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Bariatric Rapid Fire Sessions: Latest Evidence and Trends in Pediatric...
With Dr. Alan Brown
Part of
Obesity 30 items
Chapter 1 of 5 · Evidence & Research
Surgery timing
Optimal BMI for Bariatric Surgery Intervention
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
BMIs in the 40s will predictably get patients to BMIs less than 30
The younger we can intervene with bariatric surgery, the more it helps quality of life
Once you cross the BMI 50 threshold, the probability of mitigating risk associated with BMI 35 and above becomes challenging
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
Some kids will need pharmacotherapy even after bariatric surgery
Obesity is a heterogeneous disease with a very wide range of response to surgery and other treatments, requiring a continuous approach
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
Hypothalamic obesity patients have a biological drive to gain weight and defeat surgery that is profoundly different from other patients without brain injury
Dexamphetamine has an evidence base for use in hypothalamic obesity patients, both before and after surgery
Private insurers are limiting dietitian visits to 3 per year, which is insufficient for obesity as a chronic disease
Sugar taxation can be a regressive tax depending on socioeconomic class
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
Most obese patients meet objective criteria for binge eating disorder when screened with questionnaires, even if they don't come in with a diagnosis
Bariatric surgery is a very good way to extinguish binge eating behaviors
A prior diagnosis of binge eating disorder may pose a higher risk for relapse or weight regain after surgery
The rate of true binge eating disorder meeting diagnostic criteria is under 5% when screening new patients
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
Patients who lose weight due to fear of eating and restricting should be referred to an eating disorder program
Disordered eating applies to every obese patient—there are feelings or emotions around eating, food, and restricting, even if not meeting DSM criteria
Tom has presented data showing that operating at a lower degree of obesity can move people into a much healthier state
Patients above BMI 55 have only about a 14% probability of getting down to a BMI below 30 (data published by Tom in 2009)
Kelly Branno showed compelling data that sugar taxes decrease consumption and generate revenue
Jim Mitchell's work in the LABS consortium demonstrates very good resolution of binge eating disorder symptoms after bariatric surgery