Pediatric Obesity Is a Disease: Treatment, Medications, Surgery & Equity in Care with Dr. Justin Ryder
With Dr. Justin Ryder · StayCurrentMD
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Obesity is a disease impacted by behavior and represents a multifactorial disease impacted by a robust gene-environment interaction.
Obesity is influenced by numerous factors including genetics, epigenetics, appetite and satiety hormone dysregulation, stress, economics, adverse life experiences, and environmental factors like calorically dense foods and sedentary lifestyles.
Historically, about 90% of efforts over the past 50 years have been on prevention of childhood obesity.
The new AAP clinical practice guidelines clearly state that obesity is a disease.
Treatment should be offered to all children above the 85th percentile, and there should be no more watchful waiting.
The guidelines describe a non-linear continuum of care starting with intensive health, behavior, and lifestyle treatment involving more than 26 contact hours over a 3 to 12-month period.
Pharmacotherapy is FDA labeled for adolescents above the age of 12.
Currently, there are 5 medications that are FDA approved for the treatment of adolescents with obesity.
Bariatric surgery should be considered for those over the age of 13 years old with a BMI 1.2 times the 95th percentile.
Wegovy, a GLP-1 receptor agonist, causes about 17% weight loss and is FDA approved in adolescents.
Data in adults on tirzepatide shows significant change in body weight compared to placebo.
Oral GLP-1 medications are on the way in a few short years.
Bariatric surgery studies show sustained weight loss in both adults and adolescent cohorts over several years.
There is no difference between Roux-en-Y gastric bypass and vertical sleeve gastrectomy in terms of percent BMI change from baseline over a 10-year period.
There is significant heterogeneity in response to bariatric surgery, and weight regain is a significant problem.
Bariatric surgery produces substantial improvements in conditions that commonly occur with obesity, like hypertension, diabetes, and high lipids.
Weight regain is driven by a complex interplay between behaviors like physical activity and energy intake, and biological factors like energy expenditure and appetite and satiety hormones that regulate how full you feel.
Weight regain factors are all influenced by genetics and the environment, including puberty, race, and socioeconomic status.
It is much easier to lose weight than to keep it off, which is demonstrated across many studies.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent pediatric liver disease.
Obesity is a significant risk factor for MASLD.
About 20% of youth in the United States have obesity, which is roughly 15 million children.
Approximately 5 million children have both obesity and MASLD.
Between 250,000 and 1 million children with obesity and MASLD will progress to cirrhosis and needing a liver transplant or having hepatocellular carcinoma.
There are racial and ethnic differences in MASLD prevalence.
Obesity affects at least 35% of adults and 20% of children in Illinois alone.
The rates of severe forms of obesity are only increasing.
Obesity significantly increases the risk of long-term health problems and early death.
The economic impact of obesity is substantial, with reductions in GDP and increases in state spending.
Obesity is a disease driven by biology and it is no one's fault.
Access to effective obesity medications is a health equity issue.
Obesity disproportionately affects people of color and those living in poverty.
Organizations like the Stop Obesity Alliance are working to analyze how states are covering obesity medications in Medicaid programs, and there is significant variation across the country.