StayCurrentMD · Rapid Fire and Conclusion: Pediatric Obesity 2017
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Video23 min·Published Feb 2018Older

Rapid Fire and Conclusion: Pediatric Obesity 2017

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What the experts said20 expert statements · 4 host summaries
BMIs in the 40s will predictably achieve post-surgical BMIs less than 30
Clinical
Earlier intervention in bariatric surgery improves quality of life for patients
Clinical
Once BMI crosses 50 threshold, probability of mitigating risks associated with BMI 35+ becomes challenging
Clinical
Conversation about bariatric surgery should begin when BMI reaches mid-30s, especially with comorbidities
Opinion
At BMI 49, surgery may fail to get patients out of the severely obese category
Clinical
Topiramate and phentermine can be used as bridge therapy to buy time for patient maturity before surgery
Clinical
Medications can serve as bridge to surgery, primary therapeutic intervention, or post-surgical adjunct depending on patient needs
Clinical
Obesity is a heterogeneous disease requiring continuous treatment escalation based on individual patient response
Clinical
Medications should be initiated after 3-6 months in program when healthy living alone is insufficient to control disease
Guideline
Dexamphetamine has evidence base for hypothalamic obesity patients and may be needed pre- and post-surgery
Clinical
Hypothalamic obesity patients have biological drive to gain weight that defeats surgery, profoundly different from patients without brain injury
Clinical
Private insurers are limiting dietitian visits to 3 per year, inadequate for chronic disease management
Clinical
Taxing specific products like sugar will not have desired impact because obesity is not caused by sugar per se
Opinion
Most obese patients meet objective criteria for binge eating disorder when assessed with questionnaires, even without formal diagnosis
Epidemiological
Surgery is effective at extinguishing binge eating behaviors
Clinical
Prior binge eating disorder diagnosis may pose higher risk for relapse or weight regain long-term after surgery
Clinical
Disordered eating (restricting during day, overeating in evening) is present in many obese patients even without formal eating disorder diagnosis
Clinical
Rate of true diagnosable binge eating disorder in obese pediatric patients is under 5% when screened with diagnostic criteria
Epidemiological
Patients who develop fear of eating and severe restriction should be referred to eating disorders programs
Guideline
Disordered eating applies to nearly every obese patient, involving feelings and emotions around eating, food, and restricting, even without meeting DSM criteria
Clinical
Operating at lower degrees of obesity allows moving patients into a much healthier state
Host summary
Patients above BMI 55 have only about 14% probability of achieving BMI below 30 after surgery (data published by Tom in 2009)
Host summary
Sugar taxation decreases consumption and generates revenue (data shown by Gellibrano)
Host summary
Bariatric surgery demonstrates good resolution of binge eating disorder symptoms in adult literature (Jim Mitchell's work in LABS consortium)
Host summary