# Severe Obesity — GCMD Library living collection

Updated: n/a · 5 episodes · 106 cited statements

## Episodes
### Resources
- [Pharmacology: Pediatric Obesity 2017](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366) — video · 45:08 · [machine version](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366.md)
- [Adolescent Bariatric Surgery: Pediatric Obesity 2017](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371) — video · 32:47 · [machine version](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371.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)
- [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/pharmacology-pediatric-obesity-2017-366?t=0) Introduction and Speaker Presentation (Ep 1)
- [2:09](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=129) Why Consider Pharmacotherapy for Pediatric Obesity (Ep 1)
- [11:20](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=680) Limitations of Lifestyle Modification Therapy (Ep 1)
- [18:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1080) Biological Mechanisms of Obesity and Weight Regain (Ep 1)
- [25:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1500) FDA-Approved Medications: Orlistat and Phentermine (Ep 1)
- [32:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1920) Off-Label Medications and Future Directions (Ep 1)
- [37:50](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2270) Q&A: Long-term Use, Insurance Coverage, and Clinical Practice (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=0) Introduction and Study Overview (Ep 2)
- [4:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=240) Rationale for Aggressive Treatment and Mortality Risk (Ep 2)
- [8:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=480) Cincinnati FAS-5 Study Design and Retention (Ep 2)
- [13:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=780) FAS-5 Weight Loss Outcomes and BMI Trajectories (Ep 2)
- [17:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1020) Comorbidity Remission and Incidence Rates (Ep 2)
- [20:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1200) Residual BMI and Metabolic Harm (Ep 2)
- [23:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1380) Micronutrient Deficiencies in FAS-5 (Ep 2)
- [24:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1440) Swedish AMOS Study Design and Weight Outcomes (Ep 2)
- [28:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1680) AMOS Comorbidity Resolution and Complications (Ep 2)
- [30:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1800) Teen Labs Consortium: Current Status and Future Aims (Ep 2)
- [34:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=2040) Summary and Window of Opportunity (Ep 2)
- [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 3)
- [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 3)
- [7:00](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=420) Evolution of Evidence Base (Ep 3)
- [10:40](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=640) Consensus Guidelines Development History (Ep 3)
- [15:00](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=900) National Accreditation Standards (Ep 3)
- [18:20](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1100) Insurance Authorization Barriers (Ep 3)
- [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 3)
- [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 3)
- [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 3)
- [0:00](https://library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=0) Introduction and Framework for Obesity Tools (Ep 4)
- [7:00](https://library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=420) Conceptual Models: Spectrum and Pyramid Approaches (Ep 4)
- [15:00](https://library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=900) Prevention Tools: Community-Based Resources (Ep 4)
- [23:00](https://library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1380) Prevention-Plus Strategies: Collaboratives and Counseling (Ep 4)
- [30:00](https://library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=1800) Patient Education Materials and Digital Tools (Ep 4)
- [35:00](https://library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2100) Higher-Level and Tertiary Care Connections (Ep 4)
- [38:08](https://library.globalcastmd.com/watch/the-right-tool-for-the-job-child-adolescent-obesity-2015-870?t=2288) Q&A and Faculty Discussion (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=0) Introduction and Case Study: Barriers in Bariatric Care (Ep 5)
- [4:00](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=240) Epidemiology and Multifactorial Etiology of Childhood Obesity (Ep 5)
- [8:00](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=480) Comorbidities and Cardiovascular Risk in Obese Children (Ep 5)
- [12:00](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=720) AAP Algorithm and Multidisciplinary Weight Management (Ep 5)
- [17:00](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1020) Indications, Contraindications, and Surgical Procedures (Ep 5)
- [22:00](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=1320) Teen-LABS Study and Comorbidity Burden (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Of 12-year-olds with BMI at 99th percentile, all will grow up to have BMIs greater than 30, 88% will have BMIs greater than 35, and 2/3 will have class 3 obesity, according to the Bogalusa Heart Study. — Claudia Fox (epidemiological) [Ep 1 · 9:30](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=570)
- Severe obesity is defined as BMI greater than 1.2 times the 95th percentile. — Claudia Fox (guideline) [Ep 1 · 13:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=780)
- Only 2% of teenagers with severe obesity demonstrated clinically significant BMI reduction with lifestyle modification therapy. — Claudia Fox (clinical) [Ep 1 · 15:30](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=930)
- In a study comparing inpatient (6 months) versus outpatient lifestyle modification therapy followed for 2 years, there was no statistically significant difference in outcomes at 2 years despite better response during inpatient treatment. — Claudia Fox (clinical) [Ep 1 · 17:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1020)
- Mutations in the melanocortin 4 receptor (MC4R) account for the most common single gene mutation causing early onset severe obesity in pediatrics. — Claudia Fox (clinical) [Ep 1 · 21:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1260)
- Bupropion-naltrexone combination works by bupropion stimulating POMC cells to secrete alpha-MSH (which stimulates MC4 receptors to decrease hunger), while naltrexone blocks the auto-inhibitory feedback from beta-endorphin, allowing relatively more alpha-MSH activity. — Claudia Fox (clinical) [Ep 1 · 22:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1320)
- When people lose weight, they experience increased hunger, decreased satiety, increased preference for highly palatable foods, and increased metabolic efficiency—all promoting weight regain. — Claudia Fox (clinical) [Ep 1 · 28:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1680)
- Bariatric surgery is currently the most effective and durable treatment for severe obesity in adolescents. — Claudia Fox (clinical) [Ep 1 · 29:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1740)
- Orlistat is a lipase inhibitor that blocks absorption of about 30% of fat, is FDA approved for children 12 and older, and in the largest RCT of about 500 patients showed placebo-subtracted BMI difference of about 0.8 units at one year. — Claudia Fox (clinical) [Ep 1 · 30:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1800)
- Phentermine is FDA approved for age 16 and older (from 1950s approval), but there have been no RCTs in adolescents longer than 1 month duration. — Claudia Fox (clinical) [Ep 1 · 31:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1860)
- Among adults, phentermine produces mean weight loss of about 3.5 kg. — Claudia Fox (clinical) [Ep 1 · 31:30](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1890)
- In studies of adults on phentermine, there have been no withdrawal symptoms upon abruptly stopping and no reports of increased blood pressure, probably because patients are losing weight. — Claudia Fox (clinical) [Ep 1 · 32:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1920)
- In a chart review of 25 patients on phentermine only for 6 months plus lifestyle modification, compared to 274 receiving only lifestyle modification, there was about a 4% decrease in BMI favoring the phentermine group. — Claudia Fox (clinical) [Ep 1 · 33:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=1980)
- After many studies of metformin, we can expect about a one unit decrease in BMI. — Claudia Fox (clinical) [Ep 1 · 34:10](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2050)
- Liraglutide, a GLP-1 agonist, has recently been FDA approved for obesity in adults. — Claudia Fox (clinical) [Ep 1 · 34:40](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2080)
- In a pilot study of exenatide (GLP-1 agonist) with about 25 patients, during the first 3 months double-blinded portion, there was a placebo-subtracted effect of about 3% in BMI favoring the exenatide group. — Claudia Fox (clinical) [Ep 1 · 35:20](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2120)
- In a chart review of patients taking topiramate only (no other medications) with lifestyle modification therapy, there was about a 6% decrease in BMI at 6 months. — Claudia Fox (clinical) [Ep 1 · 36:30](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2190)
- In an RCT of topiramate 75mg/day after meal replacement induction phase, there was no statistically significant effect between topiramate and placebo groups by study end. — Claudia Fox (clinical) [Ep 1 · 37:10](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2230)
- Topiramate at 75mg/day was safe in adolescents, with extensive neurocognitive testing showing no signal of cognitive deficits. — Claudia Fox (clinical) [Ep 1 · 39:00](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2340)
- Topiramate is FDA approved down to age 2 for seizures and has been used in pediatrics for decades. — Claudia Fox (clinical) [Ep 1 · 38:50](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2330)
- Obesity is a chronic disease requiring indefinite medication treatment; stopping the medication results in weight regain, similar to stopping antihypertensive medication causing blood pressure to rise. — Claudia Fox (opinion) [Ep 1 · 40:50](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2450)
- Recently FDA-approved medications for adult obesity (age 18+) include topiramate-phentermine combination, liraglutide, naltrexone-bupropion combination, and lorcaserin, approved for BMI >30 or >27 with weight-related comorbidities. — Claudia Fox (clinical) [Ep 1 · 41:40](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2500)
- Early success in weight management predicts long-term weight loss success, according to adult literature. — Claudia Fox (clinical) [Ep 1 · 40:20](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2420)
- Bariatric surgery is seen as more acceptable than pharmacotherapy for pediatric obesity, despite being arguably riskier and irreversible. — Claudia Fox (opinion) [Ep 1 · 41:40](https://library.globalcastmd.com/watch/pharmacology-pediatric-obesity-2017-366?t=2500)
- FAS-5 study achieved 81% participation (58 of 74 eligible) at 8-year follow-up, mostly with in-person research visits. — Thomas Inge (clinical) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=480)
- At 8-year mean follow-up, gastric bypass patients had a mean BMI decline of 29%. — Thomas Inge (clinical) [Ep 2 · 13:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=780)
- Baseline BMI strongly correlates (R=0.75) with follow-up BMI: patients starting with BMI in the 60s end above 40, while those starting in the 40s reach near-normal BMI. — Thomas Inge (clinical) [Ep 2 · 15:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=900)
- Remission rates at 8 years: 88% for diabetes, 64% for dyslipidemia, 75% for hypertension. — Thomas Inge (clinical) [Ep 2 · 17:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1020)
- Among those without baseline comorbidities, incidence rates were 0% for diabetes, 50% for dyslipidemia (small denominator), and 3 of 29 developed hypertension. — Thomas Inge (clinical) [Ep 2 · 18:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1080)
- Follow-up BMI predicts probability of hypertension, dyslipidemia, high CRP, high insulin, insulin resistance, and low HDL; higher residual BMI is metabolically harmful. — Thomas Inge (clinical) [Ep 2 · 20:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1200)
- At 8 years, FAS-5 cohort showed low iron stores with anemia, elevated PTH, and low vitamin D in substantial numbers. — Thomas Inge (clinical) [Ep 2 · 23:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1380)
- AMOS had high internal hernia rates due to unclosed mesenteric defects at laparoscopic gastric bypass; closing defects prevents this complication. — Thomas Inge (clinical) [Ep 2 · 29:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1740)
- Teen Labs enrolled 242 adolescents (161 bypass, 67 sleeve, 14 band) at 5 centers; median age now 24, with 203 completing 5-year visits (72% in-clinic, 17% field). — Thomas Inge (clinical) [Ep 2 · 31:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1860)
- Adding 33 sleeve gastrectomy patients to Teen Labs will provide 80% power to compare bypass vs. sleeve for outcomes including blood pressure, PTH, HDL, and BMI. — Thomas Inge (clinical) [Ep 2 · 32:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1920)
- Severely obese patients have greater bone mineral density due to loading; rapid weight loss after bariatric surgery drops bone mass, raising the question of whether it stabilizes or continues to decline (bariatric bone disease). — Thomas Inge (clinical) [Ep 2 · 34:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=2040)
- Operating earlier after diagnosis of severe obesity may yield lower residual BMI and better long-term metabolic outcomes. — Thomas Inge (opinion) [Ep 2 · 32:47](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1967)
- FAS-5 study had a residual mean BMI of 38 at 8 years, with many patients remaining severely obese; this residual obesity is metabolically harmful. — Thomas Inge (clinical) [Ep 2 · 32:47](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1967)
- The 33 new sleeve patients can be enrolled within a year from consortium sites with ongoing clinical follow-up, enabling long-term comparisons. — Thomas Inge (clinical) [Ep 2 · 32:17](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1937)
- 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 27:22](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1642)
- 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 4 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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.
- Cardiovascular mortality begins to climb in the overweight range and increases definitively for adolescents at or above the 95th percentile BMI, leading to early cardiovascular death. — Thomas Inge summarizing a resource [Ep 2 · 4:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=240)
- In AMOS study, non-surgical controls with severe obesity gained weight over 5 years (BMI 42→45). — Thomas Inge summarizing a resource [Ep 2 · 25:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1500)
- AMOS gastric bypass patients had dramatic BMI reduction from 45 to 30, stable at 5 years, similar to adult controls and SOS cohort. — Thomas Inge summarizing a resource [Ep 2 · 26:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1560)
- AMOS showed 83% dyslipidemia remission, 12 of 12 hypertension cases resolved, and 75% inflammation (CRP) resolved. — Thomas Inge summarizing a resource [Ep 2 · 28:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1680)
- In AMOS, low vitamin D was found in >50% of gastric bypass patients and also in controls; low B12 and iron deficiency anemia were noted. — Thomas Inge summarizing a resource [Ep 2 · 30:00](https://library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1800)
- 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 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 3 · 25:10](https://library.globalcastmd.com/watch/aap-policy-for-adolescent-bariatric-surgery-pediatric-obesity-2017-372?t=1510)
- 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 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 5 · 35:00](https://library.globalcastmd.com/watch/obesity-advanced-practice-providers-1047?t=2100)

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