Episode 127: Obesity Update and Uterine Cancer

Saakshi presents some updates on the treatment of obesity in pediatric patients. Wendy explains a recent study connecting hair iron to uterine cancer. 

Updates on obesity management in pediatric patients.
Written by Saakshi Dulani, MS3, Western University College of Osteopathic Medicine of the Pacific. Edited by Hector Arreaza, MD.

Background information:

The American Academy of Pediatrics has released new guidelines on obesity management in pediatric patients. This is the first update regarding childhood obesity in 15 years. According to the CDC, the rates of childhood obesity have tripled since the 1980s, and as of now, 1 in every 5 children suffers from obesity in the United States. It is important to recognize obesity is a chronic, multifaceted disease that comes with its own set of complications, such as type 2 diabetes mellitus, high blood pressure, asthma, sleep apnea, heart disease, and various mental and psychosocial health issues. 

The first-line treatment used to be comprised of behavioral health and lifestyle counseling, however, now, 1st line treatment for pediatric patients includes medications and surgery in addition to the previously suggested counseling. This is because research has shown that diet and level of physical activity are not the only factors that determine weight but also include genes, hormones, and metabolism. Similar to many other chronic diseases, the sooner the treatment is started, the better. There has been no benefit shown in waiting for adulthood to treat obesity. 

Who qualifies for which treatments?

As a reminder, in the pediatric population, we use the BMI percentiles instead of the absolute number for BMI. Overweight is defined as BMI between 85-95th for patients of the same gender and age. Obesity is defined as being above the 95th percentile.

Four drugs are now approved for obesity treatment in adolescents starting at age 12, which are Saxenda® (liraglutide), Qsymia® (phentermine-topiramate), Wegovy® (semaglutide), and Xenical® or Alli® (orlistat). Phentermine as monotherapy has been approved for teens aged 16 and older. Another drug called Imcivree® has been approved for children 6 and older affected by Bardet-Biedl syndrome. The problem with medications is that they are not available to everyone due to the cost, and there are many shortages occurring due to the high demand for these drugs. 

Surgical options:

This is a MAJOR change in the recommendations for obesity treatment in children.  The new guidelines recommend discussing SURGERY with patients that are 13 years old and have severe obesity. It has been shown that bariatric surgery provides lasting results but also that it can reverse health issues such as type 2 diabetes mellitus and hypertension. It is exciting that more research is being done to provide us with more evidence regarding the treatment of obesity in children. Obesity treatment is challenging, even more so in children. So, we encourage all listeners to review the new guidelines about the use of medications and surgery to treat obesity in children and put them to practice if appropriate for your patients.

____________________________

You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.

____________________________

Hair products and uterine cancer.
Written by Wendy Collins, MS3, Ross University School of Medicine. Edited by Hector Arreaza, MD.

What is the sister study? 

The Sister Study i