Province News

Lessons Learned from Pediatric Obesity Grand Round Talk

By Sheila Kun RN, BA, BSN, MS

You must be puzzled as to why I am sharing the highlights of this outstanding grand round, given by Dr. Alaine P. Vidmar, Medical Director, Obesity Medicine & Bariatric Surgery, Children’s Hospital of Los Angeles. I know most of the readers for InTouch are adults. You are right, the key points I am sharing below might not be specific to adults, but the general principles apply. And if you have children, grandchildren or work with children, you might be able to use this information. 

I was so impressed by the latest updated information on the topic of obesity of children and adolescents that I am capturing some of the key points that are still percolating in my brain. Let me do this with the bullet points:

  • Obesity is a chronic, but treatable, disease associated with excess weight.
  • Dr. Vidmar encouraged pediatricians to review the body mass index (BMI) with patients in every visit. 
  • BMI greater than or equal to 30 are usually considered to have obesity.
  • Seize the opportunity care providers have with their patients and join in attacking this chronic condition.
  • The prevalence of obesity in children is 15% of the population, but by 2050, it could be half of the population. (Sheila’s note: the prevalence in the U.S. is 2 out of 5 in the adult population.)
  • The stigma of excessive weight gain is real. However, one needs to understand that obesity is the result of multifactorial causes: how your brain regulates hunger and satiation, hormonal balance, and digestive issues. In addition, the home environment, the social economic environment and the external environment of a society contribute to the total picture. However, we are very quick to place blame on the individual or in a child’s case, the family. 
  • Obesity treatment is not just weight control or dieting. The American Pediatric Association offers efficacy and safety pharmacotherapy guidelines in youth. Hence, obesity pharmacotherapies are an appropriate treatment in youth.
  • Agent selection (what medicine to take) is multifactorial and often based on availability and patient preference. 
  • Common concerns from patients on medication: cardiac concerns (not common), dependency, long term use, pregnancy, cognitive dulling, kidney stones, and mood changes. Dr. Vidmar did suggest that medication complications are not common if monitored properly. The above concerns, however, need to be openly discussed to alleviate the fear and myths of being put on medication.
  • Bariatric surgery – weight loss surgery involving the stomach, intestine or both to produce weight loss, in the past, is viewed as the last resort to treatment. However, Dr. Vidmar suggested that for some severe cases, bariatric surgery might be offered even with the initial consultation. 
  • It is appropriate to combine with whatever level of lifestyle modification you can offer. In other words, if the patient is ready to accept changes in food choices, but not ready to completely embrace exercise or modification of the serving portion, just focus on the baby step positive changes. It is not easy to adhere to a “comprehensive” health plan all of a sudden.
  • Sheila’s note: Interesting comments on Metformin (which is one of the medications used for control of obesity. I include this information because many of us use Metformin for diabetes type II. Side effect profile: GI effects, Vitamin B 12 deficiency, Lactic acidosis (rare). Contraindications: severe renal dysfunction, acute or chronic metabolic acidosis. Obesity indication: insulin resistance, concurrent use of atypical antipsychotic agents. Cost, as you know, is very minimal. 

(Sheila’s note: this is especially true that in our enthusiasm, we insist on complete lifestyle changes without considering the adaptation one has to make. Weight reduction is not an easy task. We are reminded that how our body regulates food has a lot to do with one’s success. Hence, if they fail or regain weight, it is not a simple matter, nor is there a simple solution. The key is to be humble, honest and genuinely partner with those that you work with)

I hope this write up would give you some insight into how to work with children in general, but it can be extrapolated to adult care; the not judgmental attitude, the understanding of obesity as a chronic disease, the multi-factors that cause and impact treatment. Lastly, bariatric surgery is not the last sentence – the doctors have to work with the problems presented and treat accordingly. In other words, they don’t wait for you to fail diet management for 2 years to offer the surgery. In short, with an open mind, every specialty needs to work with the patient and his/her caregivers to improve on the outcome. 

Your homework from the Care Ministry this week: identify 3 main points in the treatment of obesity.Love to hear from you: kunlouis@gmail.com