Managing Pediatric Obesity Using Advanced Therapies

Obesity is the most common chronic disease of childhood, affecting nearly 20% of children and adolescents in the US alone. As a result, the prevalence of weight-related co-morbidities such as hypertension, non-alcoholic fatty liver disease, type 2 diabetes, dyslipidemia, PCOS, and depression are also increasing. Treatment of pediatric obesity, to date, has largely focused on lifestyle therapy, consisting of diet and physical activity counseling supported by behavioral modification strategies. While lifestyle therapy is essential for obesity management, it is often not sufficient, 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. The challenge is that most pediatric health care providers have not received any training in how to use these therapies.Currently there are no published resources to guide pediatric health care providers on how to use advanced therapies. As the leading expert in the field of pharmacotherapy for pediatric obesity, with more than 15 years of clinical and research experience in using these therapies to treat obesity in children and adolescents, our group has developed protocols on how to use anti-obesity medications in children and adolescents in a safe and responsible fashion. We have shared these protocols with colleagues across the country at our annual conference and have used them as a basis for our Pediatric Obesity Medicine fellowship curriculum. This guidebook will detail these protocols and serve as a comprehensive "how to" for pediatric practitioners caring for children and adolescents with obesity.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.