From
StayCurrentMD
Treating pediatric obesity as a disease: medications, surgery, and health equity
With Dr. Justin Ryder
Chapter 1 of 5
Disease paradigm
Introduction and paradigm shift: obesity as a disease
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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 is a multifactorial disease impacted by a robust gene-environment interaction
Obesity is impacted 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 for adolescents with obesity is FDA labeled for those above the age of 12
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
Wagovi, 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
Weight regain factors are 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 a 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
There is significant variation across the country in how states are covering obesity medications in Medicaid programs