Pediatric Obesity Is a Disease: Treatment, Medications, Surgery & Equity in Care with Dr. Justin Ryder

Global Cat MD along with Anne and Robert H. Lurry Children's Hospital of Chicago, creating a healthier future for every child. Here at Laurie Children's, we are dedicated to the health and well-being of all children. Today we are joined by Doctor Justin Ryder, vice chair of research for the Department of Surgery at Anne and Robert H. Larry Children's Hospital of Chicago. And associate professor of surgery and pediatrics at Northwestern Feinberg School of Medicine. Dr. Ryder is a leading expert on pediatric obesity, a critical health issue affecting millions of children. The data clearly supports that obesity is a disease impacted by behavior. The big picture view is that it's a multifactorial disease impacted by a robust gene-environment interaction. And there are numerous factors at play, from genetics and epigenetics to appetite and satiety, hormone dysregulation, stress, economics, adverse life experiences, and environmental factors like calorically dense foods and sedentary lifestyles. Historically, the focus of obesity management was heavily on prevention. However, this perspective has shifted based on the newest guidelines. Historically, about 90% of our efforts over the past 50 years have been on prevention of childhood obesity. While prevention is important, the new AAP clinical practice guidelines represent a significant shift. They clearly state that obesity is a disease. The key takeaway is that the treatment should be offered to all children above the 85th percentile, and there should be no more watchful waiting. There are plenty of kids out there that deserve treatment. Here's a look at what the recommended approach to treatment looks like under these new guidelines. The guidelines clearly describe a non-linear continuum of care. It starts with intensive health, behavior, and lifestyle treatment, which should involve more than 26 contact hours over a 3 to 12-month period. For some adolescents, pharmacotherapy is an option. It's FDA labeled for those above the age of 12. Currently, there are 5 medications that are FDA approved for the treatment of adolescents with obesity. The third step on the continuum of care is bariatric surgery, which should be considered for those. Over the age of 13 years old, with a BMI 1.2 times the 95th percentile. As you can see, there are a variety of different treatment options. Now, let's dive into what the evidence shows regarding their effectiveness and some challenges that might be encountered when deciding on a treatment plan. We see promising results with various interventions, from medications like Wagovi, a GLP-1 receptor agonist, which causes about 17% weight loss and is FDA approved in adolescents. There are several medications in the pipeline as well. Data in adults on trazepetide shows significant change in body weight, compared to placebo. and oral GLP-1 medications are on the way in a few short years, with bariatric surgery studies show sustained weight loss in both adults and adolescent cohorts over several years. Looking at the difference for surgical types like Roin Yi gastric bypass and vertical sleeve gastrectomy, there's no difference. Between the groups in terms of percent BMI change from baseline over a 10-year period. However, there is significant heterogeneity in response, and weight regain is a significant problem. Bariatric surgery also produces substantial improvements in conditions that commonly occur with obesity, like hypertension, diabetes, and high lipids. Given the complex factors of pediatric obesity, what drives weight regain? Weight regain is driven by a complex interplay. It's a balance 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. These 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. Obesity is often associated with serious health conditions such as pediatric non-alcoholic fatty liver disease or metabolic dysfunction associated steatotic liver disease. How common are these and what should clinicians look out for? Metabolic dysfunction associated steatotic liver disease, or MASSL, is a major concern and the most prevalent pediatric liver disease. Obesity is a significant risk factor. About 20% of youth in the United States have obesity, which is roughly 15 million children. Of those, approximately 5 million have both obesity and mascle. The alarming statistic is that between 2,500,000 and a million of these children will progress to cirrhosis and needing a liver transplant or having hepatocellular carcinoma. There are also racial and ethnic differences in prevalence. Given the prevalence, severity, and impact on related conditions like obesity, There's a strong need for advocacy. There is indeed a critical need for advocacy. Obesity affects at least 35% of adults and 20% of children in Illinois alone, and the rates of severe forms of obesity are only increasing. It significantly increases the risk of long-term health problems and early death. The economic impact is also substantial, with reductions in GDP and increases in state spending. Crucially, we need to reiterate that obesity is a disease driven by biology and that it is no one's fault. Access to effective medications is a health equity issue. Obesity disproportionately affects people of color, those living in poverty, and individuals should have equal access to all treatments. Organizations like the Stop Obesity Alliance and many other organizations are working to analyze how states are covering obesity medications and Medicaid programs, and you can see a significant variation across the country. Pediatric obesity is a complex multifactorial disease, not just a behavioral issue. New guidelines advocate for treating all affected children with a continuum of care, including intensive lifestyle therapy, pharmacotherapy, and bariatric surgery. While treatments show promise, challenges like weight regain exist. The link to serious comorbidities like NAFLD MASLD is significant, necessitating treatment. Finally, there's a vital need for advocacy to ensure equitable access to treatment, recognizing that this is a disease driven by biology and not the patient's fault. Globalcast MD along with Anne and Robert H. Lurry Children's Hospital of Chicago, creating a healthier future for every child.