# Obesity — GCMD Library living collection

Updated: n/a · 16 episodes · 341 cited statements

## Episodes
### Resources
- [Rapid Fire and Conclusion: Pediatric Obesity 2017](https://library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373) — video · 23:37 · [machine version](https://library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373.md)
- [PDC 2020 Practice Gaps](https://library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998) — video · 1:23:26 · [machine version](https://library.globalcastmd.com/watch/pdc-2020-practice-gaps-2998.md)
- [Pediatric Obesity Is a Disease: Treatment, Medications, Surgery & Equity in Care with Dr. Justin Ryder](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602) — video · 6:48 · [machine version](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602.md)
- [Clinical Research Facilitators, Barriers, and Preferences of Parents of Children With Overweight...](https://library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-with-overweight-13884) — video · 0:41 · [machine version](https://library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-with-overweight-13884.md)
- [Identifying & Managing Eating Disorders in Pediatric Obesity Treatment: Current Practices in Weight](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13885) — video · 0:53 · [machine version](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13885.md)
- [Identifying & Managing Eating Disorders in Pediatric Obesity Treatment: Current Practices in Weight](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13886) — video · 0:53 · [machine version](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13886.md)
- [Public Policies to Address Obesity: Pediatric Obesity 2017](https://library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365) — video · 46:10 · [machine version](https://library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365.md)
- [AAP Policy for Adolescent Bariatric Surgery: Pediatric Obesity 2017](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372) — video · 27:22 · [machine version](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372.md)
- [Bariatric Surgery in the Pediatric Patient](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388) — podcast · 49:29 · [machine version](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388.md)
- [Bariatric Partial Gastrectomy Technique: Adolescent Obesity 2013](https://library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429) — video · 39:40 · [machine version](https://library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429.md)
- [Taking the Battle Out of Getting Kids to Eat Healthier and Move More: Child &...](https://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://library.globalcastmd.com/watch/taking-the-battle-out-of-getting-kids-to-eat-healthier-and-move-more-child-862.md)
- [Weight Bias: Child & Adolescent Obesity 2015](https://library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863) — video · 34:43 · [machine version](https://library.globalcastmd.com/watch/weight-bias-child-adolescent-obesity-2015-863.md)
- [Everyday Stress: Child & Adolescent Obesity 2015](https://library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864) — video · 27:59 · [machine version](https://library.globalcastmd.com/watch/everyday-stress-child-adolescent-obesity-2015-864.md)
- [Bariatric Rapid Fire Sessions: Latest Evidence and Trends in Pediatric...](https://library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869) — video · 22:06 · [machine version](https://library.globalcastmd.com/watch/bariatric-rapid-fire-sessions-latest-evidence-and-trends-in-pediatric-869.md)
- [The Right Tool for the Job: Child & Adolescent Obesity 2015](https://library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870) — video · 42:40 · [machine version](https://library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870.md)
- [Obesity: Advanced Practice Providers](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047) — video · 36:49 · [machine version](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=0) Introduction of Dr. Kelly Brownell (Ep 7)
- [1:16](https://library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=76) Conceptual Framework: Individual vs. Environmental Approaches (Ep 7)
- [7:00](https://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 7)
- [15:00](https://library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=900) Toxic Food Defaults and Personal Responsibility (Ep 7)
- [20:00](https://library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=1200) Bridging Research and Policy: The Dropped Baton Problem (Ep 7)
- [25:00](https://library.globalcastmd.com/watch/public-policies-to-address-obesity-pediatric-obesity-2017-365?t=1500) Sugar-Sweetened Beverage Taxes: Case Study and Implementation (Ep 7)
- [32:58](https://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 7)
- [38:28](https://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 7)
- [0:00](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=0) Introduction of Speaker and Topic (Ep 8)
- [0:50](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=50) Rationale for Policy Development and Obesity Prevalence (Ep 8)
- [7:00](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=420) Evolution of Evidence Base (Ep 8)
- [10:40](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=640) Consensus Guidelines Development History (Ep 8)
- [15:00](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=900) National Accreditation Standards (Ep 8)
- [18:20](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1100) Insurance Authorization Barriers (Ep 8)
- [22:30](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1350) Physician Attitudes and Procedural Prevalence (Ep 8)
- [24:30](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1470) AAP Policy Statement Development Timeline (Ep 8)
- [25:33](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1533) Closing Discussion and Current Status (Ep 8)
- [0:00](https://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 1)
- [8:18](https://library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=498) Pharmacotherapy Use Patterns in Clinical Practice (Ep 1)
- [10:42](https://library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=642) Financial Viability of Nutrition Services (Ep 1)
- [14:22](https://library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=862) Sugar Tax Policy Debate (Ep 1)
- [16:47](https://library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1007) Eating Disorders in Obesity Treatment (Ep 1)
- [22:37](https://library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1357) Closing Remarks (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=0) Introduction and Rising Need for Adolescent Bariatric Surgery (Ep 9)
- [3:02](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=182) Non-Operative Weight Loss: Effectiveness and Limitations (Ep 9)
- [7:10](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=430) Patient Selection: Age, Comorbidities, and Timing (Ep 9)
- [9:46](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=586) Preoperative Process and Multidisciplinary Team Structure (Ep 9)
- [13:46](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=826) Insurance Coverage and Advocacy (Ep 9)
- [17:42](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1062) Contraindications and Special Populations (Ep 9)
- [19:44](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1184) Procedure Overview: Sleeve Gastrectomy vs. Gastric Bypass (Ep 9)
- [23:49](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1429) Sleeve Gastrectomy: Technical Steps and Variations (Ep 9)
- [29:03](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1743) Leak Prevention at the Gastroesophageal Junction (Ep 9)
- [33:20](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2000) Postoperative Diet Advancement (Ep 9)
- [34:55](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2095) Complications: Sleeve Gastrectomy (Ep 9)
- [37:47](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2267) Complications: Gastric Bypass (Ep 9)
- [38:50](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2330) Weight Loss Outcomes and Health Benefits (Ep 9)
- [40:46](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2446) Long-Term Durability: 8-Year Follow-Up Data (Ep 9)
- [45:38](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2738) Current Research and Future Directions (Ep 9)
- [48:49](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2929) Closing Remarks (Ep 9)
- [0:00](https://library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=0) Initial access and port placement techniques (Ep 10)

## 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 1 · 0:56](https://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 1 · 1:49](https://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 1 · 3:32](https://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 1 · 3:59](https://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 1 · 5:34](https://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 1 · 6:27](https://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 1 · 7:06](https://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 1 · 7:56](https://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 1 · 8:31](https://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 1 · 9:15](https://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 1 · 9:32](https://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 1 · 13:36](https://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 1 · 15:08](https://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 1 · 19:53](https://library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1193)
- Surgery is effective at extinguishing binge eating behaviors (clinical) [Ep 1 · 20:49](https://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 1 · 21:03](https://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 1 · 21:33](https://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 1 · 21:18](https://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 1 · 21:51](https://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 1 · 22:20](https://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 2 · 6:39](https://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 2 · 7:24](https://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 2 · 11:22](https://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 2 · 16:22](https://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 2 · 17:52](https://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 2 · 17:14](https://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 2 · 19:09](https://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 2 · 27:03](https://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 2 · 38:20](https://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 2 · 39:47](https://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 2 · 56:37](https://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 2 · 58:51](https://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 2 · 69:16](https://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 3 · 0:32](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-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 3 · 0:44](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=44)
- Historically, about 90% of efforts over the past 50 years have been on prevention of childhood obesity. — Justin Ryder (epidemiological) [Ep 3 · 1:08](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=68)
- The new AAP clinical practice guidelines clearly state that obesity is a disease. — Justin Ryder (guideline) [Ep 3 · 1:15](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-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 3 · 1:25](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-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 3 · 1:41](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=101)
- Pharmacotherapy is FDA labeled for adolescents above the age of 12. — Justin Ryder (guideline) [Ep 3 · 1:55](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=115)
- Currently, there are 5 medications that are FDA approved for the treatment of adolescents with obesity. — Justin Ryder (clinical) [Ep 3 · 2:02](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-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 3 · 2:08](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=128)
- Wegovy, a GLP-1 receptor agonist, causes about 17% weight loss and is FDA approved in adolescents. — Justin Ryder (clinical) [Ep 3 · 2:29](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=149)
- Data in adults on tirzepatide shows significant change in body weight compared to placebo. — Justin Ryder (clinical) [Ep 3 · 2:44](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=164)
- Oral GLP-1 medications are on the way in a few short years. — Justin Ryder (clinical) [Ep 3 · 2:51](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=171)
- Bariatric surgery studies show sustained weight loss in both adults and adolescent cohorts over several years. — Justin Ryder (clinical) [Ep 3 · 2:51](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-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 3 · 3:03](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=183)
- There is significant heterogeneity in response to bariatric surgery, and weight regain is a significant problem. — Justin Ryder (clinical) [Ep 3 · 3:18](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-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 3 · 3:24](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-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 3 · 3:40](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=220)
- Weight regain factors are all influenced by genetics and the environment, including puberty, race, and socioeconomic status. — Justin Ryder (clinical) [Ep 3 · 3:56](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-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 3 · 4:03](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=243)
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent pediatric liver disease. — Justin Ryder (epidemiological) [Ep 3 · 4:22](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=262)
- Obesity is a significant risk factor for MASLD. — Justin Ryder (clinical) [Ep 3 · 4:31](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=271)
- About 20% of youth in the United States have obesity, which is roughly 15 million children. — Justin Ryder (epidemiological) [Ep 3 · 4:34](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=274)
- Approximately 5 million children have both obesity and MASLD. — Justin Ryder (epidemiological) [Ep 3 · 4:40](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-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 3 · 4:45](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=285)
- There are racial and ethnic differences in MASLD prevalence. — Justin Ryder (epidemiological) [Ep 3 · 4:56](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=296)
- Obesity affects at least 35% of adults and 20% of children in Illinois alone. — Justin Ryder (epidemiological) [Ep 3 · 5:09](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=309)
- The rates of severe forms of obesity are only increasing. — Justin Ryder (epidemiological) [Ep 3 · 5:09](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=309)
- Obesity significantly increases the risk of long-term health problems and early death. — Justin Ryder (clinical) [Ep 3 · 5:19](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=319)
- The economic impact of obesity is substantial, with reductions in GDP and increases in state spending. — Justin Ryder (epidemiological) [Ep 3 · 5:23](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=323)
- Obesity is a disease driven by biology and it is no one's fault. — Justin Ryder (opinion) [Ep 3 · 5:30](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=330)
- Access to effective obesity medications is a health equity issue. — Justin Ryder (opinion) [Ep 3 · 5:37](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-11602?t=337)
- Obesity disproportionately affects people of color and those living in poverty. — Justin Ryder (epidemiological) [Ep 3 · 5:41](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-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 3 · 5:49](https://library.globalcastmd.com/watch/pediatric-obesity-is-a-disease-treatment-medications-surgery-equity-in-care-with-dr-justin-ryder-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 7 · 25:00](https://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 7 · 9:00](https://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 7 · 10:00](https://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 7 · 34:01](https://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 7 · 34:01](https://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 7 · 34:01](https://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 7 · 39:51](https://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 7 · 35:11](https://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 7 · 36:54](https://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 7 · 36:54](https://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 7 · 43:51](https://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 7 · 34:01](https://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 7 · 28:20](https://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 7 · 30:00](https://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 7 · 38:28](https://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 7 · 39:51](https://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 7 · 40:50](https://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 7 · 36:40](https://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 7 · 36:40](https://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 8 · 3:30](https://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 8 · 5:50](https://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 8 · 7:00](https://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 8 · 8:00](https://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 8 · 10:40](https://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 8 · 11:10](https://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 8 · 13:00](https://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 8 · 14:00](https://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 8 · 15:20](https://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 8 · 16:00](https://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 8 · 17:00](https://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 8 · 19:10](https://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 8 · 19:50](https://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 8 · 20:40](https://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 8 · 21:00](https://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 8 · 26:20](https://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 8 · 28:00](https://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 8 · 27:22](https://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 8 · 27:22](https://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 8 · 27:22](https://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 9 · 1:44](https://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 9 · 1:44](https://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 9 · 2:20](https://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 9 · 3:15](https://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 9 · 4:34](https://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 9 · 5:15](https://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 9 · 6:21](https://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 9 · 6:21](https://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 9 · 7:13](https://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 9 · 7:13](https://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 9 · 8:25](https://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 9 · 8:25](https://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 9 · 10:08](https://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 9 · 10:08](https://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 9 · 12:12](https://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 9 · 12:12](https://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 9 · 16:09](https://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 9 · 16:09](https://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 9 · 17:52](https://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 9 · 19:11](https://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 9 · 19:57](https://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 9 · 19:57](https://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 9 · 19:57](https://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 9 · 21:14](https://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 9 · 21:14](https://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 9 · 22:13](https://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 9 · 22:13](https://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 9 · 23:49](https://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 9 · 25:58](https://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 9 · 27:34](https://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 9 · 29:03](https://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 9 · 29:03](https://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 9 · 30:27](https://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 9 · 30:27](https://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 9 · 30:27](https://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 9 · 33:23](https://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 9 · 33:23](https://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 9 · 33:23](https://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 9 · 34:56](https://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 9 · 34:56](https://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 9 · 34:56](https://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 9 · 34:56](https://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 9 · 34:56](https://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 9 · 37:47](https://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 9 · 38:50](https://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 9 · 39:06](https://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 9 · 39:06](https://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 9 · 39:06](https://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 9 · 40:52](https://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 9 · 40:52](https://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 9 · 43:48](https://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 9 · 43:48](https://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 9 · 45:59](https://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 9 · 45:59](https://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 9 · 45:59](https://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 10 · 0:51](https://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 10 · 2:41](https://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 10 · 3:39](https://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 10 · 6:40](https://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 10 · 6:40](https://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 10 · 8:01](https://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 10 · 9:11](https://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 10 · 10:46](https://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 10 · 1:56](https://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 10 · 12:52](https://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 10 · 14:32](https://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 10 · 17:17](https://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 10 · 17:17](https://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 10 · 16:08](https://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 10 · 19:35](https://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 10 · 20:33](https://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 10 · 21:55](https://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 10 · 21:55](https://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 10 · 23:56](https://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 10 · 26:10](https://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 10 · 31:21](https://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 10 · 32:34](https://library.globalcastmd.com/watch/bariatric-partial-gastrectomy-technique-adolescent-obesity-2013-429?t=1954)
- Leak rate less than 5% in adults — Mark (epidemiological) [Ep 10 · 33:34](https://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 10 · 33:47](https://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 10 · 34:28](https://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 10 · 37:29](https://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 10 · 37:59](https://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 12 · 15:00](https://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 12 · 25:00](https://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 12 · 26:30](https://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 12 · 27:00](https://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 12 · 28:00](https://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 12 · 26:00](https://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 12 · 25:30](https://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 12 · 28:30](https://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 12 · 29:40](https://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 12 · 30:10](https://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 11 · 0:00](https://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 11 · 0:00](https://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 11 · 0:00](https://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 11 · 0:00](https://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 11 · 0:00](https://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 11 · 9:58](https://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 11 · 9:58](https://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 11 · 20:40](https://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 11 · 20:40](https://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 11 · 20:40](https://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 11 · 20:40](https://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 11 · 28:22](https://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 11 · 28:22](https://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 11 · 39:26](https://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 11 · 39:26](https://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 11 · 39:26](https://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 11 · 39:26](https://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 11 · 47:55](https://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 11 · 47:55](https://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 11 · 47:55](https://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 11 · 47:55](https://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 11 · 63:00](https://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 11 · 63:00](https://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 11 · 63:00](https://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 13 · 0:00](https://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 13 · 1:00](https://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 13 · 1:30](https://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 13 · 2:00](https://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 13 · 2:30](https://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 13 · 4:00](https://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 13 · 4:30](https://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 13 · 5:00](https://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 13 · 5:30](https://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 13 · 6:00](https://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 13 · 6:30](https://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 13 · 7:00](https://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 13 · 7:30](https://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 13 · 8:00](https://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 13 · 8:30](https://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 13 · 9:00](https://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 13 · 9:30](https://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 13 · 10:00](https://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 13 · 10:30](https://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 13 · 11:00](https://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 13 · 11:30](https://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 13 · 12:00](https://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 13 · 13:00](https://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 13 · 13:30](https://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 13 · 14:00](https://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 13 · 14:30](https://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 13 · 15:00](https://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 13 · 15:30](https://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 13 · 17:00](https://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 13 · 17:30](https://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 13 · 18:00](https://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 13 · 19:00](https://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 13 · 19:30](https://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 13 · 20:00](https://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 13 · 20:30](https://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 13 · 21:30](https://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 13 · 22:00](https://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 13 · 22:30](https://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 13 · 23:00](https://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 13 · 23:30](https://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 13 · 24:00](https://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 13 · 24:30](https://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 13 · 25:00](https://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 13 · 25:30](https://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 13 · 26:00](https://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 13 · 26:30](https://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 13 · 27:00](https://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 13 · 27:30](https://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 13 · 28:00](https://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 13 · 28:30](https://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 13 · 29:00](https://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 13 · 27:59](https://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 13 · 27:59](https://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 14 · 0:16](https://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 14 · 1:08](https://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 14 · 2:24](https://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 14 · 4:53](https://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 14 · 6:07](https://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 14 · 7:16](https://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 14 · 7:50](https://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 14 · 8:35](https://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 14 · 8:35](https://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 14 · 12:55](https://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 14 · 14:27](https://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 14 · 13:52](https://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 14 · 19:09](https://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 14 · 19:09](https://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 14 · 19:09](https://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 14 · 20:35](https://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 14 · 20:35](https://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 14 · 20:35](https://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 14 · 21:37](https://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 15 · 7:00](https://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 15 · 9:00](https://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 15 · 11:00](https://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 15 · 15:00](https://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 15 · 18:00](https://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 15 · 20:00](https://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 15 · 24:00](https://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 15 · 26:00](https://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 15 · 27:00](https://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 15 · 28:00](https://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 15 · 31:00](https://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 15 · 32:00](https://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 15 · 33:30](https://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 15 · 35:00](https://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 15 · 37:00](https://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 15 · 38:30](https://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 15 · 39:40](https://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 15 · 40:50](https://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 16 · 2:00](https://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 16 · 2:30](https://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 16 · 5:00](https://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 16 · 5:30](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=330)
- Every single body system is affected by obesity. — Beth (clinical) [Ep 16 · 7:00](https://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 16 · 7:10](https://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 16 · 7:40](https://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 16 · 8:40](https://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 16 · 10:40](https://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 16 · 13:00](https://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 16 · 15:00](https://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 16 · 15:30](https://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 16 · 17:00](https://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 16 · 18:20](https://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 16 · 19:00](https://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 16 · 20:00](https://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 16 · 22:00](https://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 16 · 23:20](https://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 16 · 26:00](https://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 16 · 26:30](https://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 16 · 27:00](https://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 16 · 27:20](https://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 16 · 28:20](https://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 16 · 29:10](https://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 16 · 30:20](https://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 16 · 31:00](https://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 16 · 33:20](https://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 16 · 35:40](https://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 16 · 35:00](https://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 16 · 35:50](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=2150)

## 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 4 · 0:07](https://library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-with-overweight-13884?t=7)
- Parents reported more reasons to participate in childhood obesity research than reasons not to participate — Lizzie Lee summarizing a resource [Ep 4 · 0:15](https://library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-with-overweight-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 4 · 0:15](https://library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-with-overweight-13884?t=15)
- Research perceptions varied by family characteristics — Lizzie Lee summarizing a resource [Ep 4 · 0:26](https://library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-with-overweight-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 4 · 0:30](https://library.globalcastmd.com/watch/clinical-research-facilitators-barriers-and-preferences-of-parents-of-children-with-overweight-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 5 · 0:08](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13885?t=8)
- Most programs are screening for eating disorders but not in a standardized way — Lizzie Lee summarizing a resource [Ep 5 · 0:14](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13885?t=14)
- About 60% of programs perform some form of eating disorder screening — Lizzie Lee summarizing a resource [Ep 5 · 0:19](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-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 5 · 0:19](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13885?t=19)
- Providers are generally comfortable with screening for eating disorders — Lizzie Lee summarizing a resource [Ep 5 · 0:29](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-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 5 · 0:29](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13885?t=29)
- Clinicians report not being trained enough as a barrier to eating disorder management — Lizzie Lee summarizing a resource [Ep 5 · 0:39](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13885?t=39)
- Clinicians report not knowing how to manage eating disorders they identify as a barrier — Lizzie Lee summarizing a resource [Ep 5 · 0:39](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13885?t=39)
- Clinicians report lacking clear treatment pathways for eating disorders as a barrier — Lizzie Lee summarizing a resource [Ep 5 · 0:39](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-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 5 · 0:47](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13885?t=47)
- A national survey of pediatric weight management programs across the US was conducted — Lizzie Lee summarizing a resource [Ep 6 · 0:08](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13886?t=8)
- Most programs are screening for eating disorders, but not in a very standardized way — Lizzie Lee summarizing a resource [Ep 6 · 0:14](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13886?t=14)
- About 60% of programs are doing some form of screening — Lizzie Lee summarizing a resource [Ep 6 · 0:19](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-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 6 · 0:19](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13886?t=19)
- Providers are generally comfortable screening for eating disorders — Lizzie Lee summarizing a resource [Ep 6 · 0:29](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-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 6 · 0:29](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13886?t=29)
- Clinicians report not being trained enough as a barrier to eating disorder diagnosis and management — Lizzie Lee summarizing a resource [Ep 6 · 0:39](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13886?t=39)
- Clinicians report not knowing how to manage eating disorders they find as a barrier — Lizzie Lee summarizing a resource [Ep 6 · 0:39](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13886?t=39)
- Clinicians report lacking clear treatment pathways for eating disorders as a barrier — Lizzie Lee summarizing a resource [Ep 6 · 0:39](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13886?t=39)
- Medical providers may need more training for diagnosis and treatment of eating disorders — Lizzie Lee summarizing a resource [Ep 6 · 0:47](https://library.globalcastmd.com/watch/identifying-managing-eating-disorders-in-pediatric-obesity-treatment-current-practices-in-weight-13886?t=47)
- Operating at lower degrees of obesity allows moving patients into a much healthier state — The host summarizing the discussion [Ep 1 · 2:27](https://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 1 · 3:05](https://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 1 · 15:24](https://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 1 · 20:20](https://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 2 · 10:38](https://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 2 · 11:10](https://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 2 · 12:00](https://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 2 · 16:44](https://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 2 · 37:49](https://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 2 · 50:13](https://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 2 · 50:22](https://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 2 · 50:50](https://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 2 · 56:18](https://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 2 · 57:18](https://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 2 · 57:58](https://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 2 · 58:32](https://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 2 · 60:21](https://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 2 · 63:07](https://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 2 · 67:22](https://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 2 · 67:34](https://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 2 · 68:04](https://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 2 · 73:55](https://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 2 · 74:16](https://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 2 · 78:55](https://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 2 · 79:12](https://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 2 · 79:36](https://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 7 · 39:51](https://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 8 · 4:00](https://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 8 · 4:30](https://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 8 · 22:30](https://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 8 · 23:10](https://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 8 · 23:30](https://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 8 · 24:10](https://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 8 · 25:10](https://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 10 · 25:11](https://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 10 · 27:39](https://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 10 · 28:17](https://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 10 · 37:59](https://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 12 · 20:00](https://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 12 · 20:30](https://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 12 · 21:00](https://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 12 · 21:30](https://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 12 · 23:00](https://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 12 · 23:30](https://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 12 · 24:00](https://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 12 · 24:30](https://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 12 · 22:00](https://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 12 · 22:30](https://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 11 · 9:58](https://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 11 · 28:22](https://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 11 · 28:22](https://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 11 · 28:22](https://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 14 · 1:38](https://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 14 · 2:24](https://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 14 · 14:27](https://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 14 · 19:09](https://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 16 · 4:00](https://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 16 · 4:30](https://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 16 · 8:10](https://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 16 · 9:20](https://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 16 · 10:00](https://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 16 · 28:00](https://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 16 · 29:30](https://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 16 · 29:50](https://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 16 · 30:50](https://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 16 · 31:20](https://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 16 · 32:00](https://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 16 · 32:20](https://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 16 · 32:50](https://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 16 · 33:40](https://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 16 · 35:00](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=2100)

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