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
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, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 26 · 0:34
epidemiologicalPediatric bariatric surgeons treat approximately 0.05% of children who need surgery, well below adult treatment rates↗
▶Ep 26 · 1:10
quoteI could operate all day every day cause I don't use the robot. I still never, um, I would still never make any dent in the overall population problem↗
▶Ep 26 · 3:20
guidelineMBSAQIP requirements for verified surgeon at freestanding children's hospital: 100 lifetime cases (75 can be as fellow) and 20 stapled cases per year↗
▶Ep 26 · 5:20
epidemiologicalIn MBSAQIP database of approximately 4800 teens, only about 50 are preteens↗
▶Ep 26 · 5:40
clinicalPreteens undergoing bariatric surgery have higher rates of insulin-dependent diabetes and sleep apnea compared to teens, indicating they are sicker pre-operatively↗
▶Ep 26 · 6:20
clinicalSafety outcomes in preteens were the same or better than teens in MBSAQIP data↗
clinicalNadler's youngest bariatric surgery patients were two 4-year-olds: one homozygous for MC4R receptor deficiency and one with Rohhad syndrome↗
▶Ep 26 · 7:40
clinicalUsing BMI percentiles instead of absolute BMI values can help with insurance approval by confusing reviewers who then focus on comorbidities like diabetes↗
▶Ep 26 · 8:40
guidelineIn the DC area, most Medicaid programs have removed age cutoffs for bariatric surgery after years of education efforts↗
▶Ep 26 · 10:44
opinionOperating 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↗
▶Ep 26 · 11:21
clinicalOff-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↗
▶Ep 26 · 12:20
quotewe should be doing all of it. We should be trying all of it↗
▶Ep 26 · 13:13
opinionMedications may be no safer than surgery, with less long-term data in children, similar gallstone risk, and higher weight regain due to medication discontinuation↗
▶Ep 26 · 13:13
quoteI would argue that meds are no safer than surgery. And in fact, we have less long term data on these medications in children↗
▶Ep 26 · 14:40
quoteI think that everybody from age 2 to age 102 could do well with a little, um, with a little ADD medication↗
▶Ep 26 · 14:50
clinicalPhentermine has less addictive properties than ADD medications↗
▶Ep 26 · 19:10
epidemiologicalStudy of 490 patients from 2018-2022 included 34 with special healthcare needs: autism spectrum disorder, intellectual/developmental disabilities, Trisomy 21, and Prader-Willi syndrome↗
▶Ep 26 · 20:00
clinicalPatients with special healthcare needs lost weight after bariatric surgery, though not quite as much as neurotypical patients↗
▶Ep 26 · 20:30
opinionAutism 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↗
▶Ep 26 · 20:30
clinicalWhen 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↗
▶Ep 26 · 23:41
clinicalPatients 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↗
▶Ep 26 · 23:41
clinicalSome patients with special healthcare needs had parents who could barely care for them, and surgery made care easier rather than harder↗
▶Ep 26 · 25:38
clinicalPrader-Willi patients do not do as well with bariatric surgery but still do better than without surgery↗
▶Ep 26 · 28:10
quoteI don't personally think it's ever gonna be surgery versus medicine because I don't think they're even close to being comparable↗
▶Ep 26 · 28:58
epidemiologicalOne bariatric surgery operation costs approximately $50,000, equivalent to 3-4 years of GLP-1 agonist therapy at current prices↗
Evan's statements about Type 2 Diabetes26 statements
Evan Nadler, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 4 · 0:34
epidemiologicalPediatric bariatric surgeons treat approximately 0.05% of children who need surgery, well below adult treatment rates↗
▶Ep 4 · 1:10
quoteI could operate all day every day cause I don't use the robot. I still never, um, I would still never make any dent in the overall population problem↗
▶Ep 4 · 3:20
guidelineMBSAQIP requirements for verified surgeon at freestanding children's hospital: 100 lifetime cases (75 can be as fellow) and 20 stapled cases per year↗
▶Ep 4 · 5:20
epidemiologicalIn MBSAQIP database of approximately 4800 teens, only about 50 are preteens↗
▶Ep 4 · 5:40
clinicalPreteens undergoing bariatric surgery have higher rates of insulin-dependent diabetes and sleep apnea compared to teens, indicating they are sicker pre-operatively↗
▶Ep 4 · 6:20
clinicalSafety outcomes in preteens were the same or better than teens in MBSAQIP data↗
clinicalNadler's youngest bariatric surgery patients were two 4-year-olds: one homozygous for MC4R receptor deficiency and one with Rohhad syndrome↗
▶Ep 4 · 7:40
clinicalUsing BMI percentiles instead of absolute BMI values can help with insurance approval by confusing reviewers who then focus on comorbidities like diabetes↗
▶Ep 4 · 8:40
guidelineIn the DC area, most Medicaid programs have removed age cutoffs for bariatric surgery after years of education efforts↗
▶Ep 4 · 10:44
opinionOperating 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↗
▶Ep 4 · 11:21
clinicalOff-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↗
▶Ep 4 · 12:20
quotewe should be doing all of it. We should be trying all of it↗
▶Ep 4 · 13:13
quoteI would argue that meds are no safer than surgery. And in fact, we have less long term data on these medications in children↗
▶Ep 4 · 13:13
opinionMedications may be no safer than surgery, with less long-term data in children, similar gallstone risk, and higher weight regain due to medication discontinuation↗
▶Ep 4 · 14:40
quoteI think that everybody from age 2 to age 102 could do well with a little, um, with a little ADD medication↗
▶Ep 4 · 14:50
clinicalPhentermine has less addictive properties than ADD medications↗
▶Ep 4 · 19:10
epidemiologicalStudy of 490 patients from 2018-2022 included 34 with special healthcare needs: autism spectrum disorder, intellectual/developmental disabilities, Trisomy 21, and Prader-Willi syndrome↗
▶Ep 4 · 20:00
clinicalPatients with special healthcare needs lost weight after bariatric surgery, though not quite as much as neurotypical patients↗
▶Ep 4 · 20:30
opinionAutism 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↗
▶Ep 4 · 20:30
clinicalWhen 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↗
▶Ep 4 · 23:41
clinicalSome patients with special healthcare needs had parents who could barely care for them, and surgery made care easier rather than harder↗
▶Ep 4 · 23:41
clinicalPatients 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↗
▶Ep 4 · 25:38
clinicalPrader-Willi patients do not do as well with bariatric surgery but still do better than without surgery↗
▶Ep 4 · 28:10
quoteI don't personally think it's ever gonna be surgery versus medicine because I don't think they're even close to being comparable↗
▶Ep 4 · 28:58
epidemiologicalOne bariatric surgery operation costs approximately $50,000, equivalent to 3-4 years of GLP-1 agonist therapy at current prices↗
Summaries Evan gave as host
· 4 summaries
Recaps of other experts' statements, not Evan's own clinical position.
Evan Nadler, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 26 · 15:58
host summaryEvan Nadler summarizing a resource: Epic real-world data showed that a large number of patients after GLP-1 cessation do not regain their weight↗
▶Ep 26 · 16:40
host summaryEvan Nadler summarizing a resource: Approximately 50% of bariatric surgery patients do well long-term without additional interventions, while 50% have poor outcomes↗
Summaries Evan gave as host · Type 2 Diabetes2 summaries
Evan Nadler, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 4 · 15:58
host summaryEvan Nadler summarizing a resource: Epic real-world data showed that a large number of patients after GLP-1 cessation do not regain their weight↗
▶Ep 4 · 16:40
host summaryEvan Nadler summarizing a resource: Approximately 50% of bariatric surgery patients do well long-term without additional interventions, while 50% have poor outcomes↗
