OFFICE-BASED MANAGMENT OF PEDIATRIC OBESITY William J. Klish, M.D. Professor of Pediatrics Baylor College of Medicine
Most logical approach to controlling the obesity epidemic Prevention
However for the average practicing pediatrician treatment and prevention must go together
Treatment Options available to the Pediatrician <ul><li>Weight Loss Drugs </li></ul><ul><li>Bariatric Surgery </li></ul><u...
OBESITY TREATMENT Generic Name Trade Name Dexfenfluramine* Redux Diethylpropion Tenuate Fenfluramine* Podimin Mazindol San...
Treatment of Adolescent Obesity with Orlistat <ul><li>1 year double-blind  placebo controlled study </li></ul><ul><li>29 p...
Treatment of Adolescent Obesity with Sibutramine <ul><li>1 year double-blind  placebo controlled study  </li></ul><ul><li>...
SURGICAL THERAPY  <ul><ul><li>Only Recommended in   Selected Adult Patients </li></ul></ul><ul><ul><li>  BMI  >  40 or wit...
Roux-en-Y GBP Current Status of Medical and Surgical Therapy for Obesity Gastroenterology Vol.120, No.3 Restrictive bariat...
Adjustable gastric banding Current Status of Medical and Surgical Therapy for Obesity Gastroenterology Vol.120, No.3 Restr...
ONLY ACCEPTED WEIGHT LOSS THERAPY FOR CHILDREN <ul><ul><li>Diet </li></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul...
Behavioral treatment is more effective in children than in adults Epstein, et.al., JAMA, 1995 Kids are not just “little” a...
Medical Treatment of Obesity Success limited !!
A WEIGH OF LIFE Total number of patients 468 Number completing info packet    83 (18%) Number completing interview only   ...
A WEIGH OF LIFE Change in % IBW (all completers) -23.5+16.1 (average sessions - 18.3) Success rate for completers 98% Chan...
OFFICE BASED PRIMARY PREVENTION PROGRAM
<ul><li>If BMI is normal   </li></ul><ul><li>Patient and parents should be congratulated!  </li></ul>Recommendations Patie...
<ul><li>If patient is crossing BMI percentiles </li></ul><ul><li>The parents should be warned about the potential for obes...
 
 
 
<ul><li>If BMI is > 85 th  percentile   </li></ul><ul><li>Patients and their parents should be told they are overweight </...
 
<ul><li>If BMI is > 95 th  percentile   </li></ul><ul><li>Patients and their parents should be told they are obese </li></...
RECOMENDATIONS  ex: Parks and Recreation Programs School Based Programs Child Oriented Weight Loss Programs Become   aware...
OUTCOMES DATA IS NEEDED!
 
 
 
Upcoming SlideShare
Loading in...5
×

Office-based Management of Pediatric Obesity

716

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
716
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
12
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • Weight loss effect of Sibutramine is also modest and side effects are significant.
  • Two Bariatric procedures are being tried in children. The first is the Gastric Bypass as shown in this slide and the other is the Adjustable Gastric Band as shown in the next slide. Data is being accumulated to determine efficacy and safety for both of these procedures in children.
  • This shows the adjustable gastric band.
  • The only recommended weight loss therapy in children is diet, exercise, and behavior modification.
  • Behavioral therapy is more effective in children than adults as shown by Len Epstein.
  • Office-based Management of Pediatric Obesity

    1. 1. OFFICE-BASED MANAGMENT OF PEDIATRIC OBESITY William J. Klish, M.D. Professor of Pediatrics Baylor College of Medicine
    2. 2. Most logical approach to controlling the obesity epidemic Prevention
    3. 3. However for the average practicing pediatrician treatment and prevention must go together
    4. 4. Treatment Options available to the Pediatrician <ul><li>Weight Loss Drugs </li></ul><ul><li>Bariatric Surgery </li></ul><ul><li>Behavior Modification </li></ul>
    5. 5. OBESITY TREATMENT Generic Name Trade Name Dexfenfluramine* Redux Diethylpropion Tenuate Fenfluramine* Podimin Mazindol Sanorex, Mazanor Phendimetrazine Bontul, Plagine, Prelu-2,X-Trozine lonamin, Adipex-2 Phentermine* Fastin, Oby-trim Sibutramine Meridia *Recalled by the FDA Lipase Inhibitor Orlistat Xenacal Appetite Suppressants
    6. 6. Treatment of Adolescent Obesity with Orlistat <ul><li>1 year double-blind placebo controlled study </li></ul><ul><li>29 patients of a total of 150 studied by us </li></ul><ul><li>Orlistat group lost 2.8 kg </li></ul><ul><li>Placebo group lost 1.5 kg </li></ul><ul><li>Major side effect: oil leakage </li></ul>
    7. 7. Treatment of Adolescent Obesity with Sibutramine <ul><li>1 year double-blind placebo controlled study </li></ul><ul><li>82 adolescents (13-17 yrs of age) </li></ul><ul><li>Sibutramine group had 6.8% reduction in BMI </li></ul><ul><li>Placebo group had 5.4% reduction in BMI </li></ul><ul><li>Drug reduced in 23 subjects and discontinued in 10 due to side effects. </li></ul><ul><li>Side effects included increase blood pressure and increased pulse rate. </li></ul>Berkowitz et al, JAMA 2003;Apr 9:289(14)
    8. 8. SURGICAL THERAPY <ul><ul><li>Only Recommended in Selected Adult Patients </li></ul></ul><ul><ul><li> BMI > 40 or with Co-morbid Conditions </li></ul></ul><ul><ul><li>Very Little Experience in Children </li></ul></ul><ul><ul><li> National Collaborative Study is on-going </li></ul></ul>
    9. 9. Roux-en-Y GBP Current Status of Medical and Surgical Therapy for Obesity Gastroenterology Vol.120, No.3 Restrictive bariatric procedures
    10. 10. Adjustable gastric banding Current Status of Medical and Surgical Therapy for Obesity Gastroenterology Vol.120, No.3 Restrictive bariatric procedures
    11. 11. ONLY ACCEPTED WEIGHT LOSS THERAPY FOR CHILDREN <ul><ul><li>Diet </li></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><li>Behavior Modification </li></ul></ul>
    12. 12. Behavioral treatment is more effective in children than in adults Epstein, et.al., JAMA, 1995 Kids are not just “little” adults!
    13. 13. Medical Treatment of Obesity Success limited !!
    14. 14. A WEIGH OF LIFE Total number of patients 468 Number completing info packet 83 (18%) Number completing interview only 53 (11%) Number starting program 332 (71%) Number finishing program 92 (20%) OUTCOME (ONE YEAR STUDY)
    15. 15. A WEIGH OF LIFE Change in % IBW (all completers) -23.5+16.1 (average sessions - 18.3) Success rate for completers 98% Change in % IBW (all starters) -11.2+16 (average sessions - 9.34) OUTCOME (ONE YEAR STUDY)
    16. 16. OFFICE BASED PRIMARY PREVENTION PROGRAM
    17. 17. <ul><li>If BMI is normal </li></ul><ul><li>Patient and parents should be congratulated! </li></ul>Recommendations Patients should get Ht and Wt measured and BMI calculated at least yearly
    18. 18. <ul><li>If patient is crossing BMI percentiles </li></ul><ul><li>The parents should be warned about the potential for obesity. </li></ul><ul><li>Family given obesity prevention self-help instructions </li></ul>Recommendations
    19. 19.  
    20. 22. <ul><li>If BMI is > 85 th percentile </li></ul><ul><li>Patients and their parents should be told they are overweight </li></ul><ul><li>Risk of co-morbidities should be discussed </li></ul><ul><li>Family provided with self help instructions </li></ul><ul><li>Follow up appointment in 1 month </li></ul>Recommendations
    21. 24. <ul><li>If BMI is > 95 th percentile </li></ul><ul><li>Patients and their parents should be told they are obese </li></ul><ul><li>Risk of co-morbidities should be discussed and the </li></ul><ul><li>Patients screened with fasting serum glucose, insulin, ALT, lipid panel </li></ul><ul><li>Family provided with self help instructions </li></ul><ul><li>Follow up appointment in 1month </li></ul><ul><li>Referred to specialists if labs abnormal </li></ul><ul><li>Refer to obesity treatment program if compliant </li></ul>Recommendations
    22. 25. RECOMENDATIONS ex: Parks and Recreation Programs School Based Programs Child Oriented Weight Loss Programs Become aware of referral options
    23. 26. OUTCOMES DATA IS NEEDED!
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×