Managing Pediatric Obesity Using Advanced Therapies: Practical Guide for Pediatric Health Care Providers

ISBN-13: 9783031373794 / Angielski

Claudia K. Fox

Spis treści

• 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
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• 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)
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• 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)
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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)
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• Dietary Interventions, by Jessica Graumann, RD and Rachel Fog, RD

• Primary dietary recommendations
• Meal replacements
• Low-glycemic load diet
• Ketogenic diet
• Others
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• Physical Activity Interventions, by Carolyn Bramante, MD and Amanda Schaffran, DPT
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• 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)
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• 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)
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•   Psychological complications, by TBD
• a.       Depression
• b.       Anxiety
• c.        ADHD
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•  Behavioral Challenges, by Amy Gross, PhD
• a.       Common scenarios/issues
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• Type 2 Diabetes Mellitus, by Megan Oberle, MD
• Diagnosis (rule out T1DM)
• Management
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• Non-alcoholic Fatty Liver Disease, by TBD
• Diagnosis
• Management
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• Polycystic Ovary Syndrome, by Eric Bomberg, MD
• Diagnosis
• Management
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• Hypertension, by TBD (?Scott McEwan)
• Diagnosis
• Management
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• Precocious Puberty, by Eric Bomberg, MD
• Diagnosis
• Management
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• Dyslipidemia, by Julia Steinberger, MD

• Diagnosis
• Management

O autorze

 

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.

Blurb

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.