# Type 2 Diabetes — GCMD Library living collection

Everything in the library about type 2 diabetes — built automatically from dossiers that name it.

Updated: n/a · 5 episodes · 135 cited statements

## Episodes
### Medical Management
- [Stephanie Walsh, MD - 2024 Pediatric Bariatric Surgery Update Course](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963) — video · 16:14 · [machine version](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963.md)

### Surgical Management
- [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)

### Evidence & Research
- [Thomas Inge, MD - 2024 Pediatric Bariatric Surgery Update Course](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962) — video · 18:22 · [machine version](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962.md)
- [Justin Ryder, MD- 2024 Pediatric Bariatric Surgery Update Course](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967) — video · 12:26 · [machine version](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967.md)

### Emerging & Future Directions
- [Evan Nadler, MD - 2024 Pediatric Bariatric Surgery Update Course](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966) — video · 29:40 · [machine version](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966.md)

## Chapters
- [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 1)
- [3:02](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=182) Non-Operative Weight Loss: Effectiveness and Limitations (Ep 1)
- [7:10](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=430) Patient Selection: Age, Comorbidities, and Timing (Ep 1)
- [9:46](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=586) Preoperative Process and Multidisciplinary Team Structure (Ep 1)
- [13:46](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=826) Insurance Coverage and Advocacy (Ep 1)
- [17:42](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1062) Contraindications and Special Populations (Ep 1)
- [19:44](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1184) Procedure Overview: Sleeve Gastrectomy vs. Gastric Bypass (Ep 1)
- [23:49](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1429) Sleeve Gastrectomy: Technical Steps and Variations (Ep 1)
- [29:03](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1743) Leak Prevention at the Gastroesophageal Junction (Ep 1)
- [33:20](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2000) Postoperative Diet Advancement (Ep 1)
- [34:55](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2095) Complications: Sleeve Gastrectomy (Ep 1)
- [37:47](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2267) Complications: Gastric Bypass (Ep 1)
- [38:50](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2330) Weight Loss Outcomes and Health Benefits (Ep 1)
- [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 1)
- [45:38](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2738) Current Research and Future Directions (Ep 1)
- [48:49](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2929) Closing Remarks (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=0) Introduction and Teen-LABS study design (Ep 2)
- [5:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=300) Weight loss outcomes and comorbidity remission in adolescents vs adults (Ep 2)
- [10:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=600) Alcohol use and mortality data (Ep 2)
- [15:50](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=950) Summary and clinical implications (Ep 2)
- [0:01](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=1) Introduction and defining adequate weight loss (Ep 3)
- [3:00](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=180) Lifestyle factors and physical activity (Ep 3)
- [7:00](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=420) Medication options and perioperative use (Ep 3)
- [11:06](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=666) GLP-1 dosing and practical challenges (Ep 3)
- [14:05](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=845) Protocols for medication initiation and earlier intervention (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=0) Introduction and Preteen Bariatric Surgery Data (Ep 4)
- [8:01](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=481) Insurance Approval and Medication Strategies for Young Patients (Ep 4)
- [15:11](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=911) Patients with Special Healthcare Needs (Ep 4)
- [21:14](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1274) Ethics and Special Populations (Ep 4)
- [27:31](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1651) Future Research Directions (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=0) Introduction of Justin Ryder (Ep 5)
- [0:18](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=18) Hot Topic 1: Heterogeneity in Bariatric Surgery Response (Ep 5)
- [4:00](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=240) Hot Topic 2: Comparing Surgery to Anti-Obesity Medications (Ep 5)
- [6:20](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=380) Hot Topic 3: Mechanistic Studies in Adolescents (Ep 5)
- [8:16](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=496) Discussion: Trial Design and Diversity (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Type 2 diabetes, previously called adult-onset diabetes, is now seen in children and teenagers as a complication of obesity." — Marc Harmon (epidemiological) [Ep 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 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 1 · 45:59](https://library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2759)
- "Teen Labs 10-year latent class analysis identified four phenotypes of bariatric surgery responders." — Justin Ryder (clinical) [Ep 5 · 0:54](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=54)
- "Superior responders (18% of cohort) lost about 45% of weight at nadir and maintained that loss out to 10 years." — Justin Ryder (clinical) [Ep 5 · 1:30](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=90)
- "A second group lost about 35% at nadir and kept over 25% off at 10 years." — Justin Ryder (clinical) [Ep 5 · 2:00](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=120)
- "A third group (one-third of cohort) had 12% BMI change at 10 years, comparable to semaglutide's mean response in adolescents at 1 year." — Justin Ryder (clinical) [Ep 5 · 2:20](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=140)
- "Non-responders (red group) did not lose ideal weight, returned to baseline by 4 years, and overshot their starting weight." — Justin Ryder (clinical) [Ep 5 · 3:00](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=180)
- "In Teen Labs, the only predictor of 10-year weight change was 6-month weight loss; no demographic, clinical, or social determinant factors predicted response." — Justin Ryder (clinical) [Ep 5 · 3:30](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=210)
- "Teen Labs shows no difference in outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy at 10 years." — Justin Ryder (clinical) [Ep 5 · 4:30](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=270)
- "At 2 years, weight loss is about 30% in both sleeve gastrectomy and Roux-en-Y gastric bypass." — Justin Ryder (clinical) [Ep 5 · 5:00](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=300)
- "Tirzepatide (Eli Lilly's dual GLP-1/GIP receptor agonist) shows 25% weight loss at 72 weeks, similar to surgery at 2 years." — Justin Ryder (clinical) [Ep 5 · 5:20](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=320)
- "Randomized trials of surgery versus medications are now ethically feasible because newer AOMs have potential for comparable benefit." — Justin Ryder (opinion) [Ep 5 · 5:50](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=350)
- "Bariatric surgery will continue to receive a grade of C from policymakers until randomized trials versus alternative therapies are conducted." — Justin Ryder (opinion) [Ep 5 · 5:40](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=340)
- "Bariatric surgery is more effective in adolescents than adults, and this cannot be explained solely by duration of disease." — Justin Ryder (clinical) [Ep 5 · 6:50](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=410)
- "Remission of type 2 diabetes in adolescents versus adults after bariatric surgery highlights the need for mechanistic studies." — Justin Ryder (opinion) [Ep 5 · 7:20](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=440)
- "Mechanistic studies examining genetics, proteins, and metabolites may identify super-responders and guide combination therapies." — Justin Ryder (opinion) [Ep 5 · 7:40](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=460)
- "Oncology colleagues used genetics for precision medicine 30 years ago, and it took 20-30 years for patient impact." (clinical) [Ep 5 · 9:50](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=590)
- "Genetics should be evaluated on a large scale to identify preoperative predictors of bariatric surgery response." (opinion) [Ep 5 · 10:10](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=610)
- "Metabolic pathways perturbed by obesity are relevant to treatment response and may not have genetic origins." (opinion) [Ep 5 · 10:30](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=630)
- "Tirzepatide and semaglutide drug trials are approximately 70% white and not conducted in urban settings." (epidemiological) [Ep 5 · 11:00](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=660)
- "Real-world AOM efficacy in urban, predominantly Black and Hispanic populations does not match published trial results." (opinion) [Ep 5 · 11:20](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=680)
- "Clinical trial diversity is abysmal, and drug companies prioritize timeline over quality in enrollment." — Justin Ryder (opinion) [Ep 5 · 11:50](https://library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=710)
- "Pediatric bariatric surgeons treat approximately 0.05% of children who need surgery, well below adult treatment rates" — Evan Nadler (epidemiological) [Ep 4 · 0:34](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=34)
- "MBSAQIP requirements for verified surgeon at freestanding children's hospital: 100 lifetime cases (75 can be as fellow) and 20 stapled cases per year" — Evan Nadler (guideline) [Ep 4 · 3:20](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=200)
- "In MBSAQIP database of approximately 4800 teens, only about 50 are preteens" — Evan Nadler (epidemiological) [Ep 4 · 5:20](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=320)
- "Preteens undergoing bariatric surgery have higher rates of insulin-dependent diabetes and sleep apnea compared to teens, indicating they are sicker pre-operatively" — Evan Nadler (clinical) [Ep 4 · 5:40](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=340)
- "Safety outcomes in preteens were the same or better than teens in MBSAQIP data" — Evan Nadler (clinical) [Ep 4 · 6:20](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=380)
- "Nadler's youngest bariatric surgery patients were two 4-year-olds: one homozygous for MC4R receptor deficiency and one with Rohhad syndrome" — Evan Nadler (clinical) [Ep 4 · 7:10](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=430)
- "Using BMI percentiles instead of absolute BMI values can help with insurance approval by confusing reviewers who then focus on comorbidities like diabetes" — Evan Nadler (clinical) [Ep 4 · 7:40](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=460)
- "In the DC area, most Medicaid programs have removed age cutoffs for bariatric surgery after years of education efforts" — Evan Nadler (guideline) [Ep 4 · 8:40](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=520)
- "Insurance companies often defer to specialist clinicians for rare cases when clinical justification is provided" — Mark (opinion) [Ep 4 · 9:10](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=550)
- "The ideal age to operate may be between 12 and 14 years because these children still listen to parents and are developing habits" — Mark (opinion) [Ep 4 · 10:30](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=630)
- "Operating on 10-11 year olds may be even better because going through puberty at normal or lower weight is beneficial physically and mentally, and younger children have less independent access to food" — Evan Nadler (opinion) [Ep 4 · 10:44](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=644)
- "Off-label use of medications including Vyvanse, phentermine, topiramate, and GLP-1 agonists has been standard practice for years in young patients because the disease needs treatment" — Evan Nadler (clinical) [Ep 4 · 11:21](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=681)
- "Medications may be no safer than surgery, with less long-term data in children, similar gallstone risk, and higher weight regain due to medication discontinuation" — Evan Nadler (opinion) [Ep 4 · 13:13](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=793)
- "Treating hyperphagia early with medications like ADD drugs can prevent children from becoming heavier, even if it doesn't prevent surgery later" — Mark (clinical) [Ep 4 · 13:56](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=836)
- "Phentermine has less addictive properties than ADD medications" — Evan Nadler (clinical) [Ep 4 · 14:50](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=890)
- "Younger patients prepared in non-surgical weight management clinics before surgery show better compliance and have mental health issues addressed in a timely manner" — Mark (clinical) [Ep 4 · 15:11](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=911)
- "Epic real-world data showed that a large number of patients after GLP-1 cessation do not regain their weight" — Evan Nadler (host_summary) [Ep 4 · 15:58](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=958)
- "Approximately 50% of bariatric surgery patients do well long-term without additional interventions, while 50% have poor outcomes" — Evan Nadler (host_summary) [Ep 4 · 16:40](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1000)
- "Study of 490 patients from 2018-2022 included 34 with special healthcare needs: autism spectrum disorder, intellectual/developmental disabilities, Trisomy 21, and Prader-Willi syndrome" — Evan Nadler (epidemiological) [Ep 4 · 19:10](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1150)
- "Patients with special healthcare needs lost weight after bariatric surgery, though not quite as much as neurotypical patients" — Evan Nadler (clinical) [Ep 4 · 20:00](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1200)
- "When separated, autism spectrum disorder patients (n=16) appeared to do better than intellectual/developmental disability patients (n=13), though only 6-month excess weight loss was statistically significant" — Evan Nadler (clinical) [Ep 4 · 20:30](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1230)
- "Autism spectrum disorder patients may do better partly because more are male (males tend to have better bariatric surgery outcomes) and because some have highly structured routines and follow post-operative rules strictly" — Evan Nadler (opinion) [Ep 4 · 20:30](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1230)
- "Patients with autism spectrum disorder and selective eating often do better after surgery because post-operative requirements (protein, water, multivitamin) fit their need for structured eating patterns" — Evan Nadler (clinical) [Ep 4 · 23:41](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1421)
- "Some patients with special healthcare needs had parents who could barely care for them, and surgery made care easier rather than harder" — Evan Nadler (clinical) [Ep 4 · 23:41](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1421)
- "Prader-Willi patients do not do as well with bariatric surgery but still do better than without surgery" — Evan Nadler (clinical) [Ep 4 · 25:38](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1538)
- "Syndromic genetic obesity patients need everything: medications, surgery, and continued medications post-operatively" — Mark (opinion) [Ep 4 · 25:48](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1548)
- "For Prader-Willi syndrome, biliopancreatic diversion may be the best operation according to Steve Myers's paper, though not ideal for young children" — Mark (host_summary) [Ep 4 · 26:10](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1570)
- "One bariatric surgery operation costs approximately $50,000, equivalent to 3-4 years of GLP-1 agonist therapy at current prices" — Evan Nadler (epidemiological) [Ep 4 · 28:58](https://library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1738)
- "The top group of patients at 10 years post-op is doing much worse, while another group is only down 12% weight loss." — Stephanie Walsh (host_summary) [Ep 3 · 1:30](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=90)
- "Physical activity for girls is always lower than boys, and physical activity for kids is predominantly influenced by their moms." — Stephanie Walsh (epidemiological) [Ep 3 · 4:40](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=280)
- "Physical activity impacts mental health." — Stephanie Walsh (clinical) [Ep 3 · 5:10](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=310)
- "Bupropion post-op helps with mood and gives patients extra support toward weight loss, though patients are supposed to be 18." — Stephanie Walsh (clinical) [Ep 3 · 5:50](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=350)
- "Tom's unpublished study on phentermine and topiramate post-op included approximately 12 kids and showed improvement." — Stephanie Walsh (host_summary) [Ep 3 · 8:00](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=480)
- "Evan's unpublished study shows kids who lose weight lose weight with meds as well, with improvements across groups." — Stephanie Walsh (host_summary) [Ep 3 · 9:00](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=540)
- "In Atlanta, phentermine is only available in 15 mg capsule form, which cannot be broken in half." — Stephanie Walsh (clinical) [Ep 3 · 10:00](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=600)
- "There is significant medication hesitancy among families in Atlanta." — Stephanie Walsh (opinion) [Ep 3 · 10:40](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=640)
- "Novo Nordisk is sending out the 1.7 and 2.4 mg doses but very little of the lower doses, prioritizing people already on maintenance." — Stephanie Walsh (clinical) [Ep 3 · 11:20](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=680)
- "Some patients do really well at 1.7 mg GLP-1 but not necessarily as well at 2.4 mg." (clinical) [Ep 3 · 12:00](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=720)
- "As of last year, 1.7 mg is considered a maintenance dose, so there should be less issue with insurers covering it." — Stephanie Walsh (guideline) [Ep 3 · 12:40](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=760)
- "The lowest effective and tolerable dose should be used for each patient, and ramp-up should be individualized." — Stephanie Walsh (opinion) [Ep 3 · 13:00](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=780)
- "Medications are offered at 3 months for less than 10% total body weight loss and at 6 months for less than 15%." — Stephanie Walsh (clinical) [Ep 3 · 14:10](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=850)
- "These thresholds (10% at 3 months, 15% at 6 months) are very conservative given the Teen-LABS data." — Stephanie Walsh (opinion) [Ep 3 · 14:25](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=865)
- "In a cohort of 750 patients, modeling shows that if a patient is off the weight loss curve at 3 months, they never get back on that curve." — Stephanie Walsh (clinical) [Ep 3 · 14:40](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=880)
- "A cohort of patients did not get satiety from their sleeve despite the same amount of resection each time." — Stephanie Walsh (clinical) [Ep 3 · 15:00](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=900)
- "Patients without satiety are started on Vyvanse at 2 weeks post-op." — Stephanie Walsh (clinical) [Ep 3 · 15:15](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=915)
- "Studies looking at 6 months or later time points for medication initiation are way too late; the data strongly suggest starting earlier and being more aggressive." — Stephanie Walsh (opinion) [Ep 3 · 15:25](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=925)
- "With type 2 diabetes, there is no reason to wait for a BMI of 35 arbitrarily because diabetes is not going to get better at a BMI of 32." (opinion) [Ep 3 · 15:50](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=950)
- "The longer patients are on insulin, the less likely you are to help their diabetes." — Stephanie Walsh (clinical) [Ep 3 · 16:05](https://library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=965)
- "In the Children's Hospital Association database from 2010 to 2022, sleeve gastrectomy has become the dominant procedure and very few bypasses are being done in 2022." — Thomas Inge (epidemiological) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=0)
- "Teen-LABS is a multi-institutional longitudinal study of 242 adolescent bariatric surgery subjects with assessment preoperatively and at time points postoperatively, now in its 17th year of NIH funding with 85% retention (219 of 242 still active)." — Thomas Inge (epidemiological) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=0)
- "Teen-LABS recruited approximately 160 gastric bypasses and 100 sleeve gastrectomies." — Thomas Inge (epidemiological) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=0)
- "Weight loss after gastric bypass is equivalent in teenagers and adults at approximately 26-29% at 5 years." — Thomas Inge (clinical) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=300)
- "At 5 years post-gastric bypass, 86% of teenagers achieved diabetes remission compared to 53% of adults." — Thomas Inge (clinical) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=300)
- "At 5 years post-gastric bypass, 68% of teenagers achieved hypertension remission compared to 41% of adults." — Thomas Inge (clinical) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=300)
- "Meta-analysis of multiple pediatric bariatric cohorts (AMOS from Sweden, FBS-5 from Cincinnati, studies from Saudi Arabia and Miami) with follow-up of 5-14 years shows hypertension remission rates of 58-100%, type 2 diabetes remission rates of 72-100%, and reversal of dyslipidemia, renal dysfunction, and liver dysfunction." — Thomas Inge (clinical) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=300)
- "In Teen-LABS, percent BMI change shows nadir at 1 year of approximately 33% reduction, with very gentle increase over time to 21% average reduction at 10 years, but with significant heterogeneity." — Thomas Inge (clinical) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=300)
- "Latent class modeling of Teen-LABS 10-year weight outcomes identifies distinct groups: approximately 11% with weight gain, approximately 20% with 44% weight loss, and groups in between." — Thomas Inge (clinical) [Ep 2 · 5:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=300)
- "By 8 years post-surgery in Teen-LABS, a minority of patients have not had experience with alcohol, and most have had some experience." — Thomas Inge (epidemiological) [Ep 2 · 10:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=600)
- "The cumulative incidence of alcohol-related problems by 8.5 years post-surgery approaches half of patients in both sleeve and bypass groups." — Thomas Inge (epidemiological) [Ep 2 · 10:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=600)
- "The pharmacokinetics of alcohol are much faster (hitting the system more rapidly) after gastric bypass and probably sleeve gastrectomy as well." — Thomas Inge (clinical) [Ep 2 · 10:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=600)
- "When compared to previously published normative data, Teen-LABS patients adopt alcohol use later and at lower frequency than normal-weight controls." — Thomas Inge (epidemiological) [Ep 2 · 10:16](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=616)
- "Fourteen deaths occurred in the Teen-LABS cohort, with the first death at 3.3 years post-surgery and others occurring at 7, 10, and 14 years post-surgery." — Thomas Inge (epidemiological) [Ep 2 · 10:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=600)
- "A number of the Teen-LABS deaths were associated with multi-substance use, though this data is not yet published." — Thomas Inge (epidemiological) [Ep 2 · 10:00](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=600)
- "Preliminary comparison to an 81-patient cohort of severely obese teenagers who did not undergo surgery (recruited by Meg Zeller in Cincinnati) suggests that 10-year mortality may be a signal of severe obesity in teenage years rather than surgery itself." — Thomas Inge (opinion) [Ep 2 · 16:35](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=995)
- "For sleeve gastrectomy, an anatomy-based approach (avoiding leaving a pouch at the top and avoiding a dumbbell-shaped stomach) is recommended to prevent reflux." — Thomas Inge (opinion) [Ep 2 · 15:50](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=950)
- "Micronutrient supplementation after bariatric surgery should be taken like medicines, not like supplements, and this should be emphasized preoperatively and postoperatively." — Thomas Inge (guideline) [Ep 2 · 15:50](https://library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=950)

## Changelog
- Sep 25: 5 items added automatically

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