I do believe um it's, it's not. Uh, we say, we often say it's not all about the weight, um, but it, it is about the weight, and I think that when we can get them to these, to the lower BMIs, perhaps by operating, uh, uh, earlier after the diagnosis of severe obesity, uh, the better they're gonna be long term.
We see laxity. In some of these costochondral junctions and impingement on these intercostal nerves as the ribs slip and float and encroach upon these nerves, slipping rib syndrome can be the cause of chronic abdominal wall pain.
If you have someone come in with chest or fractures that gets stuck on a ventilator, you can do a world of good with this technique by anesthetizing just those intercostal spaces that are the problem.
I think that, uh, we have, uh, uh, been Teaching for some time that these defects have to be closed or they will lead to uh internal hernias and incarceration and uh general misery.
there's also an endoscopic gastric placation experience where you try to essentially create a small stomach like a sleeve gastrectomy, but doing an endoluminal placation
quoteWe certainly know what drives our thinking about pediatric obesity treatment um from the standpoint of, of aggressive treatment like surgery, and it's classically been described as, uh, as clinically severe obesity, where obesity is actually causing um uh some um health consequences or behavioral consequences, uh, impairments in quality of life for um teenagers.↗
▶Ep 1 · 8:00
clinicalFAS-5 study achieved 81% participation (58 of 74 eligible) at 8-year follow-up, mostly with in-person research visits.↗
clinicalAt 8-year mean follow-up, gastric bypass patients had a mean BMI decline of 29%.↗
▶Ep 1 · 13:00
quoteWhat we see on average at eight years is a BMI decline of, of 29%.↗
▶Ep 1 · 15:00
clinicalBaseline BMI strongly correlates (R=0.75) with follow-up BMI: patients starting with BMI in the 60s end above 40, while those starting in the 40s reach near-normal BMI.↗
▶Ep 1 · 17:00
clinicalRemission rates at 8 years: 88% for diabetes, 64% for dyslipidemia, 75% for hypertension.↗
▶Ep 1 · 18:00
clinicalAmong those without baseline comorbidities, incidence rates were 0% for diabetes, 50% for dyslipidemia (small denominator), and 3 of 29 developed hypertension.↗
▶Ep 1 · 20:00
clinicalFollow-up BMI predicts probability of hypertension, dyslipidemia, high CRP, high insulin, insulin resistance, and low HDL; higher residual BMI is metabolically harmful.↗
▶Ep 1 · 21:00
quoteWe see that there's a definite relationship. So where the BMI ended up matters.↗
▶Ep 1 · 21:10
quoteDoes it really matter? Are, is everything gonna be, you know, peaches and cream or gravy or the bad examples, but uh uh uh bad things. But uh is everything gonna be good with your health, um, now that you've had surgery, no matter what your BMI? And the answer to that seems to be no.↗
▶Ep 1 · 23:00
clinicalAt 8 years, FAS-5 cohort showed low iron stores with anemia, elevated PTH, and low vitamin D in substantial numbers.↗
▶Ep 1 · 29:00
quoteI think that, uh, we have, uh, uh, been Teaching for some time that these defects have to be closed or they will lead to uh internal hernias and incarceration and uh general misery.↗
▶Ep 1 · 29:00
clinicalAMOS had high internal hernia rates due to unclosed mesenteric defects at laparoscopic gastric bypass; closing defects prevents this complication.↗
▶Ep 1 · 31:00
clinicalTeen Labs enrolled 242 adolescents (161 bypass, 67 sleeve, 14 band) at 5 centers; median age now 24, with 203 completing 5-year visits (72% in-clinic, 17% field).↗
▶Ep 1 · 32:00
clinicalAdding 33 sleeve gastrectomy patients to Teen Labs will provide 80% power to compare bypass vs. sleeve for outcomes including blood pressure, PTH, HDL, and BMI.↗
▶Ep 1 · 32:17
clinicalThe 33 new sleeve patients can be enrolled within a year from consortium sites with ongoing clinical follow-up, enabling long-term comparisons.↗
▶Ep 1 · 32:47
opinionOperating earlier after diagnosis of severe obesity may yield lower residual BMI and better long-term metabolic outcomes.↗
▶Ep 1 · 32:47
clinicalFAS-5 study had a residual mean BMI of 38 at 8 years, with many patients remaining severely obese; this residual obesity is metabolically harmful.↗
▶Ep 1 · 32:47
quoteI do believe um it's, it's not. Uh, we say, we often say it's not all about the weight, um, but it, it is about the weight, and I think that when we can get them to these, to the lower BMIs, perhaps by operating, uh, uh, earlier after the diagnosis of severe obesity, uh, the better they're gonna be long term.↗
▶Ep 1 · 34:00
clinicalSeverely obese patients have greater bone mineral density due to loading; rapid weight loss after bariatric surgery drops bone mass, raising the question of whether it stabilizes or continues to decline (bariatric bone disease).↗
quoteabout half of the teenagers that present interested in bariatric surgery have had a parent who've had weight loss surgery↗
▶Ep 4 · 2:20
epidemiologicalAbout half of teenagers presenting for bariatric surgery have had a parent who underwent weight loss surgery.↗
▶Ep 4 · 45:59
quotethere's also an endoscopic gastric placation experience where you try to essentially create a small stomach like a sleeve gastrectomy, but doing an endoluminal placation↗
▶Ep 4 · 45:59
clinicalIntragastric balloons and endoscopic gastric plication are less invasive approaches with moderate adult experience and some adolescent cases; outcomes are still being evaluated.↗
quoteabout half of the teenagers that present interested in bariatric surgery have had a parent who've had weight loss surgery↗
▶Ep 4 · 2:20
epidemiologicalAbout half of teenagers presenting for bariatric surgery have had a parent who underwent weight loss surgery.↗
▶Ep 4 · 45:59
quotethere's also an endoscopic gastric placation experience where you try to essentially create a small stomach like a sleeve gastrectomy, but doing an endoluminal placation↗
▶Ep 4 · 45:59
clinicalIntragastric balloons and endoscopic gastric plication are less invasive approaches with moderate adult experience and some adolescent cases; outcomes are still being evaluated.↗
Thomas's statements about Pectus Excavatum13 statements
Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024
▶Ep 53 · 1:12
clinicalCryoablation has shown real benefits for rib fractures, slipping rib syndrome, and other endochondromas.↗
▶Ep 53 · 1:28
clinicalLaxity in costochondral junctions and impingement on intercostal nerves as the ribs slip and float causes slipping rib syndrome.↗
▶Ep 53 · 1:28
quoteWe see laxity. In some of these costochondral junctions and impingement on these intercostal nerves as the ribs slip and float and encroach upon these nerves, slipping rib syndrome can be the cause of chronic abdominal wall pain.↗
▶Ep 53 · 1:30
clinicalSlipping rib syndrome can be the cause of chronic abdominal wall pain.↗
▶Ep 53 · 1:44
clinicalPatients with slipping rib syndrome may have already had their appendix or gallbladder removed before arriving at the correct diagnosis.↗
▶Ep 53 · 1:44
quoteWe've all seen patients that come to us with it, they're already out, maybe even their gallbladder out, and nobody has arrived at the right diagnosis.↗
▶Ep 53 · 1:51
clinicalPatients with slipping rib syndrome often undergo multiple colonoscopies, CTs, and ultrasounds before diagnosis.↗
▶Ep 53 · 2:12
clinicalThe usual approach for patients with slipping rib syndrome is to refer them to chronic pain for evaluation and intercostal block with steroid and long-acting local anesthetic.↗
▶Ep 53 · 2:34
clinicalIf there's a response to intercostal block, the next step is to refer to surgery.↗
▶Ep 53 · 2:38
clinicalInterventional radiology performs cryoablation using needle probes at single or multiple levels for slipping rib syndrome.↗
▶Ep 53 · 3:01
clinicalCryoablation can be used intraoperatively in combination with surgery to remove rib tips or stabilize a slipping cartilaginous costal margin.↗
▶Ep 53 · 3:27
quoteIf you have someone come in with chest or fractures that gets stuck on a ventilator, you can do a world of good with this technique by anesthetizing just those intercostal spaces that are the problem.↗
▶Ep 53 · 3:27
clinicalFor patients with chest rib fractures who get stuck on a ventilator, cryoablation can do a world of good by anesthetizing the intercostal spaces that are the problem.↗
Thomas's statements about Severe Obesity21 statements
quoteWe certainly know what drives our thinking about pediatric obesity treatment um from the standpoint of, of aggressive treatment like surgery, and it's classically been described as, uh, as clinically severe obesity, where obesity is actually causing um uh some um health consequences or behavioral consequences, uh, impairments in quality of life for um teenagers.↗
▶Ep 2 · 8:00
clinicalFAS-5 study achieved 81% participation (58 of 74 eligible) at 8-year follow-up, mostly with in-person research visits.↗
clinicalAt 8-year mean follow-up, gastric bypass patients had a mean BMI decline of 29%.↗
▶Ep 2 · 13:00
quoteWhat we see on average at eight years is a BMI decline of, of 29%.↗
▶Ep 2 · 15:00
clinicalBaseline BMI strongly correlates (R=0.75) with follow-up BMI: patients starting with BMI in the 60s end above 40, while those starting in the 40s reach near-normal BMI.↗
▶Ep 2 · 17:00
clinicalRemission rates at 8 years: 88% for diabetes, 64% for dyslipidemia, 75% for hypertension.↗
▶Ep 2 · 18:00
clinicalAmong those without baseline comorbidities, incidence rates were 0% for diabetes, 50% for dyslipidemia (small denominator), and 3 of 29 developed hypertension.↗
▶Ep 2 · 20:00
clinicalFollow-up BMI predicts probability of hypertension, dyslipidemia, high CRP, high insulin, insulin resistance, and low HDL; higher residual BMI is metabolically harmful.↗
▶Ep 2 · 21:00
quoteWe see that there's a definite relationship. So where the BMI ended up matters.↗
▶Ep 2 · 21:10
quoteDoes it really matter? Are, is everything gonna be, you know, peaches and cream or gravy or the bad examples, but uh uh uh bad things. But uh is everything gonna be good with your health, um, now that you've had surgery, no matter what your BMI? And the answer to that seems to be no.↗
▶Ep 2 · 23:00
clinicalAt 8 years, FAS-5 cohort showed low iron stores with anemia, elevated PTH, and low vitamin D in substantial numbers.↗
▶Ep 2 · 29:00
clinicalAMOS had high internal hernia rates due to unclosed mesenteric defects at laparoscopic gastric bypass; closing defects prevents this complication.↗
▶Ep 2 · 29:00
quoteI think that, uh, we have, uh, uh, been Teaching for some time that these defects have to be closed or they will lead to uh internal hernias and incarceration and uh general misery.↗
▶Ep 2 · 31:00
clinicalTeen Labs enrolled 242 adolescents (161 bypass, 67 sleeve, 14 band) at 5 centers; median age now 24, with 203 completing 5-year visits (72% in-clinic, 17% field).↗
▶Ep 2 · 32:00
clinicalAdding 33 sleeve gastrectomy patients to Teen Labs will provide 80% power to compare bypass vs. sleeve for outcomes including blood pressure, PTH, HDL, and BMI.↗
▶Ep 2 · 32:17
clinicalThe 33 new sleeve patients can be enrolled within a year from consortium sites with ongoing clinical follow-up, enabling long-term comparisons.↗
▶Ep 2 · 32:47
quoteI do believe um it's, it's not. Uh, we say, we often say it's not all about the weight, um, but it, it is about the weight, and I think that when we can get them to these, to the lower BMIs, perhaps by operating, uh, uh, earlier after the diagnosis of severe obesity, uh, the better they're gonna be long term.↗
▶Ep 2 · 32:47
opinionOperating earlier after diagnosis of severe obesity may yield lower residual BMI and better long-term metabolic outcomes.↗
▶Ep 2 · 32:47
clinicalFAS-5 study had a residual mean BMI of 38 at 8 years, with many patients remaining severely obese; this residual obesity is metabolically harmful.↗
▶Ep 2 · 34:00
clinicalSeverely obese patients have greater bone mineral density due to loading; rapid weight loss after bariatric surgery drops bone mass, raising the question of whether it stabilizes or continues to decline (bariatric bone disease).↗
Thomas's statements about Severe Obesity42 statements
quoteWe certainly know what drives our thinking about pediatric obesity treatment um from the standpoint of, of aggressive treatment like surgery, and it's classically been described as, uh, as clinically severe obesity, where obesity is actually causing um uh some um health consequences or behavioral consequences, uh, impairments in quality of life for um teenagers.↗
▶Ep 2 · 8:00
clinicalFAS-5 study achieved 81% participation (58 of 74 eligible) at 8-year follow-up, mostly with in-person research visits.↗
clinicalAt 8-year mean follow-up, gastric bypass patients had a mean BMI decline of 29%.↗
▶Ep 2 · 13:00
quoteWhat we see on average at eight years is a BMI decline of, of 29%.↗
▶Ep 2 · 15:00
clinicalBaseline BMI strongly correlates (R=0.75) with follow-up BMI: patients starting with BMI in the 60s end above 40, while those starting in the 40s reach near-normal BMI.↗
▶Ep 2 · 17:00
clinicalRemission rates at 8 years: 88% for diabetes, 64% for dyslipidemia, 75% for hypertension.↗
▶Ep 2 · 18:00
clinicalAmong those without baseline comorbidities, incidence rates were 0% for diabetes, 50% for dyslipidemia (small denominator), and 3 of 29 developed hypertension.↗
▶Ep 2 · 20:00
clinicalFollow-up BMI predicts probability of hypertension, dyslipidemia, high CRP, high insulin, insulin resistance, and low HDL; higher residual BMI is metabolically harmful.↗
▶Ep 2 · 21:00
quoteWe see that there's a definite relationship. So where the BMI ended up matters.↗
▶Ep 2 · 21:10
quoteDoes it really matter? Are, is everything gonna be, you know, peaches and cream or gravy or the bad examples, but uh uh uh bad things. But uh is everything gonna be good with your health, um, now that you've had surgery, no matter what your BMI? And the answer to that seems to be no.↗
▶Ep 2 · 23:00
clinicalAt 8 years, FAS-5 cohort showed low iron stores with anemia, elevated PTH, and low vitamin D in substantial numbers.↗
▶Ep 2 · 29:00
clinicalAMOS had high internal hernia rates due to unclosed mesenteric defects at laparoscopic gastric bypass; closing defects prevents this complication.↗
▶Ep 2 · 29:00
quoteI think that, uh, we have, uh, uh, been Teaching for some time that these defects have to be closed or they will lead to uh internal hernias and incarceration and uh general misery.↗
▶Ep 2 · 31:00
clinicalTeen Labs enrolled 242 adolescents (161 bypass, 67 sleeve, 14 band) at 5 centers; median age now 24, with 203 completing 5-year visits (72% in-clinic, 17% field).↗
▶Ep 2 · 32:00
clinicalAdding 33 sleeve gastrectomy patients to Teen Labs will provide 80% power to compare bypass vs. sleeve for outcomes including blood pressure, PTH, HDL, and BMI.↗
▶Ep 2 · 32:17
clinicalThe 33 new sleeve patients can be enrolled within a year from consortium sites with ongoing clinical follow-up, enabling long-term comparisons.↗
▶Ep 2 · 32:47
opinionOperating earlier after diagnosis of severe obesity may yield lower residual BMI and better long-term metabolic outcomes.↗
▶Ep 2 · 32:47
clinicalFAS-5 study had a residual mean BMI of 38 at 8 years, with many patients remaining severely obese; this residual obesity is metabolically harmful.↗
▶Ep 2 · 32:47
quoteI do believe um it's, it's not. Uh, we say, we often say it's not all about the weight, um, but it, it is about the weight, and I think that when we can get them to these, to the lower BMIs, perhaps by operating, uh, uh, earlier after the diagnosis of severe obesity, uh, the better they're gonna be long term.↗
▶Ep 2 · 34:00
clinicalSeverely obese patients have greater bone mineral density due to loading; rapid weight loss after bariatric surgery drops bone mass, raising the question of whether it stabilizes or continues to decline (bariatric bone disease).↗
Thomas Inge, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 7 · 0:00
quoteI think as pediatric surgeons, we learned a long time ago, uh, when our, in our training and, and throughout all of our careers, what we do for patients in a very critical period of their lives, whether they're neonates, uh, prematures, For older kids or teenagers, as we have an opportunity to intervene and do a really good care, uh, including surgical operations that have a lifetime consequence.↗
▶Ep 7 · 0:00
epidemiologicalTeen-LABS recruited approximately 160 gastric bypasses and 100 sleeve gastrectomies.↗
▶Ep 7 · 0:00
epidemiologicalTeen-LABS is a multi-institutional longitudinal study of 242 adolescent bariatric surgery subjects with assessment preoperatively and at time points postoperatively, now in its 17th year of NIH funding with 85% retention (219 of 242 still active).↗
▶Ep 7 · 0:00
epidemiologicalIn the Children's Hospital Association database from 2010 to 2022, sleeve gastrectomy has become the dominant procedure and very few bypasses are being done in 2022.↗
▶Ep 7 · 5:00
quoteThe holy grail for bariatric surgery has always been how do you predict early on or preoperatively, how do you predict which of these groups you're gonna end up in? And I'd, I'd like to say that we have the answer but we're still working hard on that one.↗
▶Ep 7 · 5:00
clinicalWeight loss after gastric bypass is equivalent in teenagers and adults at approximately 26-29% at 5 years.↗
▶Ep 7 · 5:00
clinicalAt 5 years post-gastric bypass, 86% of teenagers achieved diabetes remission compared to 53% of adults.↗
▶Ep 7 · 5:00
clinicalAt 5 years post-gastric bypass, 68% of teenagers achieved hypertension remission compared to 41% of adults.↗
▶Ep 7 · 5:00
clinicalMeta-analysis of multiple pediatric bariatric cohorts (AMOS from Sweden, FBS-5 from Cincinnati, studies from Saudi Arabia and Miami) with follow-up of 5-14 years shows hypertension remission rates of 58-100%, type 2 diabetes remission rates of 72-100%, and reversal of dyslipidemia, renal dysfunction, and liver dysfunction.↗
▶Ep 7 · 5:00
clinicalIn Teen-LABS, percent BMI change shows nadir at 1 year of approximately 33% reduction, with very gentle increase over time to 21% average reduction at 10 years, but with significant heterogeneity.↗
▶Ep 7 · 5:00
clinicalLatent class modeling of Teen-LABS 10-year weight outcomes identifies distinct groups: approximately 11% with weight gain, approximately 20% with 44% weight loss, and groups in between.↗
▶Ep 7 · 10:00
epidemiologicalBy 8 years post-surgery in Teen-LABS, a minority of patients have not had experience with alcohol, and most have had some experience.↗
▶Ep 7 · 10:00
epidemiologicalA number of the Teen-LABS deaths were associated with multi-substance use, though this data is not yet published.↗
▶Ep 7 · 10:00
epidemiologicalFourteen deaths occurred in the Teen-LABS cohort, with the first death at 3.3 years post-surgery and others occurring at 7, 10, and 14 years post-surgery.↗
▶Ep 7 · 10:00
clinicalThe pharmacokinetics of alcohol are much faster (hitting the system more rapidly) after gastric bypass and probably sleeve gastrectomy as well.↗
▶Ep 7 · 10:00
epidemiologicalThe cumulative incidence of alcohol-related problems by 8.5 years post-surgery approaches half of patients in both sleeve and bypass groups.↗
▶Ep 7 · 10:16
epidemiologicalWhen compared to previously published normative data, Teen-LABS patients adopt alcohol use later and at lower frequency than normal-weight controls.↗
▶Ep 7 · 15:50
quoteI like to be able to go to the operating room and cure, uh, cure obesity as well as type 2 diabetes.↗
▶Ep 7 · 15:50
guidelineMicronutrient supplementation after bariatric surgery should be taken like medicines, not like supplements, and this should be emphasized preoperatively and postoperatively.↗
▶Ep 7 · 15:50
opinionFor sleeve gastrectomy, an anatomy-based approach (avoiding leaving a pouch at the top and avoiding a dumbbell-shaped stomach) is recommended to prevent reflux.↗
▶Ep 7 · 16:35
opinionPreliminary comparison to an 81-patient cohort of severely obese teenagers who did not undergo surgery (recruited by Meg Zeller in Cincinnati) suggests that 10-year mortality may be a signal of severe obesity in teenage years rather than surgery itself.↗
Thomas's statements about Slipping Rib Syndrome13 statements
Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024
▶Ep 3 · 1:12
clinicalCryoablation has shown real benefits for rib fractures, slipping rib syndrome, and other endochondromas.↗
▶Ep 3 · 1:28
quoteWe see laxity. In some of these costochondral junctions and impingement on these intercostal nerves as the ribs slip and float and encroach upon these nerves, slipping rib syndrome can be the cause of chronic abdominal wall pain.↗
▶Ep 3 · 1:28
clinicalLaxity in costochondral junctions and impingement on intercostal nerves as the ribs slip and float causes slipping rib syndrome.↗
▶Ep 3 · 1:30
clinicalSlipping rib syndrome can be the cause of chronic abdominal wall pain.↗
▶Ep 3 · 1:44
quoteWe've all seen patients that come to us with it, they're already out, maybe even their gallbladder out, and nobody has arrived at the right diagnosis.↗
▶Ep 3 · 1:44
clinicalPatients with slipping rib syndrome may have already had their appendix or gallbladder removed before arriving at the correct diagnosis.↗
▶Ep 3 · 1:51
clinicalPatients with slipping rib syndrome often undergo multiple colonoscopies, CTs, and ultrasounds before diagnosis.↗
▶Ep 3 · 2:12
clinicalThe usual approach for patients with slipping rib syndrome is to refer them to chronic pain for evaluation and intercostal block with steroid and long-acting local anesthetic.↗
▶Ep 3 · 2:34
clinicalIf there's a response to intercostal block, the next step is to refer to surgery.↗
▶Ep 3 · 2:38
clinicalInterventional radiology performs cryoablation using needle probes at single or multiple levels for slipping rib syndrome.↗
▶Ep 3 · 3:01
clinicalCryoablation can be used intraoperatively in combination with surgery to remove rib tips or stabilize a slipping cartilaginous costal margin.↗
▶Ep 3 · 3:27
quoteIf you have someone come in with chest or fractures that gets stuck on a ventilator, you can do a world of good with this technique by anesthetizing just those intercostal spaces that are the problem.↗
▶Ep 3 · 3:27
clinicalFor patients with chest rib fractures who get stuck on a ventilator, cryoablation can do a world of good by anesthetizing the intercostal spaces that are the problem.↗
Thomas's statements about Type 2 Diabetes25 statements
epidemiologicalAbout half of teenagers presenting for bariatric surgery have had a parent who underwent weight loss surgery.↗
▶Ep 1 · 2:20
quoteabout half of the teenagers that present interested in bariatric surgery have had a parent who've had weight loss surgery↗
▶Ep 1 · 45:59
quotethere's also an endoscopic gastric placation experience where you try to essentially create a small stomach like a sleeve gastrectomy, but doing an endoluminal placation↗
▶Ep 1 · 45:59
clinicalIntragastric balloons and endoscopic gastric plication are less invasive approaches with moderate adult experience and some adolescent cases; outcomes are still being evaluated.↗
Thomas Inge, MD - 2024 Pediatric Bariatric Surgery Update Course
▶Ep 2 · 0:00
epidemiologicalIn the Children's Hospital Association database from 2010 to 2022, sleeve gastrectomy has become the dominant procedure and very few bypasses are being done in 2022.↗
▶Ep 2 · 0:00
epidemiologicalTeen-LABS is a multi-institutional longitudinal study of 242 adolescent bariatric surgery subjects with assessment preoperatively and at time points postoperatively, now in its 17th year of NIH funding with 85% retention (219 of 242 still active).↗
▶Ep 2 · 0:00
epidemiologicalTeen-LABS recruited approximately 160 gastric bypasses and 100 sleeve gastrectomies.↗
▶Ep 2 · 0:00
quoteI think as pediatric surgeons, we learned a long time ago, uh, when our, in our training and, and throughout all of our careers, what we do for patients in a very critical period of their lives, whether they're neonates, uh, prematures, For older kids or teenagers, as we have an opportunity to intervene and do a really good care, uh, including surgical operations that have a lifetime consequence.↗
▶Ep 2 · 5:00
clinicalIn Teen-LABS, percent BMI change shows nadir at 1 year of approximately 33% reduction, with very gentle increase over time to 21% average reduction at 10 years, but with significant heterogeneity.↗
▶Ep 2 · 5:00
clinicalWeight loss after gastric bypass is equivalent in teenagers and adults at approximately 26-29% at 5 years.↗
▶Ep 2 · 5:00
clinicalAt 5 years post-gastric bypass, 86% of teenagers achieved diabetes remission compared to 53% of adults.↗
▶Ep 2 · 5:00
clinicalAt 5 years post-gastric bypass, 68% of teenagers achieved hypertension remission compared to 41% of adults.↗
▶Ep 2 · 5:00
clinicalMeta-analysis of multiple pediatric bariatric cohorts (AMOS from Sweden, FBS-5 from Cincinnati, studies from Saudi Arabia and Miami) with follow-up of 5-14 years shows hypertension remission rates of 58-100%, type 2 diabetes remission rates of 72-100%, and reversal of dyslipidemia, renal dysfunction, and liver dysfunction.↗
▶Ep 2 · 5:00
clinicalLatent class modeling of Teen-LABS 10-year weight outcomes identifies distinct groups: approximately 11% with weight gain, approximately 20% with 44% weight loss, and groups in between.↗
▶Ep 2 · 5:00
quoteThe holy grail for bariatric surgery has always been how do you predict early on or preoperatively, how do you predict which of these groups you're gonna end up in? And I'd, I'd like to say that we have the answer but we're still working hard on that one.↗
▶Ep 2 · 10:00
clinicalThe pharmacokinetics of alcohol are much faster (hitting the system more rapidly) after gastric bypass and probably sleeve gastrectomy as well.↗
▶Ep 2 · 10:00
epidemiologicalFourteen deaths occurred in the Teen-LABS cohort, with the first death at 3.3 years post-surgery and others occurring at 7, 10, and 14 years post-surgery.↗
▶Ep 2 · 10:00
epidemiologicalA number of the Teen-LABS deaths were associated with multi-substance use, though this data is not yet published.↗
▶Ep 2 · 10:00
epidemiologicalBy 8 years post-surgery in Teen-LABS, a minority of patients have not had experience with alcohol, and most have had some experience.↗
▶Ep 2 · 10:00
epidemiologicalThe cumulative incidence of alcohol-related problems by 8.5 years post-surgery approaches half of patients in both sleeve and bypass groups.↗
▶Ep 2 · 10:16
epidemiologicalWhen compared to previously published normative data, Teen-LABS patients adopt alcohol use later and at lower frequency than normal-weight controls.↗
▶Ep 2 · 15:50
opinionFor sleeve gastrectomy, an anatomy-based approach (avoiding leaving a pouch at the top and avoiding a dumbbell-shaped stomach) is recommended to prevent reflux.↗
▶Ep 2 · 15:50
guidelineMicronutrient supplementation after bariatric surgery should be taken like medicines, not like supplements, and this should be emphasized preoperatively and postoperatively.↗
▶Ep 2 · 15:50
quoteI like to be able to go to the operating room and cure, uh, cure obesity as well as type 2 diabetes.↗
▶Ep 2 · 16:35
opinionPreliminary comparison to an 81-patient cohort of severely obese teenagers who did not undergo surgery (recruited by Meg Zeller in Cincinnati) suggests that 10-year mortality may be a signal of severe obesity in teenage years rather than surgery itself.↗
Summaries Thomas gave as host
· 15 summaries
Recaps of other experts' statements, not Thomas's own clinical position.
Summaries Thomas gave as host · Diabetes5 summaries
host summaryThomas Inge summarizing a resource: Cardiovascular mortality begins to climb in the overweight range and increases definitively for adolescents at or above the 95th percentile BMI, leading to early cardiovascular death.↗
▶Ep 1 · 25:00
host summaryThomas Inge summarizing a resource: In AMOS study, non-surgical controls with severe obesity gained weight over 5 years (BMI 42→45).↗
▶Ep 1 · 26:00
host summaryThomas Inge summarizing a resource: AMOS gastric bypass patients had dramatic BMI reduction from 45 to 30, stable at 5 years, similar to adult controls and SOS cohort.↗
▶Ep 1 · 28:00
host summaryThomas Inge summarizing a resource: AMOS showed 83% dyslipidemia remission, 12 of 12 hypertension cases resolved, and 75% inflammation (CRP) resolved.↗
▶Ep 1 · 30:00
host summaryThomas Inge summarizing a resource: In AMOS, low vitamin D was found in >50% of gastric bypass patients and also in controls; low B12 and iron deficiency anemia were noted.↗
Summaries Thomas gave as host · Severe Obesity5 summaries
host summaryThomas Inge summarizing a resource: Cardiovascular mortality begins to climb in the overweight range and increases definitively for adolescents at or above the 95th percentile BMI, leading to early cardiovascular death.↗
▶Ep 2 · 25:00
host summaryThomas Inge summarizing a resource: In AMOS study, non-surgical controls with severe obesity gained weight over 5 years (BMI 42→45).↗
▶Ep 2 · 26:00
host summaryThomas Inge summarizing a resource: AMOS gastric bypass patients had dramatic BMI reduction from 45 to 30, stable at 5 years, similar to adult controls and SOS cohort.↗
▶Ep 2 · 28:00
host summaryThomas Inge summarizing a resource: AMOS showed 83% dyslipidemia remission, 12 of 12 hypertension cases resolved, and 75% inflammation (CRP) resolved.↗
▶Ep 2 · 30:00
host summaryThomas Inge summarizing a resource: In AMOS, low vitamin D was found in >50% of gastric bypass patients and also in controls; low B12 and iron deficiency anemia were noted.↗
Summaries Thomas gave as host · Severe Obesity5 summaries
host summaryThomas Inge summarizing a resource: Cardiovascular mortality begins to climb in the overweight range and increases definitively for adolescents at or above the 95th percentile BMI, leading to early cardiovascular death.↗
▶Ep 2 · 25:00
host summaryThomas Inge summarizing a resource: In AMOS study, non-surgical controls with severe obesity gained weight over 5 years (BMI 42→45).↗
▶Ep 2 · 26:00
host summaryThomas Inge summarizing a resource: AMOS gastric bypass patients had dramatic BMI reduction from 45 to 30, stable at 5 years, similar to adult controls and SOS cohort.↗
▶Ep 2 · 28:00
host summaryThomas Inge summarizing a resource: AMOS showed 83% dyslipidemia remission, 12 of 12 hypertension cases resolved, and 75% inflammation (CRP) resolved.↗
▶Ep 2 · 30:00
host summaryThomas Inge summarizing a resource: In AMOS, low vitamin D was found in >50% of gastric bypass patients and also in controls; low B12 and iron deficiency anemia were noted.↗
