Treatment of pediatric obesity, to date, has largely focused on lifestyle therapy. While lifestyle therapy is essential for obesity management, it is often insufficient, particularly for youth who have severe forms of the disease. Underlying the limitations of lifestyle therapy is the recognition that obesity is a biological disorder of the energy regulatory system and accordingly, to effectively manage obesity, the underpinning pathophysiology needs to be addressed. This pathophysiology can be targeted with more advanced therapies including anti-obesity medications and metabolic and bariatric…mehr
Treatment of pediatric obesity, to date, has largely focused on lifestyle therapy. While lifestyle therapy is essential for obesity management, it is often insufficient, particularly for youth who have severe forms of the disease. Underlying the limitations of lifestyle therapy is the recognition that obesity is a biological disorder of the energy regulatory system and accordingly, to effectively manage obesity, the underpinning pathophysiology needs to be addressed. This pathophysiology can be targeted with more advanced therapies including anti-obesity medications and metabolic and bariatric surgery, two treatment strategies supported by the American Academy of Pediatrics.
Written by leading experts in the field, A Practical Guide to Managing Pediatric Obesity is comprised of thirteen chapters, each including suggested protocols and case examples. The first chapter details the complex pathophysiology of obesity and sets the stage for why advanced therapies are critical for effective obesity management. Chapter two provides guidance on best practices for communicating with patients and families about obesity. The next three chapters provide direction on how to do a comprehensive patient assessment, and employ dietary and physical activity interventions. The heart of this guidebook is the chapter on pharmacological treatments, which details the mechanisms of action, research results, and recommendations for anti-obesity medication selection and monitoring outlined in a step-by-step fashion. Pre- and post-operative care for the pediatric bariatric surgery patient is detailed in the next chapter. Assessment and management of behavioral and psychological complications, type 2 diabetes, non-alcoholic fatty liver disease, polycystic ovary syndrome, hypertension, and dyslipidemia are covered in the subsequent five chapters. Syndromic and monogenic obesity are discussed in the final chapter.
Claudia K. Fox, M.D., M.P.H., FAAP, DABOM Associate Professor, Department of Pediatrics Co-Director, Center for Pediatric Obesity Medicine University of Minnesota, Medical School Minneapolis, MN, USA Claudia Fox, MD is an Associate Professor of Pediatrics and Co-Director of the Center for Pediatric Obesity Medicine at the University of Minnesota Medical School, where she earned her Medical Degree and Masters of Public Health degree. Dr. Fox is one of the first pediatricians to become board certified by the American Board of Obesity Medicine and is nationally and internationally recognized as an expert in the treatment of pediatric obesity. She is the medical director of the University of Minnesota Children's Hospital Pediatric Weight Management Program and is an accomplished researcher and educator in the field of pediatric obesity, particularly in the area of pharmacotherapy for pediatric obesity. Dr. Fox is the principle investigator and co-investigator of multiple NIH-funded clinical trials and co-directs the Pediatric Obesity Medicine Fellowship at the University of Minnesota.
Inhaltsangabe
Foreword, by Aaron Kelly, PhD
Description of the epidemiology of obesity in children and adolescents; ie the most common chronic disease of childhood
Importance of this book - need for practical guidance on how to treat children afflicted with obesity; state of the art recommendations from experts in the trenches; comprehensive approach including lifestyle therapy, pharmacotherapy, and bariatric surgery
Biology of Obesity, by Claudia Fox, MD
Critically important to understand the biology of obesity in order to provide effective, patient-centered treatment that addresses bias and stigma
Description of the pathophysiology of obesity, a chronic disease (Figure)
Patient education (Boxed)
Communication, Bias, and Stigma, by TBD
Language preferred by patients (Boxed)
Bias in healthcare and how to check your own bias
i. Parents' bringing their own experiences with bias to the clinic visit
ii. Challenges of parenting a child with obesity
Clinic setting and equipment (Boxed)
Assessment of the Pediatric Patient with Obesity, by TBD
History
i. Weight history
ii. Diet history
iii. Eating behaviours and questionnaires (Boxed)
iv. Physical activity
v. Sleep history
vi. Menstrual history
vii. Mental health history
viii. PMH
ix. Surgical history (T&A, Blounts)
x. Medications (Table)
xi. Family history
xii. Social history
xiii. Review of systems including screens for mental illness
Physical exam
i. BMI, definitions, and growth chart (Figure)
ii. Linear growth (Figure)
iii. Table of PE findings and diagnosis (Table)
iv. Body composition (bioelectrical impedance, skin-fold thickness)
v. Waist circumference
Labs
i. Standard
ii. Genetic evaluation
Metabolism
i. Indirect calorimetry
ii. MedGem
Case examples demonstrating heterogeneity of obesity (Boxed)
Dietary Interventions, by Jessica Graumann, RD and Rachel Fog, RD
Primary dietary recommendations
Meal replacements
Low-glycemic load diet
Ketogenic diet
Others
Physical Activity Interventions, by Carolyn Bramante, MD and Amanda Schaffran, DPT
Pharmacological Strategies, by Claudia Fox, MD
Indications
FDA-approved (Table) (for each medication include mechanism of action, data on outcomes, side effects, cost, protocol for use, patient selection, clinical pearls)
i. Orlistat
ii. Liraglutide
iii. Phentermine
iv. Setmelanotide
Non FDA-approved
i. Metformin
ii. Topiramate
iii. Bupropion+naltrexone
iv. Lisdexamfetamine (other stimulants)
Soon to be FDA-approved
i. Semaglutide
ii. Phentermine+topiramate ER
Goal of treatment
Case examples (Boxed)
Metabolic and Bariatric Surgery, by Sarah Raatz, MD
Description of the epidemiology of obesity in children and adolescents; ie the most common chronic disease of childhood
Importance of this book - need for practical guidance on how to treat children afflicted with obesity; state of the art recommendations from experts in the trenches; comprehensive approach including lifestyle therapy, pharmacotherapy, and bariatric surgery
Biology of Obesity, by Claudia Fox, MD
Critically important to understand the biology of obesity in order to provide effective, patient-centered treatment that addresses bias and stigma
Description of the pathophysiology of obesity, a chronic disease (Figure)
Patient education (Boxed)
Communication, Bias, and Stigma, by TBD
Language preferred by patients (Boxed)
Bias in healthcare and how to check your own bias
i. Parents' bringing their own experiences with bias to the clinic visit
ii. Challenges of parenting a child with obesity
Clinic setting and equipment (Boxed)
Assessment of the Pediatric Patient with Obesity, by TBD
History
i. Weight history
ii. Diet history
iii. Eating behaviours and questionnaires (Boxed)
iv. Physical activity
v. Sleep history
vi. Menstrual history
vii. Mental health history
viii. PMH
ix. Surgical history (T&A, Blounts)
x. Medications (Table)
xi. Family history
xii. Social history
xiii. Review of systems including screens for mental illness
Physical exam
i. BMI, definitions, and growth chart (Figure)
ii. Linear growth (Figure)
iii. Table of PE findings and diagnosis (Table)
iv. Body composition (bioelectrical impedance, skin-fold thickness)
v. Waist circumference
Labs
i. Standard
ii. Genetic evaluation
Metabolism
i. Indirect calorimetry
ii. MedGem
Case examples demonstrating heterogeneity of obesity (Boxed)
Dietary Interventions, by Jessica Graumann, RD and Rachel Fog, RD
Primary dietary recommendations
Meal replacements
Low-glycemic load diet
Ketogenic diet
Others
Physical Activity Interventions, by Carolyn Bramante, MD and Amanda Schaffran, DPT
Pharmacological Strategies, by Claudia Fox, MD
Indications
FDA-approved (Table) (for each medication include mechanism of action, data on outcomes, side effects, cost, protocol for use, patient selection, clinical pearls)
i. Orlistat
ii. Liraglutide
iii. Phentermine
iv. Setmelanotide
Non FDA-approved
i. Metformin
ii. Topiramate
iii. Bupropion+naltrexone
iv. Lisdexamfetamine (other stimulants)
Soon to be FDA-approved
i. Semaglutide
ii. Phentermine+topiramate ER
Goal of treatment
Case examples (Boxed)
Metabolic and Bariatric Surgery, by Sarah Raatz, MD
Pre-surgical evaluation
i. Eligibility (Table)
ii. Diet
iii. Psychology
iv. Physical therapy
b. Procedures (include outcomes and side effects)
i. Vertical sleeve gastrectomy
ii. Roux en Y gastric bypass
c. Post-operative care
i. Diet
ii. Supplements
iii. Labs
iv. Weight regain
d. Case examples (Boxed)
Psychological complications, by TBD
a. Depression
b. Anxiety
c. ADHD
Behavioral Challenges, by Amy Gross, PhD
a. Common scenarios/issues
Type 2 Diabetes Mellitus, by Megan Oberle, MD
Diagnosis (rule out T1DM)
Management
Non-alcoholic Fatty Liver Disease, by TBD
Diagnosis
Management
Polycystic Ovary Syndrome, by Eric Bomberg, MD
Diagnosis
Management
Hypertension, by TBD (?Scott McEwan)
Diagnosis
Management
Precocious Puberty, by Eric Bomberg, MD
Diagnosis
Management
Dyslipidemia, by Julia Steinberger, MD
Diagnosis
Management
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