. — Marc Harmon (clinical) [Ep 4 · 19:57](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1197) - Vertical sleeve gastrectomy, originally a first-stage procedure for super-obese patients, now shows good initial weight loss and comorbidity resolution at 3–4 years in adults and teens. — Marc Harmon (clinical) [Ep 4 · 19:57](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1197) - In 2015, sleeve gastrectomy was performed in 80% of adolescent bariatric cases, gastric bypass in 20%, and virtually no bands. — Todd Ponsky (epidemiological) [Ep 4 · 21:14](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1274) - Sleeve gastrectomy and gastric bypass show very comparable weight loss and comorbidity resolution results in teenagers. — Todd Ponsky (clinical) [Ep 4 · 21:14](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1274) - Gastric bypass is preferred for patients with hypothalamic obesity (e.g., post-brain tumor, pan-hypopituitarism) because sleeve and band have shown inferior weight loss in this biologically driven obesity. — Todd Ponsky (clinical) [Ep 4 · 22:13](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1333) - Theoretical and measured risks of sleeve gastrectomy are lower than gastric bypass in teenagers and adults. — Todd Ponsky (clinical) [Ep 4 · 22:13](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1333) - Sleeve gastrectomy is performed laparoscopically, starting 4–6 cm proximal to the pylorus, mobilizing the greater curvature to the diaphragm, and stapling along a 36–42 Fr bougie to the angle of His. — Marc Harmon (clinical) [Ep 4 · 23:49](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1429) - A 25 cm clamp can be used to standardize sleeve geometry, ensure complete fundus mobilization, and prevent leaving excess fundus that can cause reflux. — Todd Ponsky (clinical) [Ep 4 · 25:58](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1558) - The upper spinal firing near the GE junction is the most common site for leaks and the thinnest part of the stomach. — Todd Ponsky (clinical) [Ep 4 · 27:34](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1654) - The posterior wall of the stomach tends to slip up during the final stapler firing; counter-traction is critical to avoid leaving too much fundus or getting too close to the esophagus. — Marc Harmon (clinical) [Ep 4 · 29:03](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1743) - Close inspection of the staple line with magnification is essential; bleeding or malformed staples should be oversewn with figure-of-eight sutures. — Todd Ponsky (clinical) [Ep 4 · 29:03](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1743) - Gastric bypass is performed laparoscopically with a circularly stapled gastrojejunal anastomosis (25 mm stapler), 50 cm biliopancreatic limb, 100 cm Roux limb, and closure of jejunojejunostomy and Peterson's defects with non-absorbable suture. — Todd Ponsky (clinical) [Ep 4 · 30:27](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1827) - Antecolic Roux limb configuration works well and still requires closure of the mesenteric defect. — Marc Harmon (clinical) [Ep 4 · 30:27](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1827) - A linear stapler (2.5 cm firing) can be used for the gastrojejunal anastomosis with satisfactory results. — Marc Harmon (clinical) [Ep 4 · 30:27](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1827) - Patients start sips of water same-day postop, advance to 4 oz/hr by day 1, 6 oz/hr by day 2, and are discharged when achieving 64–96 oz/day. — Todd Ponsky (guideline) [Ep 4 · 33:23](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2003) - High-protein intake (60–80 g/day) is recommended postoperatively to preserve lean mass during rapid weight loss. — Todd Ponsky (guideline) [Ep 4 · 33:23](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2003) - Patients are on a soft mechanical diet for the first month, then less restricted; early caloric intake is 300–600 kcal/day. — Todd Ponsky (guideline) [Ep 4 · 33:23](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2003) - Sleeve gastrectomy complications include staple-line leak (most feared, especially at GE junction), bleeding at staple line, and trocar-site hernia at the extraction site. — Marc Harmon (clinical) [Ep 4 · 34:56](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2096) - Long-term sleeve complications include anemia, vitamin deficiencies, and gastroesophageal reflux (up to one-third of adults; possibly lower in teens). — Marc Harmon (clinical) [Ep 4 · 34:56](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2096) - Gastric bypass has higher complication rates than sleeve: internal hernias, stricture at gastrojejunal anastomosis (fairly high rate), and marginal ulcers. — Marc Harmon (clinical) [Ep 4 · 34:56](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2096) - Teenagers may have lower risk of post-sleeve reflux than adults because their physiologic anti-reflux barriers are more secure. — Todd Ponsky (opinion) [Ep 4 · 34:56](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2096) - Proton pump inhibitors are used postoperatively after sleeve gastrectomy. — Todd Ponsky (guideline) [Ep 4 · 34:56](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2096) - Teen-LABS data show 28–30% total body weight loss at 3 years for both gastric bypass and sleeve gastrectomy, maintained long-term. — Todd Ponsky (clinical) [Ep 4 · 37:47](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2267) - Typical teenagers lose 80–100 pounds in the first year after bariatric surgery. — Marc Harmon (clinical) [Ep 4 · 38:50](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2330) - Obstructive sleep apnea resolves within 3 weeks of surgery, before significant weight loss, suggesting a neurohormonal mechanism rather than weight-dependent improvement. — Todd Ponsky (clinical) [Ep 4 · 39:06](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2346) - Type 2 diabetes and glucose metabolism improve within days of gastric bypass surgery, independent of weight loss. — Todd Ponsky (clinical) [Ep 4 · 39:06](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2346) - Joint pain improves with weight loss after bariatric surgery. — Todd Ponsky (clinical) [Ep 4 · 39:06](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2346) - A pre-Teen-LABS cohort of 70+ gastric bypass patients followed for an average of 8 years (range 5–12) with 80% retention showed 32–33% weight loss at 1 year, 28–30% at 8 years, with durable diabetes resolution. — Todd Ponsky (clinical) [Ep 4 · 40:52](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2452) - A comparator group of severely obese teenagers who underwent lifestyle intervention gained 66% more weight over 6 years and developed diabetes at expected rates. — Todd Ponsky (clinical) [Ep 4 · 40:52](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2452) - Teen-LABS is an NIH-sponsored study (242 teenagers, 2007–2012, now in third 5-year funding cycle) tracking broad health outcomes, biospecimens, with 80–90% annual follow-up. — Todd Ponsky (epidemiological) [Ep 4 · 43:48](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2628) - Swedish long-term bariatric research shows 5-year results comparable to U.S. data. — Todd Ponsky (clinical) [Ep 4 · 43:48](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2628) - Intragastric balloons and endoscopic gastric plication are less invasive approaches with moderate adult experience and some adolescent cases; outcomes are still being evaluated. — Thomas Inge (clinical) [Ep 4 · 45:59](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2759) - Bariatric surgery is a form of medical therapy at the molecular level, affecting gut-brain signaling. — Todd Ponsky (opinion) [Ep 4 · 45:59](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2759) - Combination therapy (surgery plus pharmacotherapy such as GLP-1 agonists) may optimize outcomes and address suboptimal responders; trials are anticipated. — Todd Ponsky (opinion) [Ep 4 · 45:59](https://origin-library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2759) - OptiView trocar with 5mm zero-degree scope used for left upper quadrant access in obese patients undergoing any intraabdominal surgery, avoiding umbilical entry — Evan (clinical) [Ep 5 · 0:51](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=51) - For patients with BMI >60, surgeon stands between the legs; for BMI 41, surgeon stands on patient's left side — Evan (clinical) [Ep 5 · 2:41](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=161) - Three of four ports placed to the left of patient's midline, only one port on the right — Evan (clinical) [Ep 5 · 3:39](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=219) - Patient is 17 years 9 months old, BMI 41, with polycystic ovarian syndrome and insulin resistance on metformin — Evan (clinical) [Ep 5 · 6:40](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=400) - Patient in multidisciplinary weight management clinic for approximately one year, physically active as softball team captain, family initially resistant to surgery — Evan (clinical) [Ep 5 · 6:40](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=400) - Indications for adolescent bariatric surgery: BMI ≥35 with major comorbidities (diabetes, sleep apnea, steatohepatitis, pseudotumor cerebri) or BMI ≥40 with any weight-responsive comorbidity — Tom (guideline) [Ep 5 · 8:01](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=481) - No strict age criterion recommended; preteens can develop comorbidities and may have sufficient maturity for surgery consideration — Tom (opinion) [Ep 5 · 9:11](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=551) - Youngest patient operated was 13 years old at UAB program — Mac (clinical) [Ep 5 · 10:46](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=646) - Resection starts 5-6 cm from pylorus to spare antrum and avoid intrinsic factor deficiency and anemia — Evan (clinical) [Ep 5 · 1:56](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=116) - Adult surgeons leaving 2-3 cm of antrum; pediatric surgeon leaves 6 cm conservatively — Evan (clinical) [Ep 5 · 12:52](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=772) - B12 levels typically at low end of normal postoperatively, some in abnormal range, but no megaloblastic anemia observed — Tom (clinical) [Ep 5 · 14:32](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=872) - In 108 sleeve gastrectomy cases, 30% developed vitamin B12 deficiency during postoperative follow-up (some deficient preoperatively) — Ayed (epidemiological) [Ep 5 · 17:17](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1037) - Volume studies show the antrum expands more than the sleeve tube; leaving large antrum may lead to weight regain — Ayed (clinical) [Ep 5 · 17:17](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1037) - First staple firing performed without bougie; second stapler loaded but not fired, then bougie passed to save 30 minutes — Evan (clinical) [Ep 5 · 16:08](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=968) - Patients with severe sleep apnea (hypoxia to 50% during sleep), pulmonary hypertension, and risk of cardiac arrest from hypoxia are candidates for surgery regardless of young age — Ayed (opinion) [Ep 5 · 19:35](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1175) - 80-90% cure rate for diabetes in patients undergoing bariatric surgery — Ayed (epidemiological) [Ep 5 · 20:33](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1233) - 71% of pediatric bariatric surgery patients are compliant with follow-up and protocol, better than adults — Ayed (epidemiological) [Ep 5 · 21:55](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1315) - Pediatric bariatric patients grow normally based on growth parameters, hormones, and bone age evaluation; no significant micronutrient deficiency problems — Ayed (clinical) [Ep 5 · 21:55](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1315) - If fundal pouch not retracted laterally, can leave large remnant that may regrow, twist, or impact weight regain — Evan (clinical) [Ep 5 · 23:56](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1436) - Completely mobilizing left crus to visualize angle of His helps straighten stomach and prevent firing on folded/double stomach layer — Ayed (clinical) [Ep 5 · 26:10](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1570) - Intraoperative leak test performed with 60cc methylene blue stained saline via OG tube while occluding duodenum; never detected a leak with this method — Evan (clinical) [Ep 5 · 31:21](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1881) - Most leaks occur 7-10 days postoperatively, not during initial hospitalization; postoperative contrast studies are not predictive and have been abandoned — Evan (clinical) [Ep 5 · 32:34](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1954) - Leak rate less than 5% in adults — Mark (epidemiological) [Ep 5 · 33:34](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=2014) - Postoperative contrast studies abandoned after 75 cases as non-predictive; leaks typically occur days 3-7 — Tom (clinical) [Ep 5 · 33:47](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=2027) - 34 French bougie used; resultant stomach width typically one vertebral body or narrower on upper GI — Tom (clinical) [Ep 5 · 34:28](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=2068) - Buttresses used after first stapler firing (not on first firing with green stapler due to thick antrum); used on all subsequent firings — Tom (clinical) [Ep 5 · 37:29](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=2249) - In 200 pediatric sleeve gastrectomy cases, zero leaks observed; leak is technical problem — Ayed (epidemiological) [Ep 5 · 37:59](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=2279) - Healthcare professionals cannot visually identify which children fall into high-risk BMI categories without actually obtaining and plotting BMI percentile. — Steve (clinical) [Ep 7 · 15:00](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=900) - Using guilt, shame, and blame to motivate individuals to make healthy changes is not supported by evidence and makes individuals less likely to make healthy changes. — Steve (clinical) [Ep 7 · 25:00](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1500) - Clinical environments should have chairs that allow larger patients and parents to sit comfortably, as chairs with handrails may be too small for some families. — Steve (clinical) [Ep 7 · 26:30](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1590) - Examination tables should be rated for weights higher than 350 pounds to accommodate larger patients safely. — Steve (clinical) [Ep 7 · 27:00](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1620) - Weight scales should be placed in private areas rather than in open office spaces when dealing with the sensitive topic of weight. — Steve (clinical) [Ep 7 · 28:00](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1680) - A patient-centered, empowering approach utilizing motivational interviewing techniques can save time, improve clinical impact, and result in more pleasant provider encounters. — Steve (opinion) [Ep 7 · 26:00](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1560) - For larger teenagers, it takes a long time to reach their current weight status and will take a long time to achieve weight reduction, requiring patience from providers. — Steve (clinical) [Ep 7 · 25:30](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1530) - Parents and children come to obesity clinic visits with high defensive walls due to previous experiences with weight bias, requiring creation of a safe environment before productive conversation can occur. — Steve (clinical) [Ep 7 · 28:30](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1710) - The American Academy of Pediatrics will be releasing a policy statement regarding weight bias in the next couple of years. — Steve (guideline) [Ep 7 · 29:40](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1780) - Parents often do not recognize when their child has obesity because weight gain happens gradually, and they may be very upset and emotional when given the diagnosis. (clinical) [Ep 7 · 30:10](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1810) - Weight is not a behavior; weight loss is not something a child can go home and do. Providers should focus on healthy habits applicable to all children regardless of size. (guideline) [Ep 6 · 0:00](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=0) - Authoritarian (controlling, strict) parenting may involve hand-feeding long after developmentally appropriate or restricting intake, overriding the child's internal cues. (clinical) [Ep 6 · 0:00](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=0) - Indulgent (permissive) parenting uses food as comfort or reward to control behavior, with the child in control much of the time. (clinical) [Ep 6 · 0:00](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=0) - Uninvolved (neglectful) parenting leaves young children responsible for choosing their own food and deciding how much to eat, with no structure or expectations. (clinical) [Ep 6 · 0:00](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=0) - Authoritative (responsive) parenting sets structure and limits with clear roles, communicates warmly, respects the child's opinions but does not give in to all demands, allowing the child to learn self-regulation. (guideline) [Ep 6 · 0:00](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=0) - When parents take too much control (forcing, pressuring, restricting), they override the child's internal hunger and fullness cues or desire to be active. (clinical) [Ep 6 · 9:58](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=598) - When parents give the child too much control (indulging, bribing), it teaches the child they can get their favorite food by whining or crying. (clinical) [Ep 6 · 9:58](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=598) - Breastfeeding is the first introduction to the family table; breastfed babies get used to different flavor profiles from the mother's diet, which may prevent picky eating tendencies later. (clinical) [Ep 6 · 20:40](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1240) - A baby's crying can mean many things (wet diaper, discomfort), not just hunger. Parents should learn to read cues rather than automatically feeding in response to crying. (clinical) [Ep 6 · 20:40](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1240) - When a toddler throws food off the highchair tray, that is a cue that mealtime is over. If they continue eating food on the tray, the parent should let them continue. (clinical) [Ep 6 · 20:40](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1240) - It is acceptable for a preschooler to skip a meal. The parent should let them know the next eating opportunity will be the next scheduled meal or snack, with only water available in between. (guideline) [Ep 6 · 20:40](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1240) - The 60 minutes of daily physical activity can be broken up throughout the day (e.g., 20 minutes before school, 20 minutes after school, 20 minutes after dinner). (guideline) [Ep 6 · 28:22](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1702) - Moderate to vigorous activity means the body is working: increased heart rate, sweating, muscle fatigue, and shortness of breath are normal cues that should be taught to children as positive signs. (clinical) [Ep 6 · 28:22](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1702) - When parents praise a child for finishing all their food, it sets the child up to want to finish all meals to get praise again, overriding their hunger and fullness cues. (clinical) [Ep 6 · 39:26](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2366) - Using food as a reward for good behavior teaches the child that food is contingent on behavior rather than an expectation. Good behavior should be an expectation with or without rewards. (guideline) [Ep 6 · 39:26](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2366) - When a parent makes vegetable intake contingent on getting dessert (e.g., 'eat your broccoli to get a brownie'), it teaches the child that vegetables are yucky and dessert is the reward. (clinical) [Ep 6 · 39:26](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2366) - If dessert is on the menu, everyone in the family should get one serving regardless of what else they ate. The parent decides which days dessert is offered, not whether the child 'earned' it. (guideline) [Ep 6 · 39:26](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2366) - Productive screen time (homework, school work) does not count toward the 2-hour daily screen time limit. The limit applies to unproductive screen time (TV, video games). (guideline) [Ep 6 · 47:55](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2875) - Taking away physical activity as punishment is counterproductive. A misbehaving child may need physical activity to release pent-up energy and refocus their behavior. (clinical) [Ep 6 · 47:55](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2875) - Using physical activity as punishment (e.g., 'run 3 laps around the house') teaches the child to associate physical activity with something to avoid, undermining lifelong motivation. (clinical) [Ep 6 · 47:55](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2875) - A 'brain break' before homework—getting the child up and moving for a few minutes to raise heart rate—helps refocus the brain and makes homework more efficient. (clinical) [Ep 6 · 47:55](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=2875) - There are not enough chips to fill a child up. Snacks lacking protein will not satisfy hunger, leading to grazing and overeating at dinner. (clinical) [Ep 6 · 63:00](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=3780) - Protein is a crucial component in snacks to help keep a child feeling full until the next meal. (clinical) [Ep 6 · 63:00](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=3780) - Children should not go more than 4 hours without eating. Skipping meals or going too long without eating impairs the child's ability to gauge hunger and fullness cues at the next meal. (guideline) [Ep 6 · 63:00](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=3780) - Stress has been implicated in the development, maintenance, and exacerbation of obesity and obesity-related comorbidities through both physiological and behavioral pathways. (clinical) [Ep 8 · 0:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=0) - Stress can dysregulate the endocrine system, causing elevations of stress hormones and insulin levels, and over time contribute to accumulation of visceral fats. (clinical) [Ep 8 · 1:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=60) - Chronic stress negatively impacts cognition and mood, leading to increased worry, problems with concentration, planning, and focusing. (clinical) [Ep 8 · 1:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=90) - Stress decreases sleep quality and reduces engagement in healthy behaviors including healthy diet, regular physical activity, and restful sleep. (clinical) [Ep 8 · 2:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=120) - The relationship between stress and obesity is reciprocal: stress makes it difficult to maintain healthy behaviors, which contributes to weight gain, which then exacerbates the body's stress response. (clinical) [Ep 8 · 2:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=150) - Tolerable stress (such as loss of a loved one or moving to a new city) is buffered by social support or stress management techniques. (clinical) [Ep 8 · 4:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=240) - Toxic or chronic stress requires prolonged activation of the stress response and there is evidence it can lead to adverse changes to brain structures and organ systems. (clinical) [Ep 8 · 4:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=270) - Examples of toxic stress for children include residing in homes with domestic violence, abusive situations, poverty, and teasing/bullying experienced by children struggling with weight. (clinical) [Ep 8 · 5:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=300) - Children's metabolic and neurocognitive systems have not yet fully matured, making them particularly vulnerable to fundamental effects from stress. (clinical) [Ep 8 · 5:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=330) - Stress can exacerbate medical problems in children including asthma and diabetes, and increases mental health problems. (clinical) [Ep 8 · 6:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=360) - Among girls, stress increases internalizing disorders like anxiety and depression; among boys, conduct disorder or behavioral problems in school are more common. (epidemiological) [Ep 8 · 6:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=390) - For children struggling with weight, excess weight may have already elevated stress hormones, and additional stress further exacerbates this situation. (clinical) [Ep 8 · 7:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=420) - A CDC retrospective study of approximately 18,000 adults found a strong correlation between adverse childhood experiences (ACEs) and later development of medical and mental health problems. (epidemiological) [Ep 8 · 7:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=450) - Individuals who experienced at least one adverse childhood experience were more likely to have subsequent ACEs, suggesting the importance of early intervention. (epidemiological) [Ep 8 · 8:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=480) - Individuals who identify as ethnic minorities often report greater stress levels on a daily basis. (epidemiological) [Ep 8 · 8:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=510) - Immigrant populations, particularly first or second generation, experience greater stress from overt discrimination, subtle prejudice, stereotypes, and language barriers. (epidemiological) [Ep 8 · 9:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=540) - In immigrant families, children who are more fluent in both English and their native tongue often must navigate interactions with government or healthcare settings, creating stress and changing family dynamics. (clinical) [Ep 8 · 9:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=570) - Ethnic minority and immigrant populations are less likely to seek mental health services or other resources. (epidemiological) [Ep 8 · 10:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=600) - There is a strong link between stress experienced by those living in poverty and obesity, with significant overlap between low-SES communities and high obesity rates. (epidemiological) [Ep 8 · 10:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=630) - Food deserts—areas with lack of access to fresh fruits and vegetables and grocery stores but overabundance of calorie-dense, nutritionally poor convenience foods—put children at greater risk for obesity. (epidemiological) [Ep 8 · 11:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=660) - Parental financial and economic stressors are tied to a child's stress level. (clinical) [Ep 8 · 11:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=690) - Children in distress may exhibit physical symptoms (vague gastrointestinal problems, stomach aches with no medical cause), difficulties with concentration and attendance, academic problems, social withdrawal, sleep disturbances, and in extreme stress, bedwetting. (clinical) [Ep 8 · 12:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=720) - Psychologically, stressed children may ruminate more, have increased anxiety, possibly panic attacks, or behaviorally act out in school. (clinical) [Ep 8 · 13:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=780) - Stress eating or emotional eating is a common stress response seen in clinic, where engaging in comfort eating provides short-term relief. (clinical) [Ep 8 · 13:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=810) - During stress, people crave foods that are highly salty, fatty, or sugary rather than healthy foods like broccoli or fresh fruit. (clinical) [Ep 8 · 14:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=840) - There is evidence that highly salty, fatty, or sugary foods can diminish arousal in the body, providing short-term stress relief. (clinical) [Ep 8 · 14:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=870) - Emotional eating creates a cycle: short-term relief followed by feelings of shame, guilt, and regret (especially for those struggling with weight), leading some to turn back to food to suppress those emotions. (clinical) [Ep 8 · 15:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=900) - Studies suggest that when youth are stressed and turn to food, they also tend to engage in eating in response to other emotions, not just stress. (epidemiological) [Ep 8 · 15:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=930) - Children thrive with consistent routines for dinners, bedtimes, and physical activity, knowing what to expect. (clinical) [Ep 8 · 17:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1020) - Lack of consistent routine can be stressful for young children. (clinical) [Ep 8 · 17:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1050) - Middle school age children experience stress from puberty-related body changes, which can be a source of embarrassment and make them targets for bullying and teasing. (clinical) [Ep 8 · 18:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1080) - Teenagers experience greater importance of what others think of their appearance, pressure from friends to engage in certain behaviors, natural separation from parents creating household tension, and poor sleep patterns. (clinical) [Ep 8 · 19:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1140) - Teens struggling with weight report no longer eating lunch in the cafeteria because they are targets of ridicule or teasing and feel judged about what they eat. (clinical) [Ep 8 · 19:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1170) - Many overweight teens cannot sit comfortably in classroom chairs with attached desks, creating daily logistical stress. (clinical) [Ep 8 · 20:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1200) - Some overweight patients report fear of using public facilities at school because they may not be able to hold their weight, risking embarrassment. (clinical) [Ep 8 · 20:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1230) - The Perceived Stress Scale is one of the most widely used stress measures, consists of about 10 items, takes less than 10 minutes to administer, is written at middle school level, and is appropriate for adolescents. (guideline) [Ep 8 · 21:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1290) - A higher score on the Perceived Stress Scale indicates someone feels more overwhelmed, out of control, and stressed out in general. (guideline) [Ep 8 · 22:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1320) - The Perceived Stress Scale measures a patient's perception of their ability to handle stress rather than the types or amount of stress they face. (guideline) [Ep 8 · 22:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1350) - Physical activity does wonders for improving mood, concentration, and focus, and is a great way to get blood circulating. (clinical) [Ep 8 · 23:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1380) - Brief bouts of physical activity during homework (dancing, jumping jacks, short walks) can help manage stress by getting blood circulating and giving the mind a break to refocus. (clinical) [Ep 8 · 23:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1410) - Diaphragmatic breathing activates the parasympathetic nervous system, helps decrease heart rate, boosts mood and blood circulation, and helps the body return to homeostasis. (clinical) [Ep 8 · 24:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1440) - Deep breathing takes less than 3 minutes to teach a child. (clinical) [Ep 8 · 24:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1470) - For deep breathing to be effective as a stress management tool, children should practice twice daily for 3-4 minutes, ideally paired with a daily activity like brushing teeth or showering. (guideline) [Ep 8 · 25:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1500) - Children and adolescents are recommended to get at least 9 hours of sleep, and most teens fall 1-2 hours short of that. (guideline) [Ep 8 · 25:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1530) - Sleep deprivation has a depressed effect on mood, decreases energy, and makes it difficult to engage in effective coping strategies. (clinical) [Ep 8 · 26:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1560) - Daily physical activity can help increase sleep pressure at night. (clinical) [Ep 8 · 26:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1590) - Eliminating caffeine in the afternoons, establishing bedtime routines, having consistent wake/sleep times, and limiting screens 30 minutes before bed can improve sleep quality. (guideline) [Ep 8 · 27:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1620) - The first line treatment for anxiety involves teaching patients how to manage stress more effectively through stress management techniques. (guideline) [Ep 8 · 27:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1650) - Studies show that the level of parental stress children perceive has been associated with increases in child fast food consumption, poor sleep quality, decreased likelihood of meeting physical activity recommendations, and less likely boundaries on screen time. (epidemiological) [Ep 8 · 28:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1680) - When parents are stressed and unable to cope, it is difficult to set boundaries and be present with children, leading to more convenient paths like eating out. (clinical) [Ep 8 · 28:30](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1710) - Children look to parents for how to interact with the world; if they see a parent managing time efficiently and making time for physical activity and healthy habits, those behaviors will seem natural to them. (clinical) [Ep 8 · 29:00](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1740) - The PASQL is a measure of overall well-being and how children feel they are adjusting. (guideline) [Ep 8 · 27:59](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1679) - Children are losing time to be creative and bored because they are using so many screens; being bored is not a bad thing. (opinion) [Ep 8 · 27:59](https://origin-library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864?t=1679) - BMIs in the 40s will predictably get patients to BMIs less than 30 — Tom (clinical) [Ep 10 · 0:16](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=16) - The younger we can intervene with bariatric surgery, the more it helps quality of life — Sheetel (opinion) [Ep 10 · 1:08](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=68) - Once you cross the BMI 50 threshold, the probability of mitigating risk associated with BMI 35 and above becomes challenging — Mark (clinical) [Ep 10 · 2:24](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=144) - At BMI 49, the time for medication has passed and surgery must be discussed because at that BMI surgery may fail to get patients out of the severely obese category — Tom (clinical) [Ep 10 · 4:53](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=293) - Some kids will need pharmacotherapy even after bariatric surgery — Claudia (clinical) [Ep 10 · 6:07](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=367) - Obesity is a heterogeneous disease with a very wide range of response to surgery and other treatments, requiring a continuous approach — Alan Brown (clinical) [Ep 10 · 7:16](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=436) - If a patient has been in a program for 3 to 6 months and healthy living is not sufficient to control the disease, you need to move on to medications — Alan Brown (guideline) [Ep 10 · 7:50](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=470) - Hypothalamic obesity patients have a biological drive to gain weight and defeat surgery that is profoundly different from other patients without brain injury — Tom (clinical) [Ep 10 · 8:35](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=515) - Dexamphetamine has an evidence base for use in hypothalamic obesity patients, both before and after surgery — Tom (clinical) [Ep 10 · 8:35](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=515) - Private insurers are limiting dietitian visits to 3 per year, which is insufficient for obesity as a chronic disease — Claudia (clinical) [Ep 10 · 12:55](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=775) - Taxing sugar products will not have the desired impact because we don't get obesity from sugar per se, and people are biologically wired to replace it with something else — Tom (opinion) [Ep 10 · 14:27](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=867) - Sugar taxation can be a regressive tax depending on socioeconomic class — Mark (opinion) [Ep 10 · 13:52](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=832) - Most obese patients meet objective criteria for binge eating disorder when screened with questionnaires, even if they don't come in with a diagnosis — Tom (clinical) [Ep 10 · 19:09](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=1149) - Bariatric surgery is a very good way to extinguish binge eating behaviors — Tom (clinical) [Ep 10 · 19:09](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=1149) - A prior diagnosis of binge eating disorder may pose a higher risk for relapse or weight regain after surgery — Tom (clinical) [Ep 10 · 19:09](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=1149) - The rate of true binge eating disorder meeting diagnostic criteria is under 5% when screening new patients — Claudia (epidemiological) [Ep 10 · 20:35](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=1235) - Many obese patients have disordered eating consisting of restricting during the day and overeating in the evening, though not meeting DSM criteria for eating disorders — Claudia (clinical) [Ep 10 · 20:35](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=1235) - Patients who lose weight due to fear of eating and restricting should be referred to an eating disorder program — Claudia (guideline) [Ep 10 · 20:35](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=1235) - Disordered eating applies to every obese patient—there are feelings or emotions around eating, food, and restricting, even if not meeting DSM criteria (clinical) [Ep 10 · 21:37](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=1297) - The 2007 AAP guidelines form the framework for obesity treatment tools, organizing interventions by age and obesity severity (85th-94th percentile, 95th-98th percentile, 99th percentile, and above 99th percentile). — Chris Foley (guideline) [Ep 11 · 7:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=420) - Obesity treatment exists on a spectrum from prevention and healthy lifestyle promotion through surgical intervention, with practice capacity, resources, and community needs determining where a practice operates on this spectrum. — Chris Foley (clinical) [Ep 11 · 9:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=540) - The pyramid model of obesity intervention shows progressively fewer patients requiring increasingly intensive interventions as severity increases, with universal prevention at the base and severe obesity treatment at the apex. — Chris Foley (clinical) [Ep 11 · 11:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=660) - Let's Go Maine (letsgo.org) is the origin of the 5-2-1-0 prevention messaging and provides toolkits, community interaction strategies, office materials including posters and logos for practices implementing prevention programs. — Chris Foley (clinical) [Ep 11 · 15:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=900) - The AAP Pediatric e-Practice (PEP) at pep.aap.org is a virtual office tool jointly created by AAP and the Institute for Healthy Childhood Weight, organizing resources by office location (exam room, waiting room, billing office) and topic area. — Chris Foley (clinical) [Ep 11 · 18:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1080) - Healthy Active Living for Families (HALF) on healthychildren.org provides age-organized nutrition guidance, physical activity recommendations, and parenting strategies for all families, with strong obesity prevention messaging. — Chris Foley (clinical) [Ep 11 · 20:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1200) - Motivational interviewing training is the cornerstone counseling skill for pediatricians doing weight management, and can be obtained through schools of public health, nursing, health education, or motivationalinterviewing.org, regardless of whether the course is weight-specific. — Chris Foley (clinical) [Ep 11 · 24:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1440) - Motivational interviewing addresses the 'why' of behavior change while cognitive behavioral therapy (CBT) strategies address the 'how,' and elements of both are helpful in weight management. — Chris Foley (clinical) [Ep 11 · 26:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1560) - The Cognito Change Talk app and desktop site, developed with Bob Schwartz from the Section on Obesity, provides free pediatric obesity-specific motivational interviewing training. — Chris Foley (clinical) [Ep 11 · 27:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1620) - Content for obesity prevention should be personalized to the practice, use local vernacular and logo, and reference locally available resources rather than generic national programs that may not exist in the community. — Chris Foley (clinical) [Ep 11 · 28:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1680) - The Super Tracker tool on ChooseMyPlate.gov allows families to track physical activity and food intake, find recipes, and compare their eating patterns to age-appropriate recommendations. — Chris Foley (clinical) [Ep 11 · 31:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1860) - ChopChop magazine (chopchopmag.org), created by the Institute for Healthy Childhood Weight and New Balance Foundation, promotes fruit and vegetable intake based on the principle that children are more likely to eat foods they help prepare. — Chris Foley (clinical) [Ep 11 · 32:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1920) - Activity tracking devices (Fitbit, pedometers, accelerometers) and food tracking apps (MyFitnessPal, Lose It) are appropriate tools to recommend for certain families in obesity treatment. — Chris Foley (clinical) [Ep 11 · 33:30](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2010) - For higher-level obesity care, pediatricians need to develop expertise in managing comorbidities including interpreting elevated hemoglobin A1C, blood glucose, and abnormal lipid profiles, functioning more like internists. — Chris Foley (clinical) [Ep 11 · 35:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2100) - Obesity contacts at tertiary care centers may reside in multiple divisions including gastroenterology, endocrinology, GI, cardiology, and psychology, requiring providers to search across departments. — Chris Foley (clinical) [Ep 11 · 37:00](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2220) - The Next Steps program uses 17 behavioral goals; Foley's adapted version focuses on 8 core goals including the 5-2-1-0 behaviors plus restricting eating out to 3 times weekly, portion control, healthy snacks, and eating breakfast. — Chris Foley (clinical) [Ep 11 · 38:30](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2310) - Super Tracker resources allow families to obtain age-appropriate eating plans and perform self-monitoring by entering food intake to compare against recommendations, though not all families will use all available tools. (clinical) [Ep 11 · 39:40](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2380) - Starting with topics where the clinician feels comfortable (such as sugar-sweetened beverages, screen time, or sleep) and gradually expanding to other areas is an effective approach for implementing obesity care in practice. (opinion) [Ep 11 · 40:50](https://origin-library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2450) - Overweight is defined as ≥85th percentile for age and gender; obese as ≥95th percentile; severely obese as ≥99th percentile. — Beth (guideline) [Ep 12 · 2:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=120) - In the speaker's clinic, all patients are at or above the 99th percentile (severely obese) and are very sick. — Beth (clinical) [Ep 12 · 2:30](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=150) - Obesity is not just an issue of eating less and exercising more; it is a complex relationship between genes, environment, and behaviors. — Beth (clinical) [Ep 12 · 5:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=300) - Genes tell the body how to process food, when to eat, and when to move. — Beth (clinical) [Ep 12 · 5:30](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=330) - Every single body system is affected by obesity. — Beth (clinical) [Ep 12 · 7:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=420) - The prevalence of obesity-related comorbidities is increasing in children and adolescents; conditions normally seen in adults are now common in young children. — Beth (epidemiological) [Ep 12 · 7:10](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=430) - Over 50% of children in the clinic have cardiovascular and metabolic risk factors; 29% have fatty liver disease; 32% have dyslipidemia. — Beth (epidemiological) [Ep 12 · 7:40](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=460) - A 12-year-old patient in the weight management program died of a heart attack. — Beth (clinical) [Ep 12 · 8:40](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=520) - The multidisciplinary team at Children's of Alabama includes a psychologist or counselor, dietitian, physical therapist or exercise specialist, primary care provider, bariatric nurse, nurse practitioner, social worker, and surgeon. — Beth (clinical) [Ep 12 · 10:40](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=640) - Indications for bariatric surgery: BMI ≥40 with weight-related comorbidities, physiologic maturity (Tanner stage 4 or 5), commitment to pre- and post-operative evaluation, agreement to avoid pregnancy for one year (if female), and supportive, committed family. — Beth (guideline) [Ep 12 · 13:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=780) - Patients must demonstrate decisional capacity and maturity to give informed consent, often assessed by psychologists. — Beth (clinical) [Ep 12 · 15:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=900) - Contraindications include medically correctable cause of obesity, active substance abuse, tobacco use, medical or psychiatric problems impairing adherence, current breastfeeding, pregnancy, or plans to become pregnant within one year. — Beth (guideline) [Ep 12 · 15:30](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=930) - Roux-en-Y gastric bypass is the most common bariatric procedure; it is both restrictive (small pouch holds ~2 ounces) and malabsorptive (duodenum bypassed, reducing fat and sugar absorption). — Beth (clinical) [Ep 12 · 17:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1020) - Vertical sleeve gastrectomy removes a large portion of the stomach, leaving a small sleeve; the rest of the anatomy is not altered. Ghrelin (hunger hormone) is largely removed with the excised stomach. — Beth (clinical) [Ep 12 · 18:20](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1100) - Sleeve gastrectomy is not reversible but can be converted to gastric bypass if weight loss is inadequate or complications persist. — Beth (clinical) [Ep 12 · 19:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1140) - Laparoscopic adjustable gastric band is not FDA-approved for patients under 18 and has not been used at the speaker's center. — Beth (guideline) [Ep 12 · 20:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1200) - Teen-LABS is an NIH NIDDK-funded observational study tracking adolescents (ages 13–19) undergoing bariatric surgery to determine the risks and benefits of operating in the teen years versus waiting until adulthood. — Beth (clinical) [Ep 12 · 22:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1320) - In the Teen-LABS cohort, 50% of teens have 1–3 comorbidities, 39% have 4–5 comorbidities, and 12% have more than 6 comorbidities. — Beth (epidemiological) [Ep 12 · 23:20](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1400) - Children with obesity often do not readily disclose how badly they are being treated or how hurt they are; they will say everything is fine when it rarely is. — Beth (clinical) [Ep 12 · 26:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1560) - Psychological burdens include poor self-image, low self-worth, depression, suicidality, self-harm (cutting), and multiple suicide attempts. — Beth (clinical) [Ep 12 · 26:30](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1590) - School difficulties manifest as grade drops, absenteeism, withdrawal from school, or transition to homeschooling. — Beth (clinical) [Ep 12 · 27:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1620) - Bullying is severe and includes verbal abuse, food thrown at them, tripping, and exclusion; teachers may fail to stop it or may participate. — Beth (clinical) [Ep 12 · 27:20](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1640) - Social isolation is common; teens may not date, attend prom with a sibling or cousin, or sit on the bench in sports despite having better skills than thinner players. — Beth (clinical) [Ep 12 · 28:20](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1700) - Many of these children have binge eating disorders because food is their 'best friend.' — Beth (clinical) [Ep 12 · 29:10](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1750) - 64% of teens with obesity report being victims of weight-based stigmatization; nearly every patient in the speaker's clinic reports teasing or bullying during intake. — Beth (epidemiological) [Ep 12 · 30:20](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1820) - Perpetrators of weight-based stigma include peers, teachers, parents, and healthcare professionals. — Beth (clinical) [Ep 12 · 31:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1860) - If patients seeking help detect these negative attitudes from healthcare providers, it defeats them and prevents them from moving forward. — Beth (opinion) [Ep 12 · 33:20](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=2000) - Using graphic words to shock patients into making changes does not work; it turns them off instead. — Beth (clinical) [Ep 12 · 35:40](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=2140) - Bariatric surgery has led to tremendous gains in the health of children: improved metabolic parameters, significant weight loss, resolution of diabetes (no longer requiring medications), cure of sleep apnea, and improved dyslipidemia. — Beth (clinical) [Ep 12 · 35:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=2100) - Psychological outcomes are vastly improved after bariatric surgery; quality of life starts lower than children with cancer but becomes better than population norms and is sustained over time. — Beth (clinical) [Ep 12 · 35:50](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=2150) - MBSAQIP criteria for freestanding pediatric centers require 100 lifetime cases, 75 of which can be completed during fellowship training, and 20 cases per year to maintain accreditation as MBS director or verified MBS surgeon — Evan (guideline) [Ep 26 · 0:46](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=46) - If partnering with an adult bariatric program, pediatric surgeons do not need to meet the verified surgeon criteria because adult surgeons serve as the verified surgeons, allowing the pediatric surgeon to practice without independent credentialing — Evan (guideline) [Ep 26 · 1:35](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=95) - Annual case volume requirement was reduced to 15 cases per year for pediatric centers — Evan (guideline) [Ep 26 · 2:01](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=121) - A pediatric surgeon can partner with an adult surgeon for 1-3 years until reaching 100 cases and 15 annual cases in their program, then practice independently — Mika (guideline) [Ep 26 · 2:01](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=121) - Medicaid reimbursement for facility fees averages approximately 50% for bariatric surgery, which is better than many private payers in some regions (clinical) [Ep 26 · 2:56](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=176) - The robotic surgical system has an excellent simulator that allows surgeons to train for many hours before operating on patients — Todd Ponsky (clinical) [Ep 26 · 5:35](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=335) - The gut microbiome changes after bariatric surgery in adolescents, with increases in Firmicutes and other beneficial species associated with better health — Denise (clinical) [Ep 26 · 6:35](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=395) - It is nearly impossible to separate whether microbiome changes cause weight loss or result from weight loss and surgery, even in adult data — Denise (clinical) [Ep 26 · 6:35](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=395) - An adult bariatric surgeon completed 4 bariatric cases by 11 AM using robotic surgery with two operating rooms flipping, demonstrating efficiency potential (clinical) [Ep 26 · 9:41](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=581) - The pharmaceutical industry has significant interest in proving GLP-1 medications are the best method for treating obesity — Denise (opinion) [Ep 26 · 10:36](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=636) - Twenty years ago there was a huge disparity between adolescents receiving bariatric surgery and those who needed it — Mika (epidemiological) [Ep 26 · 8:54](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=534) - Even with 500 pediatric bariatric cases performed, the field is not moving the needle on the overall problem of adolescent obesity (opinion) [Ep 26 · 9:41](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=581) - The vast majority of medical schools do not adequately teach about the disease of obesity in pathophysiology curricula — Evan (opinion) [Ep 26 · 11:42](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=702) - Teen Labs 10-year latent class analysis identified four phenotypes of bariatric surgery responders. — Justin Ryder (clinical) [Ep 25 · 0:54](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=54) - Superior responders (18% of cohort) lost about 45% of weight at nadir and maintained that loss out to 10 years. — Justin Ryder (clinical) [Ep 25 · 1:30](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=90) - A second group lost about 35% at nadir and kept over 25% off at 10 years. — Justin Ryder (clinical) [Ep 25 · 2:00](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=120) - A third group (one-third of cohort) had 12% BMI change at 10 years, comparable to semaglutide's mean response in adolescents at 1 year. — Justin Ryder (clinical) [Ep 25 · 2:20](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=140) - Non-responders (red group) did not lose ideal weight, returned to baseline by 4 years, and overshot their starting weight. — Justin Ryder (clinical) [Ep 25 · 3:00](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=180) - In Teen Labs, the only predictor of 10-year weight change was 6-month weight loss; no demographic, clinical, or social determinant factors predicted response. — Justin Ryder (clinical) [Ep 25 · 3:30](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=210) - Teen Labs shows no difference in outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy at 10 years. — Justin Ryder (clinical) [Ep 25 · 4:30](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=270) - At 2 years, weight loss is about 30% in both sleeve gastrectomy and Roux-en-Y gastric bypass. — Justin Ryder (clinical) [Ep 25 · 5:00](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=300) - Tirzepatide (Eli Lilly's dual GLP-1/GIP receptor agonist) shows 25% weight loss at 72 weeks, similar to surgery at 2 years. — Justin Ryder (clinical) [Ep 25 · 5:20](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=320) - Randomized trials of surgery versus medications are now ethically feasible because newer AOMs have potential for comparable benefit. — Justin Ryder (opinion) [Ep 25 · 5:50](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=350) - Bariatric surgery will continue to receive a grade of C from policymakers until randomized trials versus alternative therapies are conducted. — Justin Ryder (opinion) [Ep 25 · 5:40](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=340) - Bariatric surgery is more effective in adolescents than adults, and this cannot be explained solely by duration of disease. — Justin Ryder (clinical) [Ep 25 · 6:50](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=410) - Remission of type 2 diabetes in adolescents versus adults after bariatric surgery highlights the need for mechanistic studies. — Justin Ryder (opinion) [Ep 25 · 7:20](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=440) - Mechanistic studies examining genetics, proteins, and metabolites may identify super-responders and guide combination therapies. — Justin Ryder (opinion) [Ep 25 · 7:40](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=460) - Oncology colleagues used genetics for precision medicine 30 years ago, and it took 20-30 years for patient impact. (clinical) [Ep 25 · 9:50](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=590) - Genetics should be evaluated on a large scale to identify preoperative predictors of bariatric surgery response. (opinion) [Ep 25 · 10:10](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=610) - Metabolic pathways perturbed by obesity are relevant to treatment response and may not have genetic origins. (opinion) [Ep 25 · 10:30](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=630) - Tirzepatide and semaglutide drug trials are approximately 70% white and not conducted in urban settings. (epidemiological) [Ep 25 · 11:00](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=660) - Real-world AOM efficacy in urban, predominantly Black and Hispanic populations does not match published trial results. (opinion) [Ep 25 · 11:20](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=680) - Clinical trial diversity is abysmal, and drug companies prioritize timeline over quality in enrollment. — Justin Ryder (opinion) [Ep 25 · 11:50](https://origin-library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=710) - Children on Medicare and Medicaid are up to 2 times more likely to suffer from obesity, but comprise just over a third of patients obtaining bariatric services. — Manish Raiji (epidemiological) [Ep 23 · 9:00](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=540) - There is a large mismatch between the number of bariatric centers per state versus the prevalence of obesity in those states. — Manish Raiji (epidemiological) [Ep 23 · 9:30](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=570) - Children as young as 7 or 8 years of age require assent, especially for invasive procedures. — Manish Raiji (guideline) [Ep 23 · 9:50](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=590) - Most guidelines suggest no age limits for the performance of bariatric surgery. — Manish Raiji (guideline) [Ep 23 · 10:05](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=605) - Children with intellectual and developmental delays are 1.5 to 2 times more likely to have obesity due to medications, behavioral issues, and dietary issues. — Manish Raiji (epidemiological) [Ep 23 · 10:15](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=615) - Bariatric surgery should be thought of as a very effective strategy and more as a primary intervention rather than an endpoint to a spectrum of failed other options. — Manish Raiji (opinion) [Ep 23 · 10:52](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=652) - Clinical practice guidelines intend to offer bariatric therapy when it's available, not when everything else has been tried. (guideline) [Ep 23 · 11:15](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=675) - Many referring pediatricians and families still think bariatric surgery is risky and dangerous. (opinion) [Ep 23 · 11:35](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=695) - Obesity disproportionately affects vulnerable populations that don't have the same kind of insurance access. (epidemiological) [Ep 23 · 12:15](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=735) - Societal bias that obesity is a personal choice is the first barrier that leads people not to seek any kind of care or treatment. — Karen (opinion) [Ep 23 · 12:41](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=761) - Tonsillectomy and adenoidectomy for sleep apnea is only 35% effective in kids with obesity. (clinical) [Ep 23 · 14:22](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=862) - ENT surgeons are now recognizing the limited effectiveness of tonsillectomy in children with obesity and sleep apnea. (clinical) [Ep 23 · 14:43](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=883) - Bariatric surgery fits in the category of low-risk, high-reward procedures based on data showing procedures are safe in children with excellent outcomes. — Manish Raiji (clinical) [Ep 23 · 8:00](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=480) - In adult patient-physician relationships, the patient and physician are at the central portion of the relationship, but in pediatrics the parents and entire family unit must be included. — Manish Raiji (clinical) [Ep 23 · 4:00](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=240) - A 17-year-old cancer patient has a lot of influence on the decisions being made for her, unlike a neonate who has no autonomy. — Manish Raiji (clinical) [Ep 23 · 5:00](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=300) - The medical values of children as they become adults are influenced very heavily by their parents. — Manish Raiji (clinical) [Ep 23 · 7:00](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=420) - Incapacitated adults often have a lifetime of behavior upon which surrogate decision makers can base perceived values, but none of that exists for a child. — Manish Raiji (clinical) [Ep 23 · 8:00](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=480) - Pediatric bariatric surgeons treat approximately 0.05% of children who need surgery, well below adult treatment rates — Evan Nadler (epidemiological) [Ep 24 · 0:34](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=34) - MBSAQIP requirements for verified surgeon at freestanding children's hospital: 100 lifetime cases (75 can be as fellow) and 20 stapled cases per year — Evan Nadler (guideline) [Ep 24 · 3:20](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=200) - In MBSAQIP database of approximately 4800 teens, only about 50 are preteens — Evan Nadler (epidemiological) [Ep 24 · 5:20](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=320) - Preteens undergoing bariatric surgery have higher rates of insulin-dependent diabetes and sleep apnea compared to teens, indicating they are sicker pre-operatively — Evan Nadler (clinical) [Ep 24 · 5:40](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=340) - Safety outcomes in preteens were the same or better than teens in MBSAQIP data — Evan Nadler (clinical) [Ep 24 · 6:20](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=380) - Nadler's youngest bariatric surgery patients were two 4-year-olds: one homozygous for MC4R receptor deficiency and one with Rohhad syndrome — Evan Nadler (clinical) [Ep 24 · 7:10](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=430) - Using BMI percentiles instead of absolute BMI values can help with insurance approval by confusing reviewers who then focus on comorbidities like diabetes — Evan Nadler (clinical) [Ep 24 · 7:40](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=460) - In the DC area, most Medicaid programs have removed age cutoffs for bariatric surgery after years of education efforts — Evan Nadler (guideline) [Ep 24 · 8:40](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=520) - Insurance companies often defer to specialist clinicians for rare cases when clinical justification is provided — Mark (opinion) [Ep 24 · 9:10](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=550) - The ideal age to operate may be between 12 and 14 years because these children still listen to parents and are developing habits — Mark (opinion) [Ep 24 · 10:30](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=630) - Operating on 10-11 year olds may be even better because going through puberty at normal or lower weight is beneficial physically and mentally, and younger children have less independent access to food — Evan Nadler (opinion) [Ep 24 · 10:44](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=644) - Off-label use of medications including Vyvanse, phentermine, topiramate, and GLP-1 agonists has been standard practice for years in young patients because the disease needs treatment — Evan Nadler (clinical) [Ep 24 · 11:21](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=681) - Medications may be no safer than surgery, with less long-term data in children, similar gallstone risk, and higher weight regain due to medication discontinuation — Evan Nadler (opinion) [Ep 24 · 13:13](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=793) - Treating hyperphagia early with medications like ADD drugs can prevent children from becoming heavier, even if it doesn't prevent surgery later — Mark (clinical) [Ep 24 · 13:56](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=836) - Phentermine has less addictive properties than ADD medications — Evan Nadler (clinical) [Ep 24 · 14:50](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=890) - Younger patients prepared in non-surgical weight management clinics before surgery show better compliance and have mental health issues addressed in a timely manner — Mark (clinical) [Ep 24 · 15:11](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=911) - Study of 490 patients from 2018-2022 included 34 with special healthcare needs: autism spectrum disorder, intellectual/developmental disabilities, Trisomy 21, and Prader-Willi syndrome — Evan Nadler (epidemiological) [Ep 24 · 19:10](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1150) - Patients with special healthcare needs lost weight after bariatric surgery, though not quite as much as neurotypical patients — Evan Nadler (clinical) [Ep 24 · 20:00](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1200) - When separated, autism spectrum disorder patients (n=16) appeared to do better than intellectual/developmental disability patients (n=13), though only 6-month excess weight loss was statistically significant — Evan Nadler (clinical) [Ep 24 · 20:30](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1230) - Autism spectrum disorder patients may do better partly because more are male (males tend to have better bariatric surgery outcomes) and because some have highly structured routines and follow post-operative rules strictly — Evan Nadler (opinion) [Ep 24 · 20:30](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1230) - Patients with autism spectrum disorder and selective eating often do better after surgery because post-operative requirements (protein, water, multivitamin) fit their need for structured eating patterns — Evan Nadler (clinical) [Ep 24 · 23:41](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1421) - Some patients with special healthcare needs had parents who could barely care for them, and surgery made care easier rather than harder — Evan Nadler (clinical) [Ep 24 · 23:41](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1421) - Prader-Willi patients do not do as well with bariatric surgery but still do better than without surgery — Evan Nadler (clinical) [Ep 24 · 25:38](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1538) - Syndromic genetic obesity patients need everything: medications, surgery, and continued medications post-operatively — Mark (opinion) [Ep 24 · 25:48](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1548) - One bariatric surgery operation costs approximately $50,000, equivalent to 3-4 years of GLP-1 agonist therapy at current prices — Evan Nadler (epidemiological) [Ep 24 · 28:58](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1738) - According to 2022 MBSAQIP database, 90% of primary bariatric procedures in children are sleeve gastrectomies, 9% are laparoscopic gastric bypass, with some biliopancreatic diversions. — Janey Pratt (epidemiological) [Ep 22 · 1:05](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=65) - The most common revisional procedure is sleeve to bypass, done for inadequate weight loss or bile reflux. — Janey Pratt (clinical) [Ep 22 · 2:30](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=150) - In the US, 90% of pediatric bariatric cases are sleeve gastrectomies, but this is not necessarily true around the world. — Janey Pratt (epidemiological) [Ep 22 · 3:00](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=180) - For sleeve gastrectomy, the top reason for revision is inadequate weight loss, followed by bile reflux and then stenosis or kinking. — Janey Pratt (clinical) [Ep 22 · 3:20](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=200) - For gastric bypass with inadequate weight loss, revision is ineffective—lengthening limbs or making the pouch smaller doesn't work, with no evidence supporting these approaches. — Janey Pratt (clinical) [Ep 22 · 4:20](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=260) - Converting bypass to BPD for inadequate weight loss is extremely difficult due to the anatomy. — Janey Pratt (clinical) [Ep 22 · 4:50](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=290) - Gastric bypass is often revised for ulcer disease, including gastrojejunal ulcers that can develop when patients start smoking as adults, leading to stenosis, ulcers, pain, bleeding, and food intolerance. — Janey Pratt (clinical) [Ep 22 · 5:10](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=310) - Re-sleeving is fairly effective in a moderate number of patients with large antrum, inadequate weight loss, or non-bile reflux from retained fundus, though there is data in adults but no data in children. — Janey Pratt (clinical) [Ep 22 · 5:40](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=340) - In one anastomosis gastric bypass (OAGB), the small intestine is measured from the ligament of Treitz at 150 to 200 centimeters, leaving at least 300 centimeters in the common channel. — Janey Pratt (clinical) [Ep 22 · 4:40](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=280) - In biliopancreatic diversion, approximately 100 centimeters is left from the gastric anastomosis to the terminal ileum, with intestinal length split between the other two limbs. — Janey Pratt (clinical) [Ep 22 · 5:20](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=320) - In SADI (single anastomosis duodenoileal bypass with sleeve), the anastomosis is made 300 centimeters from the ileocecal valve. — Janey Pratt (clinical) [Ep 22 · 5:50](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=350) - Greater curvature plication is purported to have advantages including wider acceptance in younger patients because it's not a resection, potential metabolic benefit beyond restriction, reversibility (especially early on), possibly less risk of leak, and ability to progress to full sleeve or other procedures. — David Lanning (clinical) [Ep 22 · 6:19](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=379) - There are limited studies on gastric plication, with most done in adults and only one other study outside of the presenter's experience involving a dozen adolescent patients overseas. — David Lanning (epidemiological) [Ep 22 · 7:30](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=450) - In the pilot study of gastric plication, four patients aged 16-17 were enrolled with average weight 139 kg and average BMI 48 (range 41.7 to 53.7). — David Lanning (epidemiological) [Ep 22 · 8:00](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=480) - Two of four plication patients withdrew from the study after 90 days, both living over an hour outside of Richmond, leaving only two patients followed for the full 3 years. — David Lanning (epidemiological) [Ep 22 · 8:40](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=520) - The gastric plication procedure took an average of 202 minutes with minimal blood loss, and patients were kept for 2 to 3 days. — David Lanning (clinical) [Ep 22 · 10:20](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=620) - Weight loss at 90 days after plication averaged 17.7 kg, and at 3 years for the two patients who completed the study averaged 45.7 kg, with one patient losing up to 70 kg and another losing some weight but gaining a little back. — David Lanning (clinical) [Ep 22 · 10:50](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=650) - Percent change of BMI after plication was 17.5% at 90 days and 39.7% at 36 months. — David Lanning (clinical) [Ep 22 · 11:30](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=690) - Plication patients reported early satiety and good hunger control for the duration of follow-up with limited nausea. — David Lanning (clinical) [Ep 22 · 11:50](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=710) - Two plication patients followed long-term had mild reflux symptoms that resolved without significant long-term intervention, and one had abdominal pain that resolved on its own. — David Lanning (clinical) [Ep 22 · 12:10](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=730) - There were no major complications from plication, with only one readmission for nausea requiring a 23-hour stay. — David Lanning (clinical) [Ep 22 · 12:35](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=755) - At 9 years post-plication, one patient went from 142-143 kg to losing about 40 kg with BMI decreasing from 55.8 to 40.4, with resolution of pre-diabetes. — David Lanning (clinical) [Ep 22 · 11:20](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=680) - At 9 years post-plication, a second patient (5'11" tall) went from 175 kg to 100 kg with BMI decreasing from 53.8 to 30.7, with resolution of severe sleep apnea that had required CPAP. — David Lanning (clinical) [Ep 22 · 12:00](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=720) - Both plication patients at 9 years continue to have good early satiety and hunger control. — David Lanning (clinical) [Ep 22 · 12:40](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=760) - Gastric plication may have a role in severely obese patients whose care providers are reluctant to remove 80% of the stomach, particularly in younger patients. — David Lanning (opinion) [Ep 22 · 12:20](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=740) - In the adult population, if patients have BMI over 50 or childhood onset obesity, sleeve to SADI is typically performed for revision. — Janey Pratt (clinical) [Ep 22 · 13:36](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=816) - When performing revision surgery on 20-year-olds who had sleeves, bypasses result in significant weight loss. — Janey Pratt (clinical) [Ep 22 · 13:36](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=816) - Kids respond differently to revisional surgery than adults, and more research is needed. — Janey Pratt (opinion) [Ep 22 · 13:36](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=816) - Physical activity for girls is always lower than boys, and physical activity for kids is predominantly influenced by their moms. — Stephanie Walsh (epidemiological) [Ep 21 · 4:40](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=280) - Physical activity impacts mental health. — Stephanie Walsh (clinical) [Ep 21 · 5:10](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=310) - Bupropion post-op helps with mood and gives patients extra support toward weight loss, though patients are supposed to be 18. — Stephanie Walsh (clinical) [Ep 21 · 5:50](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=350) - In Atlanta, phentermine is only available in 15 mg capsule form, which cannot be broken in half. — Stephanie Walsh (clinical) [Ep 21 · 10:00](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=600) - There is significant medication hesitancy among families in Atlanta. — Stephanie Walsh (opinion) [Ep 21 · 10:40](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=640) - Novo Nordisk is sending out the 1.7 and 2.4 mg doses but very little of the lower doses, prioritizing people already on maintenance. — Stephanie Walsh (clinical) [Ep 21 · 11:20](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=680) - Some patients do really well at 1.7 mg GLP-1 but not necessarily as well at 2.4 mg. (clinical) [Ep 21 · 12:00](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=720) - As of last year, 1.7 mg is considered a maintenance dose, so there should be less issue with insurers covering it. — Stephanie Walsh (guideline) [Ep 21 · 12:40](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=760) - The lowest effective and tolerable dose should be used for each patient, and ramp-up should be individualized. — Stephanie Walsh (opinion) [Ep 21 · 13:00](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=780) - Medications are offered at 3 months for less than 10% total body weight loss and at 6 months for less than 15%. — Stephanie Walsh (clinical) [Ep 21 · 14:10](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=850) - These thresholds (10% at 3 months, 15% at 6 months) are very conservative given the Teen-LABS data. — Stephanie Walsh (opinion) [Ep 21 · 14:25](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=865) - In a cohort of 750 patients, modeling shows that if a patient is off the weight loss curve at 3 months, they never get back on that curve. — Stephanie Walsh (clinical) [Ep 21 · 14:40](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=880) - A cohort of patients did not get satiety from their sleeve despite the same amount of resection each time. — Stephanie Walsh (clinical) [Ep 21 · 15:00](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=900) - Patients without satiety are started on Vyvanse at 2 weeks post-op. — Stephanie Walsh (clinical) [Ep 21 · 15:15](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=915) - Studies looking at 6 months or later time points for medication initiation are way too late; the data strongly suggest starting earlier and being more aggressive. — Stephanie Walsh (opinion) [Ep 21 · 15:25](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=925) - With type 2 diabetes, there is no reason to wait for a BMI of 35 arbitrarily because diabetes is not going to get better at a BMI of 32. (opinion) [Ep 21 · 15:50](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=950) - The longer patients are on insulin, the less likely you are to help their diabetes. — Stephanie Walsh (clinical) [Ep 21 · 16:05](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=965) - Robotic platforms provide markedly superior 3D stereoscopic visualization compared to laparoscopic cameras. — Guillermo Ares (clinical) [Ep 20 · 0:50](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=50) - Wristed robotic instruments improve dexterity and enable more complex intraoperative procedures including intracorporeal suturing and complex anastomoses. — Guillermo Ares (clinical) [Ep 20 · 2:00](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=120) - In robotic surgery, the surgeon assists themselves and controls the entire operation including dissection and exposure, displacing one staffing member. — Guillermo Ares (clinical) [Ep 20 · 3:40](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=220) - Controlling the operation from all angles is especially important in revisional bariatric surgery where retraction matters significantly. — Guillermo Ares (clinical) [Ep 20 · 4:40](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=280) - The Da Vinci XI platform is what should be used for robotic bariatric surgery; other platforms are outdated and don't provide the same support. — Guillermo Ares (opinion) [Ep 20 · 7:20](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=440) - Development of a robotic stapler was the last piece to equalize laparoscopic versus robotic surgery, occurring in the later half of the last decade. — Guillermo Ares (clinical) [Ep 20 · 7:20](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=440) - Obesity hurts kidneys and obesity hurts transplanted kidneys. — Guillermo Ares (clinical) [Ep 20 · 8:20](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=500) - Robotic technology is still in its infancy. — Mark Wulkan (opinion) [Ep 20 · 12:00](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=720) - There has been one robotic vendor for the last 20 years; now there will be at least 2 other robots coming on the market this year, which should create competition and improve instruments. — Mark Wulkan (clinical) [Ep 20 · 12:20](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=740) - Laparoscopic sleeve gastrectomy can be performed with a medical student assistant without taking excessive time. — Mark Wulkan (clinical) [Ep 20 · 12:50](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=770) - Until the cost of the robot decreases, it will not be widely adopted. — Mark Wulkan (opinion) [Ep 20 · 13:10](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=790) - Ares's first robotic case to second robotic case, OR time cut in half, and continued to decrease from there. — Guillermo Ares (clinical) [Ep 20 · 14:16](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=856) - Turnover time between robotic cases is similar to laparoscopic when there is a dedicated robotic team; without one, turnaround time is palpably longer. — Guillermo Ares (clinical) [Ep 20 · 14:40](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=880) - Wristed instruments and 3D vision are better than straight instruments and 2D vision. (opinion) [Ep 20 · 15:20](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=920) - Once a surgeon has done robotic surgery, they want to only do robotic surgery because it is so much better than laparoscopic. (opinion) [Ep 20 · 15:50](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=950) - In 2004-2005, ASMBS developed a Centers of Excellence framework in response to public and professional concerns related to patient safety in bariatric surgery. — Marc Michalsky (clinical) [Ep 18 · 2:24](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=144) - Ken Champion and Walter Porre led a consensus conference in 2004 that addressed bariatric surgery safety issues and published a treatise in 2005. — Marc Michalsky (clinical) [Ep 18 · 2:48](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=168) - Centers of Excellence provided a means to identify bariatric surgery programs that provide comprehensive and standardized care and long-term follow-up. — Marc Michalsky (clinical) [Ep 18 · 3:06](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=186) - The Centers of Excellence framework served as a way to report and compile patient outcomes within a national registry to assess and verify risks and benefits. — Marc Michalsky (clinical) [Ep 18 · 3:24](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=204) - Between 2005 and 2012, major payers declared that authorization for bariatric surgical care needed to be done in accredited centers, in part due to reduction in mortality attributable to national accreditation. — Marc Michalsky (epidemiological) [Ep 18 · 4:18](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=258) - In 2012, ASMBS and ACS combined forces to merge their two separate accreditation programs. — Marc Michalsky (clinical) [Ep 18 · 4:42](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=282) - Robin Blackstone led the merging of the two accreditation programs and championed incorporating pediatrics, stating it was the right thing to do. — Marc Michalsky (clinical) [Ep 18 · 4:54](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=294) - MBSAQIP was released in 2014 and has undergone a number of iterations over subsequent years. — Marc Michalsky (clinical) [Ep 18 · 5:18](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=318) - The MBSAQIP framework and ASMBS best practice guidelines informed the recent American Academy of Pediatrics policy statement and clinical practice guidelines on pediatric bariatric surgery. — Marc Michalsky (guideline) [Ep 18 · 5:30](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=330) - There are currently 958 MBSAQIP accredited programs throughout the United States. — Marc Michalsky (epidemiological) [Ep 18 · 6:36](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=396) - 109 programs are adult care centers with adolescent designation, representing 11% of all accredited centers. — Marc Michalsky (epidemiological) [Ep 18 · 6:48](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=408) - 7 freestanding children's hospitals have MBSAQIP accreditation for adolescent bariatric surgery, representing about 1% of total accredited centers. — Marc Michalsky (epidemiological) [Ep 18 · 7:00](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=420) - Pediatric bariatric surgery volume in the MBSAQIP registry appears to be increasing, approaching 500 cases in 2023 based on extrapolation. — Marc Michalsky (epidemiological) [Ep 18 · 7:12](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=432) - A significant number of high-quality, high-volume pediatric bariatric surgery centers are not part of MBSAQIP. — Marc Michalsky (epidemiological) [Ep 18 · 7:36](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=456) - MBSAQIP accreditation translates into institutional commitment to providing the resources and equipment required to provide safe and timely care. — Marc Michalsky (clinical) [Ep 18 · 8:06](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=486) - The centralized MBSAQIP database allows for generation of risk-adjusted institutional-specific data analysis on a bi-quarterly basis. — Marc Michalsky (clinical) [Ep 18 · 8:24](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=504) - Risk-adjusted outcome reports inform required quality improvement projects using standard PDSA or QI framework. — Marc Michalsky (clinical) [Ep 18 · 8:42](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=522) - ERAS implementation at Nationwide Children's Hospital showed reduced hospital length of stay and reduced opioid use. — Marc Michalsky (clinical) [Ep 18 · 9:00](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=540) - Age less than 18 is cited as the most common reason for bariatric surgery insurance denials. — Marc Michalsky (epidemiological) [Ep 18 · 9:18](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=558) - Major payers require MBSAQIP accreditation for adult bariatric surgery programs. — Marc Michalsky (clinical) [Ep 18 · 9:36](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=576) - It is uncertain whether major payers will require MBSAQIP accreditation for pediatric bariatric surgery centers in the future. — Marc Michalsky (opinion) [Ep 18 · 9:48](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=588) - The American Academy of Pediatrics has made bariatric surgery a widely disseminated therapeutic paradigm through education. — Marc Michalsky (clinical) [Ep 18 · 10:06](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=606) - Major payers have been asked to pay attention to the AAP guidelines on pediatric bariatric surgery. — Marc Michalsky (clinical) [Ep 18 · 10:24](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=624) - Patients have been denied bariatric surgery coverage by payers because the institution was not MBSAQIP accredited, even for pediatric cases. — Marc Michalsky (clinical) [Ep 18 · 12:30](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=750) - Some children's hospitals do not freely provide the resources required to set up a safe bariatric surgery service. — Marc Michalsky (opinion) [Ep 18 · 13:18](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=798) - MBSAQIP accreditation requires hospitals to commit to making all required equipment and resources available, which costs money. — Marc Michalsky (clinical) [Ep 18 · 13:42](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=822) - The MBSAQIP application price is high, but active discussions are underway to accommodate pediatric programs and reduce the cost. — Marc Michalsky (clinical) [Ep 18 · 14:25](https://origin-library.globalcastmd.com/watch/marc-michalsky-md-2024-pediatric-bariatric-surgery-update-course-7959?t=865) - Reports of ERAS protocols in pediatric metabolic and bariatric surgery are limited — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 0:30](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=30) - In 2018, the institution developed an ERAS protocol for adolescents undergoing robotically assisted vertical sleeve gastrectomy focusing on pain management, nausea control, and early oral intake and ambulation — Wendy Jo Svetanoff (clinical) [Ep 16 · 0:50](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=50) - The study was a single institution retrospective review with pre-post analysis of patients who underwent robotic sleeve gastrectomy from July 2015 to July 2021 — Wendy Jo Svetanoff (clinical) [Ep 16 · 2:00](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=120) - The ERAS algorithm was developed as part of a multi-specialty quality improvement project with four main areas of focus: post-operative pain, nausea, narcotic use, and oral fluid intake — Wendy Jo Svetanoff (clinical) [Ep 16 · 2:30](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=150) - Pre-operative management included allowing a carbohydrate electrolyte drink on day of surgery, along with pre-operative pain and nausea medication — Wendy Jo Svetanoff (clinical) [Ep 16 · 3:00](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=180) - Intraoperatively, ketorolac and bilateral TAP blocks were given for pain control, while metoclopramide and dexamethasone were given for nausea management — Wendy Jo Svetanoff (clinical) [Ep 16 · 3:30](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=210) - Post-operatively, a multimodal non-narcotic pain regimen was scheduled, while narcotic pain medication was available on an as needed basis — Wendy Jo Svetanoff (clinical) [Ep 16 · 4:00](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=240) - Patients were discharged after demonstrating tolerance of a bariatric phase one diet without nausea or vomiting and had good pain control with oral medications only — Wendy Jo Svetanoff (clinical) [Ep 16 · 4:30](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=270) - 110 patients were included in the analysis, with 60 patients in the pre-ERAS group and 50 patients in the post-ERAS group — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 5:00](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=300) - There was a significantly higher percentage of females in the pre-ERAS group, while all other demographic characteristics were similar between the two groups — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 5:20](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=320) - No difference was noted in operating time or total OR time between groups — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 5:40](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=340) - Significantly more patients in the post-ERAS group received intraoperative acetaminophen and ketorolac — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 5:55](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=355) - Patients in the post-ERAS group received significantly fewer opioid medications — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 6:15](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=375) - The median time to first oral intake was 1.5 hours sooner in the post-ERAS group — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 6:30](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=390) - The time to first ambulation was 1 hour sooner after initiation of ERAS — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 6:50](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=410) - Post-operative hospital stay was almost one day less in the post-ERAS group — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 7:05](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=425) - Post-ERAS patients received only a median of 7.5 morphine milliequivalents of opioids compared to the pre-ERAS group who received a median of 58.1 morphine milliequivalents — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 7:20](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=440) - All patients in the pre-ERAS group required narcotics, while only 76% utilized narcotics in the post-ERAS group during their hospital stay — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 7:50](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=470) - Only 64% of post-ERAS patients required opioids post-operatively — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 8:10](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=490) - There was no difference in post-operative complications between groups — Wendy Jo Svetanoff (epidemiological) [Ep 16 · 8:25](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=505) - Balancing measures looking specifically at nausea, vomiting, and dehydration requiring admission were either the same or lower in the post-ERAS group, indicating that protocol implementation did not elicit added harm to the patients — Wendy Jo Svetanoff (clinical) [Ep 16 · 8:40](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=520) - Initiation of a targeted ERAS protocol for patients undergoing robotic assisted sleeve gastrectomy led to a significant decrease in narcotic consumption and length of stay without any change in 30-day complication rates — Wendy Jo Svetanoff (clinical) [Ep 16 · 9:10](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=550) - Kids and teens experiencing obesity are at higher risk for mood disorders including depression and anxiety, body image difficulties, self-esteem issues, peer relationship problems (including bullying and teasing), and lower resilience. — Tracy Williams (clinical) [Ep 19 · 0:34](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=34) - There is a reciprocal relationship among psychosocial factors in obesity: poor sleep impacts mood and attention, and kids with obesity are at risk for ADHD; these factors are interconnected and affect self-perception. — Tracy Williams (clinical) [Ep 19 · 2:00](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=120) - All psychosocial aspects of patients' lives need monitoring even after bariatric surgery. — Tracy Williams (clinical) [Ep 19 · 3:00](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=180) - Long-term mental health care is advised post-operatively, including assessment such as 3-month screening for depression and anxiety, and some places recommend screening for body dysmorphia. — Tracy Williams (guideline) [Ep 19 · 5:00](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=300) - There is a connection between quality of physical health and quality of moods, emotions, and relationships: as physical health improves, mood and relationships are likely to improve. — Tracy Williams (clinical) [Ep 19 · 6:20](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=380) - Pre-operative discussions about post-surgical lifestyle changes are important because teenagers typically do not spend much time thinking in future tense. — Tracy Williams (clinical) [Ep 19 · 6:40](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=400) - Post-operative check-ins should assess not only adherence to recommended behaviors but also how patients are managing lifestyle changes. — Tracy Williams (clinical) [Ep 19 · 7:30](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=450) - Developmental transitions such as finishing high school, academic stress, and preparing to launch from home are important considerations, as stress has a connection with relationship to food. — Tracy Williams (clinical) [Ep 19 · 8:00](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=480) - People who experience obesity tend to have disconnection from their body and are not fully connected to their sense of physical self. — Tracy Williams (clinical) [Ep 19 · 9:00](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=540) - After bariatric surgery, physical changes happen rapidly but the change in how patients view themselves does not happen as quickly, leading to a disconnect where patients do not recognize they are changing even when others comment on it. — Tracy Williams (clinical) [Ep 19 · 9:40](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=580) - Positive body image and physical satisfaction continue to be a work in progress post-operatively and will not automatically result from bariatric surgery or subsequent cosmetic surgery; this is a subconscious process that takes time. — Tracy Williams (clinical) [Ep 19 · 10:20](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=620) - Cosmetic surgery teams should assess for body dysmorphia. — Tracy Williams (guideline) [Ep 19 · 11:00](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=660) - Patients who have been bullied and socially isolated may be at risk when they suddenly receive attention (such as male attention) after weight loss post-surgery. — Tracy Williams (clinical) [Ep 19 · 11:48](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=708) - Social concerns should be addressed preoperatively; mild concerns require basic tools for managing peer conflicts and difficult conversations, while severe concerns (difficulties forming or keeping friendships, dating issues) require referral for concurrent treatment during the bariatric journey. — Tracy Williams (guideline) [Ep 19 · 12:30](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=750) - Pre-surgical evaluation should include discussion of who knows about the surgery, who is supporting the patient, and the quality of that support, as well as how to address lack of support from family members. — Tracy Williams (guideline) [Ep 19 · 13:26](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=806) - Patients should be prepared with responses for when people comment on their changed appearance post-surgery, particularly if they have not disclosed the surgery. — Tracy Williams (guideline) [Ep 19 · 14:30](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=870) - Separate conversations with parents and with teens are a crucial component of pre-surgical evaluation. — Tracy Williams (guideline) [Ep 19 · 15:45](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=945) - In the world of bariatric surgery and obesity, pediatric patients do not look like typical eating disorder patients, and screening needs to address disordered eating behavior which is different from eating disorder symptoms. (clinical) [Ep 19 · 16:14](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=974) - Bariatric surgery patients have disordered eating but are often not welcome in disordered eating outpatient programs because their BMI or symptomatology does not meet inclusion criteria. — Tracy Williams (clinical) [Ep 19 · 16:54](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=1014) - Access to mental health services is difficult, and bariatric patients are often excluded from targeted disordered eating treatment because their BMI status does not meet criteria despite being on the eating disorder spectrum. — Tracy Williams (clinical) [Ep 19 · 16:54](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=1014) - In the mental health world, there is not a good understanding of obesity or how obesity develops, and the general assumption is that obesity results from binging or binge eating, which is not typically the case. (opinion) [Ep 19 · 17:53](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=1073) - Many bariatric surgery patients have restrictive eating patterns, not binge eating as commonly assumed. — Tracy Williams (clinical) [Ep 19 · 18:12](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=1092) - PSYPACT allows for telemedicine visiting across 40 states, enabling psychologists to provide care without being locally licensed. (clinical) [Ep 19 · 18:24](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=1104) - Unless patients had a true BED (binge eating disorder) diagnosis, they could not access eating disorder treatment programs and had to be managed pre-op and post-op within the bariatric program. (clinical) [Ep 19 · 19:00](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=1140) - The 2019 AAP technical report and policy statement on bariatric surgery established selection criteria that were less conservative than previous guidelines and more aligned with adult criteria. — Karen Mangarelli (guideline) [Ep 17 · 2:00](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=120) - Pediatric bariatric surgery candidates include patients with BMI ≥40 or ≥140% of the 95th percentile (whichever is lower), or BMI ≥35 or ≥120% of the 95th percentile (whichever is lower) with a comorbid condition. — Karen Mangarelli (guideline) [Ep 17 · 3:00](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=180) - The 2019 AAP guidelines removed a minimum age limit for bariatric surgery and recommended case-by-case consideration of special populations including those with developmental disability or cognitive impairment, rather than automatic exclusion. — Karen Mangarelli (guideline) [Ep 17 · 4:30](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=270) - Essential multidisciplinary team members for pediatric bariatric surgery are surgeon, medical specialist, behavioral/mental health specialist, and registered dietitian. — Karen Mangarelli (guideline) [Ep 17 · 6:00](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=360) - Since December 2020, the FDA has approved three new medications for obesity treatment in patients 12 years and older, including two GLP-1 agonists. — Karen Mangarelli (clinical) [Ep 17 · 10:00](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=600) - The American Society of Anesthesiologists recently issued consensus-based guidance recommending that daily GLP-1 medications be held on the day of procedure and weekly GLP-1 medications be held one week prior to procedure, regardless of whether used for diabetes or obesity. — Karen Mangarelli (guideline) [Ep 17 · 11:00](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=660) - GLP-1 medications work in part by slowing gastric emptying, raising theoretical and practical concerns about regurgitation and pulmonary aspiration of gastric contents perioperatively. — Karen Mangarelli (clinical) [Ep 17 · 11:30](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=690) - In the Teen-LABS 5-year data, micronutrient deficiencies occurred postoperatively, with iron being the most common deficiency both pre- and postoperatively, and the percentage of patients with deficiencies increased over time. — Karen Mangarelli (epidemiological) [Ep 17 · 13:00](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=780) - Dr. Mangarelli's program has screened preoperatively for iron and vitamin D specifically, but is considering expanding screening after encountering postoperative cases of thiamine (B1) and folate deficiency. — Karen Mangarelli (clinical) [Ep 17 · 14:00](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=840) - In Dr. Mangarelli's inner-city patient population in a state where marijuana is legal recreationally and medicinally, marijuana use is common among adolescent bariatric surgery candidates. — Karen Mangarelli (epidemiological) [Ep 17 · 15:30](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=930) - Some bariatric programs require complete abstinence from substances before proceeding with surgery, but Dr. Mangarelli's team has adopted a harm reduction approach rather than denying surgery to patients who may need it for medical reasons. — Karen Mangarelli (opinion) [Ep 17 · 16:30](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=990) - Short-term studies (up to 2 years) in adult populations have not shown that bariatric surgery outcomes differ in patients who disclosed marijuana use. — Karen Mangarelli (epidemiological) [Ep 17 · 17:30](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1050) - Two current patients in Dr. Mangarelli's program disclosed regular marijuana use for self-medicating anxiety disorders, and anxiety disorders have increased approximately fourfold pre- versus post-COVID. — Karen Mangarelli (epidemiological) [Ep 17 · 18:00](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1080) - Teen-LABS data show that alcohol use disorder is not uncommon postoperatively in pediatric bariatric surgery patients. — Karen Mangarelli (epidemiological) [Ep 17 · 18:17](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1097) - Some insurance companies, particularly CMS, require drug screens for bariatric surgery candidates and may deny coverage if results are positive. (clinical) [Ep 17 · 18:43](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1123) - At least one insurer has treated marijuana use similarly to nicotine smoking and requested ABG and pulmonary function tests for bariatric surgery candidates. — Karen Mangarelli (clinical) [Ep 17 · 19:33](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1173) - The adult bariatric establishment is more concerned about wound healing related to substance use than the pediatric bariatric community typically is. (opinion) [Ep 17 · 20:49](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1249) - Nicotine use leads to ulcers after gastric bypass, making it contraindicated in bypass patients, but this is less of a concern with sleeve gastrectomy. (clinical) [Ep 17 · 20:49](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1249) - Excess cannabis use can lead to cannabis hyperemesis syndrome, causing continuous vomiting. (clinical) [Ep 17 · 21:20](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1280) - A 2019 study published in Surgery for Obesity and Related Diseases examined phentermine and topiramate use before and after sleeve gastrectomy in adults with BMI >50 and found no negative signal; there was greater weight loss preoperatively and postoperatively when medications were continued. (epidemiological) [Ep 17 · 23:33](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1413) - Rapid gastric emptying induced by sleeve gastrectomy is believed to be part of the mechanism by which the sleeve increases GLP-1 levels. (clinical) [Ep 17 · 24:20](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1460) - There is theoretical concern that preoperative GLP-1 use, which slows gastric emptying, could cause receptor upregulation or downregulation that interferes with postoperative bariatric surgery outcomes, but no data currently exist on this question. (opinion) [Ep 17 · 24:50](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1490) - In the future, almost every patient will likely receive some combination of GLP-1 or multi-agonist medications and surgery, making the distinction between surgical versus medication-driven weight loss less clinically relevant if total health benefit is equivalent. (opinion) [Ep 17 · 25:09](https://origin-library.globalcastmd.com/watch/preoperative-optimization-and-management-caren-mangarelli-md-2024-pediatric-bari-7957?t=1509) - Bariatric surgery has significant health benefits in adult patients. — Alexander Gibbens (clinical) [Ep 13 · 0:00](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628?t=0) - There was no difference in weight loss between adolescent and adult gastric bypass groups at five years, with both achieving 25% to 30% weight loss. — Alexander Gibbens (clinical) [Ep 13 · 0:00](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628?t=0) - Type 2 diabetes remission at five years was 86% in the adolescent gastric bypass group versus 53% in the adult group. — Alexander Gibbens (clinical) [Ep 13 · 0:00](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628?t=0) - Hypertension remission at five years was 68% in the adolescent gastric bypass group versus 41% in the adult group. — Alexander Gibbens (clinical) [Ep 13 · 0:00](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628?t=0) - Low ferritin levels occurred in 48% of the adolescent gastric bypass group versus 29% of the adult group at five years. — Alexander Gibbens (clinical) [Ep 13 · 0:00](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628?t=0) - There was a higher rate of abdominal reoperations in the adolescent gastric bypass group. — Alexander Gibbens (clinical) [Ep 13 · 0:00](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628?t=0) - Most abdominal reoperations in the adolescent group were for laparoscopic cholecystectomy rather than complications. — Alexander Gibbens (clinical) [Ep 13 · 3:38](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628?t=218) - Some abdominal reoperations in the adolescent group were for small bowel obstruction. — Alexander Gibbens (clinical) [Ep 13 · 3:38](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628?t=218) - Numbers from 2017 show approximately 14.5 million children in the United States are struggling with obesity. — Jeffrey Ponsky (epidemiological) [Ep 15 · 1:18](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=78) - Big increases in pediatric obesity have been seen with COVID. — Jeffrey Ponsky (epidemiological) [Ep 15 · 1:18](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=78) - Pediatric obesity is a worldwide problem, particularly in countries that have become more developed. — Stephanie Walsh (epidemiological) [Ep 15 · 1:47](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=107) - Obesity is a disease, and once weight is gained, the body fights to keep it on. — Jeffrey Ponsky (clinical) [Ep 15 · 2:15](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=135) - Epigenetic changes are thought to be causing higher levels of obesity. — Jeffrey Ponsky (clinical) [Ep 15 · 2:15](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=135) - Talking about weight with children increases the likelihood they will develop eating disorders in the future. — Jeffrey Ponsky (clinical) [Ep 15 · 3:06](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=186) - Management should focus on health and the whole family doing healthy habits together rather than discussing weight. — Jeffrey Ponsky (clinical) [Ep 15 · 3:25](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=205) - Stopping sugar drinks and sodas is recommended because these are easy calories to eliminate and are harmful to the body and liver. — Jeffrey Ponsky (clinical) [Ep 15 · 3:25](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=205) - There has been a tremendous decrease in physical activity among children. — Jeffrey Ponsky (epidemiological) [Ep 15 · 3:25](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=205) - Physical activity provides metabolic improvements in muscles, lungs, and other systems beyond just burning calories. — Stephanie Walsh (clinical) [Ep 15 · 4:17](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=257) - Everybody gets lifestyle changes regardless of treatment path. — Jeffrey Ponsky (clinical) [Ep 15 · 4:46](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=286) - There is an increase in the use of medications for pediatric obesity, with off-label use until age 18 supported by research. — Jeffrey Ponsky (clinical) [Ep 15 · 4:46](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=286) - Bariatric surgery is not a last resort but a viable treatment option that should be offered to children. — Jeffrey Ponsky (opinion) [Ep 15 · 4:46](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=286) - Bariatric surgery works well across races and cultures, being equally effective for Black, White, and Asian patients. — Jeffrey Ponsky (clinical) [Ep 15 · 4:46](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=286) - Medications used for pediatric obesity include GLP-1 inhibitors, phentermine, Wellbutrin, and Topamax, all used off-label. — Jeffrey Ponsky (clinical) [Ep 15 · 5:40](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=340) - Some GLP-1 inhibitors have been approved for ages 12 to 18. — Jeffrey Ponsky (clinical) [Ep 15 · 5:40](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=340) - Phentermine can cause jitteriness, increased heart rate, and usual stimulant side effects. — Stephanie Walsh (clinical) [Ep 15 · 6:31](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=391) - Wellbutrin has a black box warning because it is an antidepressant, but it can help as an activator giving patients a boost. — Jeffrey Ponsky (clinical) [Ep 15 · 6:31](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=391) - Some patients stay on obesity medications forever, while others can stop and sustain weight loss, though it is difficult to predict which patients will need long-term medication. — Stephanie Walsh (clinical) [Ep 15 · 7:18](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=438) - The combination of phentermine and Topamax is a medication that can be taken indefinitely. — Stephanie Walsh (clinical) [Ep 15 · 7:18](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=438) - Adult bariatric surgery patients typically have BMIs in the low 40s at the time of surgery. — Jeffrey Ponsky (epidemiological) [Ep 15 · 8:07](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=487) - Pediatric bariatric surgery patients typically have BMIs closer to 50 at the time of surgery. — Jeffrey Ponsky (epidemiological) [Ep 15 · 8:07](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=487) - Bariatric surgery produces approximately a 25 to 35% decrease in BMI. — Jeffrey Ponsky (clinical) [Ep 15 · 8:07](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=487) - Bariatric surgery in pediatrics is offered late, and starting at BMIs of 50 or 60 limits how far patients can expect to go with surgery. — Jeffrey Ponsky (clinical) [Ep 15 · 8:07](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=487) - Pediatric bariatric surgery requires a multi-month preparation process including exercise logs, food logs, and lifestyle changes. — Stephanie Walsh (clinical) [Ep 15 · 8:52](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=532) - Children's frontal lobes are not fully developed, limiting their ability to plan, which requires working with their developmental level to build skills for post-operative success. — Jeffrey Ponsky (clinical) [Ep 15 · 8:52](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=532) - Patients are given clear numbers about expected weight loss (approximately 25%) and told their body type will remain the same, just becoming a smaller, healthier version. — Stephanie Walsh (clinical) [Ep 15 · 10:10](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=610) - Most pediatric bariatric surgery patients have not been disappointed in their weight loss, with any weight loss making them feel good, stronger, and happier. — Jeffrey Ponsky (clinical) [Ep 15 · 10:10](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=610) - The sleeve gastrectomy decreases hunger after surgery because many ghrelin cells are removed. — Jeffrey Ponsky (clinical) [Ep 15 · 11:32](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=692) - The sleeve gastrectomy is the first choice procedure for adolescents, with Roux-en-Y gastric bypass as the second choice. — Stephanie Walsh (clinical) [Ep 15 · 12:24](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=744) - Almost all adolescent bariatric surgeries are sleeve gastrectomies. — Jeffrey Ponsky (epidemiological) [Ep 15 · 12:51](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=771) - After gastric bypass, the duodenum and gastric remnant cannot be visualized, which is a concern in young people with long life expectancy. — Jeffrey Ponsky (clinical) [Ep 15 · 12:51](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=771) - If sleeve gastrectomy does not work, it can be converted to a gastric bypass. — Jeffrey Ponsky (clinical) [Ep 15 · 12:51](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=771) - Initial post-operative issues after sleeve gastrectomy include getting patients back to eating, ensuring adequate caloric intake, and some dehydration, though dehydration has improved. — Stephanie Walsh (clinical) [Ep 15 · 14:05](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=845) - Research shows that after sleeve gastrectomy, approximately one-third of patients develop reflux, one-third experience improvement in reflux, and one-third remain the same. — Stephanie Walsh (clinical) [Ep 15 · 14:23](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=863) - New recommendations suggest performing endoscopy before patients transition to adult care after five years to check for Barrett's esophagus. — Stephanie Walsh (guideline) [Ep 15 · 14:23](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=863) - Currently, zero pediatric sleeve gastrectomy patients have required conversion to Roux-en-Y gastric bypass, though this may be seen by adult surgeons since the average patient age is 17. — Jeffrey Ponsky (clinical) [Ep 15 · 15:16](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=916) - Patients can be followed until age 21 at the speaker's institution. — Stephanie Walsh (clinical) [Ep 15 · 15:16](https://origin-library.globalcastmd.com/watch/staycurrent-forums-obesity-in-children-5280?t=916) - Over the last few years, there has been increased understanding and research that children with overweight and obesity may be sick, and oftentimes those children are not being appropriately screened for comorbidities. — Corey (epidemiological) [Ep 9 · 7:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=420) - The algorithm relies on existing guidelines: 2007 Expert Committee recommendations, US Department of Health and Human Services cardiovascular guidelines, and American Diabetes Association guidelines. — Corey (guideline) [Ep 9 · 9:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=540) - The algorithm is not a protocol but a suggested course of action that provides guidance to be used with clinical judgment. — Corey (guideline) [Ep 9 · 11:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=660) - The algorithm applies to patients 2 years and older and does not address the birth to 2-year age group. — Corey (guideline) [Ep 9 · 12:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=720) - For all patients irrespective of weight, screening for genetic dyslipidemia should include obtaining a non-fasting lipid profile for children between ages 9-11 and again between 18-21, per cardiovascular guidelines from about 3 years ago. — Corey (guideline) [Ep 9 · 17:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1020) - Positive symptoms in the review of systems that could indicate risk for comorbidities include snoring, sleep disturbances, abdominal pain, menstrual irregularities, hip/knee/leg pain, polyuria, polydipsia, and depression. — Corey (clinical) [Ep 9 · 21:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1260) - Physical exam findings that may indicate comorbidities include pre-hypertension or hypertension (with correct cuff size), acanthosis nigricans, tonsillar hypertrophy, goiter, abdominal tenderness, hepatomegaly, bowing of legs (Blount disease), limited hip range of motion (slipped capital femoral epiphysis), fuzzy optic discs (pseudotumor cerebri), acne, and skin inflammation. — Corey (clinical) [Ep 9 · 23:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1380) - Family history risk factors in first and second degree relatives include obesity, type 2 diabetes, hypertension, lipid level abnormalities, and heart disease. — Corey (clinical) [Ep 9 · 26:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1560) - Patients in the overweight category (BMI 85th-94th percentile) with strong family history, positive review of systems, or positive physical exam should receive further screening for comorbidities, similar to patients in the obese category. — Corey (guideline) [Ep 9 · 28:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1680) - Some providers obtain non-fasting labs for patient convenience, particularly in rural areas where patients travel long distances and are unlikely to return for fasting labs. — Corey (clinical) [Ep 9 · 32:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1920) - Some subspecialty clinics screen for vitamin D and insulin resistance by obtaining vitamin D and fasting insulin levels, but the clinical utility and cost-effectiveness of such tests is yet to be determined, and the costs are very high. — Corey (opinion) [Ep 9 · 34:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2040) - There are no current guidelines on when to start laboratory testing for patients with obesity, but based on patient health risks, some experts may start screening patients as early as 2 years of age. — Corey (guideline) [Ep 9 · 35:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2100) - Constipation is a very common comorbidity in children with obesity that is easily treated, and treating it helps patients feel better, eat more, and be more physically active. — Corey (clinical) [Ep 9 · 37:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2220) - Not every patient is ready for treatment, and when patients or parents are not ready, the appropriate response is to say 'that's OK, when you're ready, I'm ready' rather than using fear tactics. — Corey (opinion) [Ep 9 · 41:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2460) - There are no quick fixes for obesity treatment; even patients eligible for surgical treatment require many months of behavior modification and treatment before surgery. — Corey (clinical) [Ep 9 · 42:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2520) - Small behavior changes can have a profound effect on health and are usually much more sustainable than large changes. — Corey (opinion) [Ep 9 · 44:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2640) - In pediatrics, by and large up until growth plates fuse, children are going to get taller, which is advantageous for weight management. — Corey (clinical) [Ep 9 · 46:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2760) - Patients should start at the least intensive stage and advance through stages based on response to treatment, age, BMI, health risks, and most importantly the motivation of the patient and family. — Corey (guideline) [Ep 9 · 48:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2880) - An empathetic, empowering counseling style such as motivational interviewing should be employed to empower patients and families in behavior change, with no fear tactics. — Corey (guideline) [Ep 9 · 46:57](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Stage 1 (Prevention Plus) consists of planned follow-up themed visits of 15-20 minutes in primary care, focusing on behaviors that resonate with the patient, family, and provider, with the patient's preferences coming first. — Corey (guideline) [Ep 9 · 46:57](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - The goals for Stage 1 are positive behavior change irregardless of change in BMI, and weight maintenance or decrease in BMI velocity. — Corey (guideline) [Ep 9 · 46:57](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Children ages 2-5 with obesity should not lose more than 1 pound per month, and older children and adolescents with obesity should not lose more than an average of 2 pounds per week. — Corey (guideline) [Ep 9 · 46:57](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Many experts recommend monthly follow-up visits for Stage 1, though follow-up can be tailored to patient and family motivation and can include text, email, or Facebook communication. — Corey (guideline) [Ep 9 · 46:57](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - After 3-6 months in Stage 1, if BMI and weight status does not improve, consider advancing to Stage 2. — Corey (guideline) [Ep 9 · 46:57](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Stage 2 (Structured Weight Management) is the same intervention as Stage 1 but includes more intensive support and structure to achieve healthy behaviors, with follow-up every 2-4 weeks. — Corey (guideline) [Ep 9 · 46:57](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Stage 3 (Comprehensive Multidisciplinary Intervention) is often done by a pediatric weight management clinic with a multidisciplinary team including social workers and dietitians, with structured behavior modification including food and activity monitoring. — Corey (guideline) [Ep 9 · 46:57](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - Stage 4 (Tertiary Care Intervention) is for patients greater than the 95th percentile with significant comorbidities, happens in a pediatric weight management center with providers with expertise in treating childhood obesity, and includes very intensive diet and activity counseling with consideration of medications and age-appropriate surgery. — Corey (guideline) [Ep 9 · 46:57](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) - The goal for Stage 4 is a decrease in BMI because these children are sick and need to get their BMI down, though behavior change is still initially important. — Corey (guideline) [Ep 9 · 46:57](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2817) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - Researchers surveyed more than 100 parents of children with overweight or obesity to understand what influences their decision to participate in research — Lizzie Lee summarizing a resource [Ep 28 · 0:07](https://origin-library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=7) - Parents reported more reasons to participate in childhood obesity research than reasons not to participate — Lizzie Lee summarizing a resource [Ep 28 · 0:15](https://origin-library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=15) - Mistrust, time demands, and social pressure are barriers that make it harder for parents to participate in childhood obesity research — Lizzie Lee summarizing a resource [Ep 28 · 0:15](https://origin-library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=15) - Research perceptions varied by family characteristics — Lizzie Lee summarizing a resource [Ep 28 · 0:26](https://origin-library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=26) - To improve childhood obesity research, studies need to be easier to join, reduce participation burden, and build trust with families from the beginning — Lizzie Lee summarizing a resource [Ep 28 · 0:30](https://origin-library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-w-13884?t=30) - A national survey examined pediatric weight management programs across the US regarding eating disorder screening practices — Lizzie Lee summarizing a resource [Ep 29 · 0:08](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=8) - Most programs are screening for eating disorders but not in a standardized way — Lizzie Lee summarizing a resource [Ep 29 · 0:14](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=14) - About 60% of programs perform some form of eating disorder screening — Lizzie Lee summarizing a resource [Ep 29 · 0:19](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=19) - Much of the screening is informal, using homegrown questionnaires or clinical judgment rather than validated tools — Lizzie Lee summarizing a resource [Ep 29 · 0:19](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=19) - Providers are generally comfortable with screening for eating disorders — Lizzie Lee summarizing a resource [Ep 29 · 0:29](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=29) - Medical providers lag behind behavioral health specialists by a wide margin when diagnosing conditions like binge eating disorder — Lizzie Lee summarizing a resource [Ep 29 · 0:29](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=29) - Clinicians report not being trained enough as a barrier to eating disorder management — Lizzie Lee summarizing a resource [Ep 29 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=39) - Clinicians report not knowing how to manage eating disorders they identify as a barrier — Lizzie Lee summarizing a resource [Ep 29 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=39) - Clinicians report lacking clear treatment pathways for eating disorders as a barrier — Lizzie Lee summarizing a resource [Ep 29 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=39) - Medical providers may need more training for diagnosis and treatment of eating disorders in pediatric obesity settings — Lizzie Lee summarizing a resource [Ep 29 · 0:47](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13885?t=47) - A national survey of pediatric weight management programs across the US was conducted — Lizzie Lee summarizing a resource [Ep 30 · 0:08](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=8) - Most programs are screening for eating disorders, but not in a very standardized way — Lizzie Lee summarizing a resource [Ep 30 · 0:14](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=14) - About 60% of programs are doing some form of screening — Lizzie Lee summarizing a resource [Ep 30 · 0:19](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=19) - A lot of screening uses informal, homegrown questionnaires or just clinical judgment rather than validated tools — Lizzie Lee summarizing a resource [Ep 30 · 0:19](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=19) - Providers are generally comfortable screening for eating disorders — Lizzie Lee summarizing a resource [Ep 30 · 0:29](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=29) - When it comes to diagnosing binge eating disorder, medical providers lag behind behavioral health specialists by a wide margin — Lizzie Lee summarizing a resource [Ep 30 · 0:29](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=29) - Clinicians report not being trained enough as a barrier to eating disorder diagnosis and management — Lizzie Lee summarizing a resource [Ep 30 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=39) - Clinicians report not knowing how to manage eating disorders they find as a barrier — Lizzie Lee summarizing a resource [Ep 30 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=39) - Clinicians report lacking clear treatment pathways for eating disorders as a barrier — Lizzie Lee summarizing a resource [Ep 30 · 0:39](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=39) - Medical providers may need more training for diagnosis and treatment of eating disorders — Lizzie Lee summarizing a resource [Ep 30 · 0:47](https://origin-library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-pra-13886?t=47) - Operating at lower degrees of obesity allows moving patients into a much healthier state — The host summarizing the discussion [Ep 3 · 2:27](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=147) - Patients above BMI 55 have only about 14% probability of achieving BMI below 30 after surgery (data published by Tom in 2009) — The host summarizing the discussion [Ep 3 · 3:05](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=185) - Sugar taxation decreases consumption and generates revenue (data shown by Gellibrano) — The host summarizing the discussion [Ep 3 · 15:24](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=924) - Bariatric surgery demonstrates good resolution of binge eating disorder symptoms in adult literature (Jim Mitchell's work in LABS consortium) — The host summarizing the discussion [Ep 3 · 20:20](https://origin-library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1220) - NASPGHAN and European counterparts recommend screening endoscopy at 10 years of age for esophageal atresia patients, whether or not they're on anti-reflux medications — Liz Byerly summarizing the discussion [Ep 14 · 10:38](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=638) - NASPGHAN guidelines recommend screening endoscopy in early adulthood for esophageal atresia patients, and then every 5 to 10 years for adults — Liz Byerly summarizing the discussion [Ep 14 · 11:10](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=670) - Studies from the Netherlands and Finland showed an increased risk of esophageal carcinoma in patients with repaired esophageal atresia — Liz Byerly summarizing the discussion [Ep 14 · 12:00](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=720) - A survey of pediatric surgeons in the United States found that 28% had experienced gas embolism during neonatal laparoscopy — Liz Byerly summarizing the discussion [Ep 14 · 16:44](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=1004) - Canadian CDH Collaborative readiness criteria for surgery include normal blood pressure for age, urine output >1cc/kg/hr, serum lactate <3, FiO2 <50%, preductal saturation around 90%, and pulmonary artery pressures less than systemic — Eric Skarsgard summarizing the discussion [Ep 14 · 37:49](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=2269) - A randomized trial of spontaneous pneumothorax showed roughly equivalent lung re-expansion by 8 weeks (high 90%) between conservative management and intervention groups — Eric Skarsgard summarizing the discussion [Ep 14 · 50:13](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3013) - The spontaneous pneumothorax trial showed a threefold increase in adverse events in the interventional group, including bleeding, need for catheter repositioning, and continuing air leaks — Eric Skarsgard summarizing the discussion [Ep 14 · 50:22](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3022) - The spontaneous pneumothorax trial showed a twofold increase in twelve-month recurrence rates for patients who received intervention versus conservative management — Eric Skarsgard summarizing the discussion [Ep 14 · 50:50](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3050) - ATLS 10th edition guidelines recommend limiting crystalloid to not more than 20cc per kilogram in pediatric trauma resuscitation — Eric Skarsgard summarizing the discussion [Ep 14 · 56:18](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3378) - Military data from Afghanistan and Iraq showed that increased use of massive transfusion protocols in pediatric trauma patients correlated with decreased mortality between 2001 and 2013 — Eric Skarsgard summarizing the discussion [Ep 14 · 57:18](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3438) - Early balanced blood product resuscitation (red cells, platelets, and plasma) results in using less blood products overall and significantly improved mortality and morbidity outcomes — Eric Skarsgard summarizing the discussion [Ep 14 · 57:58](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3478) - Military studies clearly show a survival advantage from use of tranexamic acid in trauma patients — Eric Skarsgard summarizing the discussion [Ep 14 · 58:32](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3512) - SCOPE Collaborative guidelines for peritoneal dialysis catheter placement include preoperative antibiotic with gram-positive coverage, downward or lateral exit site placement, and no suture at the exit site — Todd Ponsky summarizing the discussion [Ep 14 · 60:21](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3621) - Failure rates for dialysis access are quite high: 45% within two months for hemodialysis catheters and 30 to 50% for peritoneal dialysis catheters — Todd Ponsky summarizing the discussion [Ep 14 · 63:07](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=3787) - Analysis of a large international registry shows over 70% of children have a hemodialysis catheter placed and only 26% receive an AV fistula — Todd Ponsky summarizing the discussion [Ep 14 · 67:22](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=4042) - Multiple studies show superior primary and secondary patency rates for AV fistulas compared to catheters in pediatric patients — Todd Ponsky summarizing the discussion [Ep 14 · 67:34](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=4054) - Organizations have recommended considering AV fistula use in children over 20 kg who will require at least 12 months of hemodialysis — Todd Ponsky summarizing the discussion [Ep 14 · 68:04](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=4084) - Entyvio (vedolizumab) is a monoclonal antibody targeted at the gut epithelium with a great safety profile in adult studies — Todd Ponsky summarizing the discussion [Ep 14 · 73:55](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=4435) - In a 2017 review of 64 children who had failed anti-TNF therapy, 25 reached steroid-free remission with Entyvio — Todd Ponsky summarizing the discussion [Ep 14 · 74:16](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=4456) - The risk of cancer in complete androgen insensitivity is probably lower than previously thought, closer to 1 to 2% rather than 2 to 5% — Todd Ponsky summarizing the discussion [Ep 14 · 78:55](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=4735) - Patients with androgen insensitivity report feeling abnormal after gonadectomy even when given estrogens, because the testes are a source of estrogen as well as testosterone that is converted peripherally — Todd Ponsky summarizing the discussion [Ep 14 · 79:12](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=4752) - Women on estrogens for prolonged periods after gonadectomy have increased cardiovascular risk — Todd Ponsky summarizing the discussion [Ep 14 · 79:36](https://origin-library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998?t=4776) - The hunger community believes that restricting SNAP benefits for sugar-sweetened beverages would further stigmatize people already facing poverty-related stigma. — Kelly Brownell summarizing the discussion [Ep 1 · 39:51](https://origin-library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=2391) - Extremely obese children and teens have a very high propensity of carrying obesity into their adult years, supported by large cross-sectional studies. — Mark summarizing the discussion [Ep 2 · 4:00](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=240) - Non-surgical weight loss paradigms show very disappointing results in the literature for severely obese adolescents. — Mark summarizing the discussion [Ep 2 · 4:30](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=270) - In Susan Woolford's survey of 375 pediatricians and equal number of family physicians, almost half declared they would never refer an adolescent patient for weight loss surgery. — Mark summarizing the discussion [Ep 2 · 22:30](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1350) - About half of surveyed physicians endorsed a minimal age of 18 for bariatric surgery referral. — Mark summarizing the discussion [Ep 2 · 23:10](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1390) - 99% of surveyed physicians endorsed participation in a monitored weight management program prior to referral for weight loss surgery. — Mark summarizing the discussion [Ep 2 · 23:30](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1410) - Kelleher's 2012 study using the Kids Inpatient Database showed a significant increase in adolescent bariatric surgery from 2000 to 2003, but essentially no statistically significant change from 2003 to 2009, suggesting a plateau. — Mark summarizing the discussion [Ep 2 · 24:10](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1450) - A 2013 Children's Hospital Association survey of 188 hospitals (54% response rate) found that 49 centers had stage 4 obesity treatment (including drug therapy protocols and/or bariatric surgery), with 88% of those 49 centers stating they had some access to bariatric surgery. — Mark summarizing the discussion [Ep 2 · 25:10](https://origin-library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1510) - Leaks occur at uppermost portion of sleeve in adult studies; requires careful attention at GE junction — Evan summarizing the discussion [Ep 5 · 25:11](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1511) - Some high-volume adult surgeons place prophylactic reinforcement stitch at GE junction and suspend to crus to recreate angle of His and reduce reflux — Evan summarizing the discussion [Ep 5 · 27:39](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1659) - Reflux reported in up to one-third of sleeve gastrectomy patients in longer-term follow-up — Evan summarizing the discussion [Ep 5 · 28:17](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1697) - Tachycardia and fever are 60% predictive for leak; CT scan with oral and IV contrast is 90%+ predictive — Ayed summarizing the discussion [Ep 5 · 37:59](https://origin-library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=2279) - Weight bias has increased substantially over the last decade since 2006, with rates continuing to rise in more recent data. — Steve summarizing the discussion [Ep 7 · 20:00](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1200) - Weight bias is more prevalent in women than men and increases with severity of obesity. — Steve summarizing the discussion [Ep 7 · 20:30](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1230) - Children experience weight bias from peers, family members, school environments, and healthcare professionals. — Steve summarizing the discussion [Ep 7 · 21:00](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1260) - Studies document that individuals affected by obesity experience differences in hiring preferences, promotions, wages, and early termination in the workplace. — Steve summarizing the discussion [Ep 7 · 21:30](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1290) - Healthcare professionals are among the worst offenders of weight bias as experienced by patients, according to research studies. — Steve summarizing the discussion [Ep 7 · 23:00](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1380) - Physicians view individuals challenged by weight as noncompliant, dishonest, lazy, lacking self-control, weak-willed, unintelligent, and unsuccessful. — Steve summarizing the discussion [Ep 7 · 23:30](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1410) - In one study, 31% of nurses said they would prefer not to care for individuals affected by obesity and 24% said individuals with obesity repulse them. — Steve summarizing the discussion [Ep 7 · 24:00](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1440) - Psychologists in controlled studies endorse that patients with obesity have more pathology, more severe symptoms, more negative family qualities, and worse prognosis on initial assessment. — Steve summarizing the discussion [Ep 7 · 24:30](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1470) - Individuals endorsing more weight bias have higher levels of depression, anxiety, low self-esteem, and poor body image. — Steve summarizing the discussion [Ep 7 · 22:00](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1320) - Weight bias leads to less preventative health services, fewer exams, more appointment cancellations, more delays in care, and less healthcare access. — Steve summarizing the discussion [Ep 7 · 22:30](https://origin-library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863?t=1350) - Research shows it can take 10, 15, or more exposures for a child to accept a previously refused food. — The host summarizing a resource [Ep 6 · 9:58](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=598) - The American Academy of Pediatrics recommends no screen time for infants, and for children 2 years and older, no more than 2 hours of screen time daily. — The host summarizing a resource [Ep 6 · 28:22](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1702) - Toddlers need at least 30 minutes of structured physical activity daily and at least 60 minutes (up to several hours) of unstructured physical activity. They should not be sedentary for more than 60 minutes at a time except when sleeping. — The host summarizing a resource [Ep 6 · 28:22](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1702) - School-age children need to be active 60 minutes a day, with most activity being aerobic at moderate to vigorous intensity, plus muscle and bone strengthening activities. — The host summarizing a resource [Ep 6 · 28:22](https://origin-library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862?t=1702) - Tom has presented data showing that operating at a lower degree of obesity can move people into a much healthier state — Alan Brown summarizing the discussion [Ep 10 · 1:38](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=98) - Patients above BMI 55 have only about a 14% probability of getting down to a BMI below 30 (data published by Tom in 2009) — Mark summarizing the discussion [Ep 10 · 2:24](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=144) - Kelly Branno showed compelling data that sugar taxes decrease consumption and generate revenue — Tom summarizing the discussion [Ep 10 · 14:27](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=867) - Jim Mitchell's work in the LABS consortium demonstrates very good resolution of binge eating disorder symptoms after bariatric surgery — Tom summarizing the discussion [Ep 10 · 19:09](https://origin-library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869?t=1149) - Over 43 million children under age 5 are affected by obesity worldwide; 170 million under 18 worldwide; more than one-third of US children are affected. — Beth summarizing the discussion [Ep 12 · 4:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=240) - One in eight preschoolers in the US are already affected by obesity. — Beth summarizing the discussion [Ep 12 · 4:30](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=270) - 61% of obese 5- to 10-year-olds already have one or more cardiovascular risk factors; 25% have two or more. — Beth summarizing the discussion [Ep 12 · 8:10](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=490) - Children who are overweight or obese as preschoolers are 5 times more likely to be overweight or obese as adults. — Beth summarizing the discussion [Ep 12 · 9:20](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=560) - The American Academy of Pediatrics recommends Stage 3 care (comprehensive multidisciplinary weight management center) and Stage 4 care (intensive intervention including medications, very low calorie diets, and surgery). — Beth summarizing the discussion [Ep 12 · 10:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=600) - Studies show children with obesity are chosen last as a friend, even compared to children with disabilities or in wheelchairs. — Beth summarizing the discussion [Ep 12 · 28:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1680) - Quality of life for children with obesity is similar to or lower than that of children with cancer. — Beth summarizing the discussion [Ep 12 · 29:30](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1770) - Weight-based discrimination may prevent acceptance to prestigious colleges or hiring for jobs, leading to lower socioeconomic status and income. — Beth summarizing the discussion [Ep 12 · 29:50](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1790) - Weight is now the number one reason for teasing and bullying. — Beth summarizing the discussion [Ep 12 · 30:50](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1850) - Studies show dietitians view patients with obesity negatively, expect noncompliance, and attribute obesity to emotional problems; dietetic students view these patients as ugly, insecure, and slow. — Beth summarizing the discussion [Ep 12 · 31:20](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1880) - Psychologists assign greater pathology to patients with obesity and have lower expectations of their ability to improve. — Beth summarizing the discussion [Ep 12 · 32:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1920) - Nurses view patients with obesity as lazy, lacking self-control, noncompliant, repulsive, and prefer not to be assigned to them or touch them. — Beth summarizing the discussion [Ep 12 · 32:20](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1940) - Medical students view patients with obesity as having poor self-control and being sloppy, awkward, unsuccessful, and unpleasant; these attitudes persist as they become physicians. — Beth summarizing the discussion [Ep 12 · 32:50](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1970) - Most healthcare professionals who work with children want to help but feel inadequate and don't know what to do. — Beth summarizing the discussion [Ep 12 · 33:40](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=2020) - Parents ask that providers avoid offensive words like 'obese,' 'heavy,' 'chubby,' and 'fat,' and instead use medically neutral terms like 'weight,' 'unhealthy weight,' 'high BMI,' or 'weight problems.' — Beth summarizing the discussion [Ep 12 · 35:00](https://origin-library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=2100) - Gastric bands in teenagers show modest early weight loss but at 5 and 10 years, weight regain and band replacement or explantation is the rule — Todd Ponsky summarizing the discussion [Ep 26 · 4:46](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=286) - Gastric bands were never FDA approved for use in teenagers — Todd Ponsky summarizing the discussion [Ep 26 · 4:46](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=286) - Non-nutritive sweeteners do not decrease weight and may actually increase weight gain, similar to sugar-sweetened drinks — Mika summarizing the discussion [Ep 26 · 7:44](https://origin-library.globalcastmd.com/watch/wrap-up-discussions-2024-pediatric-bariatric-surgery-update-course-7968?t=464) - Published papers show that bariatric surgery is a safe procedure in children and is safer than not operating on them. — The host summarizing the discussion [Ep 23 · 12:15](https://origin-library.globalcastmd.com/watch/manish-raiji-md-2024-pediatric-bariatric-surgery-update-course-7965?t=735) - Epic real-world data showed that a large number of patients after GLP-1 cessation do not regain their weight — Evan Nadler summarizing a resource [Ep 24 · 15:58](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=958) - Approximately 50% of bariatric surgery patients do well long-term without additional interventions, while 50% have poor outcomes — Evan Nadler summarizing a resource [Ep 24 · 16:40](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1000) - For Prader-Willi syndrome, biliopancreatic diversion may be the best operation according to Steve Myers's paper, though not ideal for young children — Mark summarizes what Dr. Evan Nadler said [Ep 24 · 26:10](https://origin-library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1570) - Studies suggest gastric plication tends to do better in patients with BMI less than 40 and may have more of a role in younger patients. — David Lanning summarizes what Dr. Janey Pratt said [Ep 22 · 12:40](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=760) - Limited studies show some metabolic changes in hormone levels with gastric plication, though not completely characterized, suggesting metabolic changes beyond just plication. — David Lanning summarizes what Dr. Janey Pratt said [Ep 22 · 14:33](https://origin-library.globalcastmd.com/watch/janey-pratt-md-and-david-lanning-md-2024-pediatric-bariatric-surgery-update-cour-7964?t=873) - The top group of patients at 10 years post-op is doing much worse, while another group is only down 12% weight loss. — Stephanie Walsh summarizing the discussion [Ep 21 · 1:30](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=90) - Tom's unpublished study on phentermine and topiramate post-op included approximately 12 kids and showed improvement. — Stephanie Walsh summarizing the discussion [Ep 21 · 8:00](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=480) - Evan's unpublished study shows kids who lose weight lose weight with meds as well, with improvements across groups. — Stephanie Walsh summarizing the discussion [Ep 21 · 9:00](https://origin-library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=540) - Studies using EMG, motion tracking, and questionnaires show statistically significant increased muscle strain, postoperative pain, and overuse of muscles in surgeons performing laparoscopic versus robotic surgery. — Guillermo Ares summarizing the discussion [Ep 20 · 2:30](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=150) - Statistically significant change in surgeon irritability is quoted after robotic versus laparoscopic surgery. — Guillermo Ares summarizing the discussion [Ep 20 · 3:20](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=200) - Studies show decreased conversion to open in robotic revisional bariatric surgery compared to laparoscopic. — Guillermo Ares summarizing the discussion [Ep 20 · 5:10](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=310) - More advanced or complicated revisional surgeries are being performed on robotic platforms compared to laparoscopic ones, suggesting intuitive selection of robotics for harder cases. — Guillermo Ares summarizing the discussion [Ep 20 · 5:40](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=340) - A retrospective study from 2015 to 2020 showed that over time, more robotic cases were performed, complication rates decreased, OR times decreased significantly (in some centers to no difference versus laparoscopic), sicker patients were operated robotically, and more robotic cases were revisional compared to laparoscopic. — Guillermo Ares summarizing the discussion [Ep 20 · 6:20](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=380) - Simultaneous robotic sleeve gastrectomy and kidney transplants are now being performed on morbidly obese patients, with longer operative times but no increased complications or blood loss, and good 1-year kidney function with significant weight reduction. — Guillermo Ares summarizing the discussion [Ep 20 · 7:44](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=464) - Large comparative studies show really no difference in outcomes between robotic and laparoscopic bariatric surgery. — Mark Wulkan summarizing the discussion [Ep 20 · 9:19](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=559) - A large study shows there may be a little bit of increase in infectious complications with robotic surgery. — Mark Wulkan summarizing the discussion [Ep 20 · 10:20](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=620) - In the MBSAQIP database study of almost 800,000 patients, robotic Roux-en-Y had slightly lower infectious complications, but with sleeve it was higher, and robotic surgeries had higher 30-day readmission and reoperative rates. — Mark Wulkan summarizing the discussion [Ep 20 · 10:46](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=646) - In centers doing robotic bariatric surgery repeatedly with a dedicated OR robotic team, operative times approach or equal laparoscopic surgery times. — Guillermo Ares summarizing the discussion [Ep 20 · 13:25](https://origin-library.globalcastmd.com/watch/guillermo-ares-md-and-mark-wulkan-md-2024-pediatric-bariatric-surgery-update-cou-7961?t=805) - Enhanced recovery after surgery (ERAS) protocols have been shown to improve outcomes in many adult surgical specialties — Wendy Jo Svetanoff summarizing a resource [Ep 16 · 0:00](https://origin-library.globalcastmd.com/watch/bob-ped-surg-2023-wendy-jo-svetanoff-ipeg-presentation-6360?t=0) - Bariatric surgery has a significant and positive impact on the psychological comorbidities of obese teenagers and improves their quality of life and overall health. — Tracy Williams summarizing a resource [Ep 19 · 3:20](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=200) - Research shows that psychosocial symptomatology in bariatric surgery patients tends to remit or improve for the most part, and psychosocial concerns seen post-operatively are typically pre-existing conditions rather than new symptoms. — Tracy Williams summarizing a resource [Ep 19 · 4:00](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=240) - Follow-up research shows decreases in mood disorder symptoms (anxiety, depression, anger, disruptive behavior), improvements in social isolation, and improvements in mood and relationships as patients feel better about themselves. — Tracy Williams summarizing a resource [Ep 19 · 5:40](https://origin-library.globalcastmd.com/watch/traci-williams-md-2024-pediatric-bariatric-surgery-update-course-7960?t=340) - The higher rate of low ferritin in adolescents may be due to decreased compliance in taking multivitamins. — Alexander Gibbens summarizing a resource [Ep 13 · 0:00](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628?t=0) - The higher reoperation rate in adolescents may be due to pediatric bariatric surgeons being more willing to take their patients back to the operating room. — Alexander Gibbens summarizing a resource [Ep 13 · 0:00](https://origin-library.globalcastmd.com/watch/bariatric-surgery-has-improved-remission-of-dmii-and-htn-when-performed-1628?t=0) - The 2007 Expert Committee recommendations state that for patients with BMI over the 85th percentile, providers should be thinking differently about them and having a pausing moment because these children could be sick. — Corey summarizing the discussion [Ep 9 · 19:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1140) - The 2007 Expert Committee recommendations state that a fasting glucose, fasting lipid profile, ALT, and AST should be obtained in patients in the overweight category with risk factors and in the obese category. — Corey summarizing the discussion [Ep 9 · 30:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1800) - Guidelines from the ADA and Endocrine Society recommend hemoglobin A1c, fasting glucose, or oral glucose tolerance test to screen for diabetes or pre-diabetes. — Corey summarizing the discussion [Ep 9 · 31:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=1860) - The Children's Hospital Association consensus statements on comorbidities may help keep management of children with obesity in their medical home and provide guidance to sites that may not have specialists available. — Corey summarizing the discussion [Ep 9 · 39:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2340) - Research by Ken Resnicow and his team at University of Michigan shows that motivational interviewing works for behavior change and for obesity management and treatment. — Corey summarizing the discussion [Ep 9 · 43:00](https://origin-library.globalcastmd.com/watch/making-the-assessment-management-and-treatment-of-obesity-come-alive-in-your-865?t=2580) ## Changelog - Oct 1: 1 item added automatically - Sep 24: 13 items added automatically - Sep 16: 6 items added automatically - Sep 15: 4 items added automatically - Sep 12: 1 item no longer name obesity - Sep 7: 3 items added automatically - Sep 7: 4 items added automatically --- Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://origin-library.globalcastmd.com/ai