# Type 2 Diabetes — GCMD Library living collection

Everything in the library about type 2 diabetes — built automatically from dossiers that name it.

Updated: n/a · 5 episodes · 138 cited statements

## Episodes
### Medical Management
- [Stephanie Walsh, MD - 2024 Pediatric Bariatric Surgery Update Course](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963) — video · 16:14 · [machine version](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963.md)

### Surgical Management
- [Bariatric Surgery in the Pediatric Patient](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388) — podcast · 49:29 · [machine version](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388.md)

### Evidence & Research
- [Thomas Inge, MD - 2024 Pediatric Bariatric Surgery Update Course](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962) — video · 18:22 · [machine version](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962.md)
- [Justin Ryder, MD- 2024 Pediatric Bariatric Surgery Update Course](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967) — video · 12:26 · [machine version](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967.md)

### In-Depth Reviews
- [Evan Nadler, MD - 2024 Pediatric Bariatric Surgery Update Course](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966) — video · 29:40 · [machine version](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=0) Introduction and Rising Need for Adolescent Bariatric Surgery (Ep 1)
- [3:02](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=182) Non-Operative Weight Loss: Effectiveness and Limitations (Ep 1)
- [7:10](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=430) Patient Selection: Age, Comorbidities, and Timing (Ep 1)
- [9:46](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=586) Preoperative Process and Multidisciplinary Team Structure (Ep 1)
- [13:46](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=826) Insurance Coverage and Advocacy (Ep 1)
- [17:42](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1062) Contraindications and Special Populations (Ep 1)
- [19:44](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1184) Procedure Overview: Sleeve Gastrectomy vs. Gastric Bypass (Ep 1)
- [23:49](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1429) Sleeve Gastrectomy: Technical Steps and Variations (Ep 1)
- [29:03](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1743) Leak Prevention at the Gastroesophageal Junction (Ep 1)
- [33:20](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2000) Postoperative Diet Advancement (Ep 1)
- [34:55](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2095) Complications: Sleeve Gastrectomy (Ep 1)
- [37:47](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2267) Complications: Gastric Bypass (Ep 1)
- [38:50](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2330) Weight Loss Outcomes and Health Benefits (Ep 1)
- [40:46](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2446) Long-Term Durability: 8-Year Follow-Up Data (Ep 1)
- [45:38](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2738) Current Research and Future Directions (Ep 1)
- [48:49](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2929) Closing Remarks (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=0) Introduction and Teen-LABS Study Design (Ep 2)
- [5:00](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=300) Long-term Weight Loss and Comorbidity Remission Outcomes (Ep 2)
- [10:00](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=600) Alcohol Use and Mortality Data (Ep 2)
- [15:50](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=950) Summary and Clinical Implications (Ep 2)
- [0:01](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=1) Defining adequate weight loss and patient heterogeneity (Ep 3)
- [5:00](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=300) Lifestyle factors and medication options (Ep 3)
- [8:20](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=500) Emerging evidence on post-operative medication use (Ep 3)
- [11:06](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=666) Practical challenges: insurance, dosing, and family attitudes (Ep 3)
- [14:05](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=845) Protocols for medication initiation and earlier intervention (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=0) Introduction and Preteen Bariatric Surgery Data (Ep 4)
- [8:01](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=481) Discussion of Young Patient Selection and Pharmacotherapy (Ep 4)
- [16:57](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1017) Patients with Special Healthcare Needs (Ep 4)
- [25:16](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1516) Prader-Willi Syndrome and Future Research Directions (Ep 4)
- [0:00](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=0) Introduction of Justin Ryder (Ep 5)
- [0:18](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=18) Ten-year Teen Labs response phenotypes (Ep 5)
- [5:30](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=330) Surgery versus medications and mechanistic research (Ep 5)
- [8:16](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=496) Trial design considerations and diversity (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Type 2 diabetes, previously called adult-onset diabetes, is now seen in children and teenagers as a complication of obesity. — Marc Harmon (epidemiological) [Ep 1 · 1:44](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=104)
- Obstructive sleep apnea, hypertension, dyslipidemias, and cardiovascular risk factors are comorbidities now appearing in obese children. — Marc Harmon (clinical) [Ep 1 · 1:44](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=104)
- About half of teenagers presenting for bariatric surgery have had a parent who underwent weight loss surgery. — Thomas Inge (epidemiological) [Ep 1 · 2:20](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=140)
- The success rate of non-operative weight loss falls dramatically and linearly from age 6 to 16; a severely obese teenager may have only a 1% chance of losing significant weight with lifestyle interventions. — Todd Ponsky (epidemiological) [Ep 1 · 3:15](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=195)
- Lifestyle management research defines success as 5–10% total body weight loss, whereas bariatric surgery in teens achieves about 30% weight loss at 3–5 years. — Marc Harmon (clinical) [Ep 1 · 4:34](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=274)
- Caloric restriction is the primary mechanism for weight loss; exercise is more effective for maintaining weight loss once achieved. — Todd Ponsky (clinical) [Ep 1 · 5:15](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=315)
- Orlistat is the only FDA-approved weight-loss drug for pediatrics, causing greasy stools and achieving only about 2% weight loss. — Todd Ponsky (clinical) [Ep 1 · 6:21](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=381)
- Topiramate and phentermine, approved for adults, affect appetite and satiety pathways in teenagers identically to adults and are used off-label. — Todd Ponsky (clinical) [Ep 1 · 6:21](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=381)
- Most U.S. bariatric surgeons limit surgery to teenagers (youngest reported case age 13) to ensure physiologic maturity and avoid harm to development. — Marc Harmon (guideline) [Ep 1 · 7:13](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=433)
- A colleague in Saudi Arabia has performed weight loss surgery on children as young as 6–7 with reported good long-term results. — Marc Harmon (clinical) [Ep 1 · 7:13](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=433)
- Surgery can prevent diabetes in adolescents with elevated blood sugar who are not yet diabetic. — Todd Ponsky (clinical) [Ep 1 · 8:25](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=505)
- Adult bariatric studies show a longevity benefit for surgery in morbid obesity. — Todd Ponsky (clinical) [Ep 1 · 8:25](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=505)
- Most insurance plans covering bariatric surgery require a 6-month period of medically supervised weight loss before surgery. — Todd Ponsky (guideline) [Ep 1 · 10:08](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=608)
- Patients are put through 'surgery school' during the 6-month preoperative period to teach them about the surgery, nutrition, risks, and benefits, ensuring informed, non-coerced consent. — Todd Ponsky (guideline) [Ep 1 · 10:08](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=608)
- A multidisciplinary team for adolescent bariatric surgery includes pediatric endocrinology, gastroenterology, psychology (2), exercise physiology (2), nutrition (2), and surgery. — Marc Harmon (guideline) [Ep 1 · 12:12](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=732)
- Patients may be in a medical obesity program for 3 years before considering surgery, allowing the surgical team to build longitudinal relationships with families. — Marc Harmon (guideline) [Ep 1 · 12:12](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=732)
- Many patients who need bariatric surgery lack insurance coverage due to policy exclusions, even when surgery is medically indicated. — Todd Ponsky (epidemiological) [Ep 1 · 16:09](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=969)
- Surgeons advocate for patients when insurance denies coverage but it is not an absolute exclusion. — Todd Ponsky (guideline) [Ep 1 · 16:09](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=969)
- Teens with chaotic lives, uncontrolled medical problems, or untreated psychiatric illness may not be ready for surgery and require preparation by the multidisciplinary team. — Todd Ponsky (clinical) [Ep 1 · 17:52](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1072)
- Syndromic obesity and monogenic obesity (single-gene mutations driving appetite) account for 6–7% of severely obese children by age 10; outcomes with bariatric surgery in this group are mixed and require further study. — Marc Harmon (clinical) [Ep 1 · 19:11](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1151)
- Roux-en-Y gastric bypass has the longest track record in adults and teenagers. — Marc Harmon (clinical) [Ep 1 · 19:57](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1197)
- Adjustable gastric band has a high reoperation rate in teenagers and adults and is no longer widely offered. — Marc Harmon (clinical) [Ep 1 · 19:57](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1197)
- Vertical sleeve gastrectomy, originally a first-stage procedure for super-obese patients, now shows good initial weight loss and comorbidity resolution at 3–4 years in adults and teens. — Marc Harmon (clinical) [Ep 1 · 19:57](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1197)
- In 2015, sleeve gastrectomy was performed in 80% of adolescent bariatric cases, gastric bypass in 20%, and virtually no bands. — Todd Ponsky (epidemiological) [Ep 1 · 21:14](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1274)
- Sleeve gastrectomy and gastric bypass show very comparable weight loss and comorbidity resolution results in teenagers. — Todd Ponsky (clinical) [Ep 1 · 21:14](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1274)
- Gastric bypass is preferred for patients with hypothalamic obesity (e.g., post-brain tumor, pan-hypopituitarism) because sleeve and band have shown inferior weight loss in this biologically driven obesity. — Todd Ponsky (clinical) [Ep 1 · 22:13](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1333)
- Theoretical and measured risks of sleeve gastrectomy are lower than gastric bypass in teenagers and adults. — Todd Ponsky (clinical) [Ep 1 · 22:13](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1333)
- Sleeve gastrectomy is performed laparoscopically, starting 4–6 cm proximal to the pylorus, mobilizing the greater curvature to the diaphragm, and stapling along a 36–42 Fr bougie to the angle of His. — Marc Harmon (clinical) [Ep 1 · 23:49](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1429)
- A 25 cm clamp can be used to standardize sleeve geometry, ensure complete fundus mobilization, and prevent leaving excess fundus that can cause reflux. — Todd Ponsky (clinical) [Ep 1 · 25:58](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1558)
- The upper spinal firing near the GE junction is the most common site for leaks and the thinnest part of the stomach. — Todd Ponsky (clinical) [Ep 1 · 27:34](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1654)
- The posterior wall of the stomach tends to slip up during the final stapler firing; counter-traction is critical to avoid leaving too much fundus or getting too close to the esophagus. — Marc Harmon (clinical) [Ep 1 · 29:03](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1743)
- Close inspection of the staple line with magnification is essential; bleeding or malformed staples should be oversewn with figure-of-eight sutures. — Todd Ponsky (clinical) [Ep 1 · 29:03](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1743)
- Gastric bypass is performed laparoscopically with a circularly stapled gastrojejunal anastomosis (25 mm stapler), 50 cm biliopancreatic limb, 100 cm Roux limb, and closure of jejunojejunostomy and Peterson's defects with non-absorbable suture. — Todd Ponsky (clinical) [Ep 1 · 30:27](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1827)
- Antecolic Roux limb configuration works well and still requires closure of the mesenteric defect. — Marc Harmon (clinical) [Ep 1 · 30:27](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1827)
- A linear stapler (2.5 cm firing) can be used for the gastrojejunal anastomosis with satisfactory results. — Marc Harmon (clinical) [Ep 1 · 30:27](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=1827)
- Patients start sips of water same-day postop, advance to 4 oz/hr by day 1, 6 oz/hr by day 2, and are discharged when achieving 64–96 oz/day. — Todd Ponsky (guideline) [Ep 1 · 33:23](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2003)
- High-protein intake (60–80 g/day) is recommended postoperatively to preserve lean mass during rapid weight loss. — Todd Ponsky (guideline) [Ep 1 · 33:23](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2003)
- Patients are on a soft mechanical diet for the first month, then less restricted; early caloric intake is 300–600 kcal/day. — Todd Ponsky (guideline) [Ep 1 · 33:23](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2003)
- Sleeve gastrectomy complications include staple-line leak (most feared, especially at GE junction), bleeding at staple line, and trocar-site hernia at the extraction site. — Marc Harmon (clinical) [Ep 1 · 34:56](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2096)
- Long-term sleeve complications include anemia, vitamin deficiencies, and gastroesophageal reflux (up to one-third of adults; possibly lower in teens). — Marc Harmon (clinical) [Ep 1 · 34:56](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2096)
- Gastric bypass has higher complication rates than sleeve: internal hernias, stricture at gastrojejunal anastomosis (fairly high rate), and marginal ulcers. — Marc Harmon (clinical) [Ep 1 · 34:56](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2096)
- Teenagers may have lower risk of post-sleeve reflux than adults because their physiologic anti-reflux barriers are more secure. — Todd Ponsky (opinion) [Ep 1 · 34:56](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2096)
- Proton pump inhibitors are used postoperatively after sleeve gastrectomy. — Todd Ponsky (guideline) [Ep 1 · 34:56](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2096)
- Teen-LABS data show 28–30% total body weight loss at 3 years for both gastric bypass and sleeve gastrectomy, maintained long-term. — Todd Ponsky (clinical) [Ep 1 · 37:47](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2267)
- Typical teenagers lose 80–100 pounds in the first year after bariatric surgery. — Marc Harmon (clinical) [Ep 1 · 38:50](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2330)
- Obstructive sleep apnea resolves within 3 weeks of surgery, before significant weight loss, suggesting a neurohormonal mechanism rather than weight-dependent improvement. — Todd Ponsky (clinical) [Ep 1 · 39:06](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2346)
- Type 2 diabetes and glucose metabolism improve within days of gastric bypass surgery, independent of weight loss. — Todd Ponsky (clinical) [Ep 1 · 39:06](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2346)
- Joint pain improves with weight loss after bariatric surgery. — Todd Ponsky (clinical) [Ep 1 · 39:06](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2346)
- A pre-Teen-LABS cohort of 70+ gastric bypass patients followed for an average of 8 years (range 5–12) with 80% retention showed 32–33% weight loss at 1 year, 28–30% at 8 years, with durable diabetes resolution. — Todd Ponsky (clinical) [Ep 1 · 40:52](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2452)
- A comparator group of severely obese teenagers who underwent lifestyle intervention gained 66% more weight over 6 years and developed diabetes at expected rates. — Todd Ponsky (clinical) [Ep 1 · 40:52](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2452)
- Teen-LABS is an NIH-sponsored study (242 teenagers, 2007–2012, now in third 5-year funding cycle) tracking broad health outcomes, biospecimens, with 80–90% annual follow-up. — Todd Ponsky (epidemiological) [Ep 1 · 43:48](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2628)
- Swedish long-term bariatric research shows 5-year results comparable to U.S. data. — Todd Ponsky (clinical) [Ep 1 · 43:48](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2628)
- Intragastric balloons and endoscopic gastric plication are less invasive approaches with moderate adult experience and some adolescent cases; outcomes are still being evaluated. — Thomas Inge (clinical) [Ep 1 · 45:59](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2759)
- Bariatric surgery is a form of medical therapy at the molecular level, affecting gut-brain signaling. — Todd Ponsky (opinion) [Ep 1 · 45:59](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2759)
- Combination therapy (surgery plus pharmacotherapy such as GLP-1 agonists) may optimize outcomes and address suboptimal responders; trials are anticipated. — Todd Ponsky (opinion) [Ep 1 · 45:59](https://qa.library.globalcastmd.com/watch/bariatric-surgery-in-the-pediatric-patient-388?t=2759)
- Ten-year Teen Labs latent class analysis identified four phenotypes of bariatric surgery responders. — Justin Ryder (clinical) [Ep 5 · 0:42](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=42)
- Superior responders (18% of cohort) lost about 45% weight at nadir and maintained that weight loss out to 10 years. — Justin Ryder (clinical) [Ep 5 · 1:12](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=72)
- A second response group lost about 35% weight at nadir and kept over 25% off at 10 years. — Justin Ryder (clinical) [Ep 5 · 1:36](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=96)
- A third group (one-third of cohort) achieved 12% BMI change at 10 years, comparable to semaglutide's mean response in adolescents at 1 year. — Justin Ryder (clinical) [Ep 5 · 1:54](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=114)
- A fourth group (poor responders) did not lose ideal weight, returned to baseline by 4 years, and overshot their starting weight. — Justin Ryder (clinical) [Ep 5 · 2:42](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=162)
- In Teen Labs, the only predictor of 10-year weight change was 6-month weight loss; demographic factors, clinical characteristics, and social determinants of health were not predictive. — Justin Ryder (clinical) [Ep 5 · 3:18](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=198)
- At 2 years, weight loss is about 30% in both sleeve gastrectomy and Roux-en-Y gastric bypass in Teen Labs 10-year data. — Justin Ryder (clinical) [Ep 5 · 5:30](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=330)
- No difference was found between Roux-en-Y gastric bypass and sleeve gastrectomy out to 10 years in Teen Labs. — Justin Ryder (clinical) [Ep 5 · 5:30](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=330)
- Tirzepatide (dual GLP-1/GIP receptor agonist) shows 25% weight loss at 72 weeks, similar to 2-year surgical outcomes. — Justin Ryder (clinical) [Ep 5 · 6:00](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=360)
- Bariatric surgery receives a grade of C from policymakers and advocacy organizations due to lack of randomized trials versus alternative therapies. — Justin Ryder (opinion) [Ep 5 · 6:30](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=390)
- Randomizing children to lifestyle intervention alone would be unethical. — Justin Ryder (opinion) [Ep 5 · 6:54](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=414)
- Bariatric surgery is more effective when performed at younger ages. — Justin Ryder (clinical) [Ep 5 · 7:30](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=450)
- The superior effectiveness of bariatric surgery in adolescents versus adults cannot be explained by duration of disease alone. — Justin Ryder (opinion) [Ep 5 · 7:36](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=456)
- Oncology colleagues began using genetics for precision medicine about 30 years ago, with 20-30 years required for patient impact. (clinical) [Ep 5 · 9:36](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=576)
- Metabolic pathways perturbed by obesity may be relevant to treatment response independent of genetic origins. (opinion) [Ep 5 · 10:06](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=606)
- A DC pediatric bariatric cohort is approximately 60-66% Black, 20% Hispanic, and 20% white or other. (epidemiological) [Ep 5 · 10:41](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=641)
- Tirzepatide and semaglutide drug trials are approximately 70% or more white participants and not conducted in urban settings. (epidemiological) [Ep 5 · 10:54](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=654)
- Anti-obesity medications do not work in real-world urban populations as effectively as shown in clinical trials. (opinion) [Ep 5 · 11:12](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=672)
- Drug companies prioritize timeline over quality in clinical trial diversity. — Justin Ryder (opinion) [Ep 5 · 12:00](https://qa.library.globalcastmd.com/watch/justin-ryder-md-2024-pediatric-bariatric-surgery-update-course-7967?t=720)
- Expected weight loss after pediatric bariatric surgery is typically quoted as 25-35% total body weight loss. — Stephanie Walsh (clinical) [Ep 3 · 1:22](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=82)
- Kids who can lose weight usually lose weight, and kids who cannot do not—this group requires focused intervention. — Stephanie Walsh (clinical) [Ep 3 · 2:30](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=150)
- When adolescents start drinking sugar after bariatric surgery, it is usually because they are not eating food and the sugar makes them feel better. — Stephanie Walsh (clinical) [Ep 3 · 4:40](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=280)
- Physical activity in adolescent girls is lower than in boys, and is predominantly influenced by their mothers' activity levels. — Stephanie Walsh (epidemiological) [Ep 3 · 5:40](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=340)
- Physical activity impacts mental health in addition to physical strength. — Stephanie Walsh (clinical) [Ep 3 · 6:05](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=365)
- Bupropion post-operatively helps with mood and provides additional weight loss benefit, though it is labeled for age 18 and older. — Stephanie Walsh (clinical) [Ep 3 · 6:35](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=395)
- Pre-operative anti-obesity medications can provide psychological benefit by helping adolescents stabilize or lose weight, keeping them engaged in the program. — Stephanie Walsh (clinical) [Ep 3 · 7:50](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=470)
- Most pediatric bariatric patients can only access phentermine and topiramate; GLP-1 agonists are not available for most patients. — Stephanie Walsh (clinical) [Ep 3 · 8:10](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=490)
- When using medications that decrease hunger post-operatively after a surgery that also decreases hunger, clinicians must ensure patients are still eating adequate nutrition. — Stephanie Walsh (clinical) [Ep 3 · 8:30](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=510)
- Medication availability is almost entirely determined by insurance coverage and supply constraints. — Stephanie Walsh (clinical) [Ep 3 · 10:30](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=630)
- In Atlanta, phentermine is only available in 15 mg capsule form, which cannot be split. — Stephanie Walsh (clinical) [Ep 3 · 10:45](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=645)
- Many families are hesitant about long-term medication use despite accepting bariatric surgery. — Stephanie Walsh (opinion) [Ep 3 · 11:20](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=680)
- Novo Nordisk is prioritizing shipment of 1.7 mg and 2.4 mg semaglutide doses for patients already on therapy, with very limited availability of lower initiation doses. — Stephanie Walsh (clinical) [Ep 3 · 11:42](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=702)
- Some patients do well on 1.7 mg semaglutide but not necessarily better on 2.4 mg, suggesting individualized dosing may be appropriate. — Karen (clinical) [Ep 3 · 12:10](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=730)
- As of last year, 1.7 mg semaglutide is considered a maintenance dose, which should reduce insurance coverage barriers. — Stephanie Walsh (guideline) [Ep 3 · 12:40](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=760)
- Clinicians should use the lowest medication dose that the patient can tolerate and that is effective, which varies by individual. — Stephanie Walsh (clinical) [Ep 3 · 13:00](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=780)
- One protocol offers medications at 3 months for less than 10% total body weight loss and at 6 months for less than 15% weight loss; these thresholds are conservative given Teen-LABS data. — Stephanie Walsh (guideline) [Ep 3 · 14:10](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=850)
- In a cohort of 750 patients, modeling showed that if a patient is off the expected weight loss curve at 3 months, they never return to that curve. — Stephanie Walsh (epidemiological) [Ep 3 · 14:40](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=880)
- A cohort of sleeve gastrectomy patients did not achieve satiety despite standard resection; these patients were started on Vyvanse at 2 weeks post-operatively. — Stephanie Walsh (clinical) [Ep 3 · 15:00](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=900)
- Studies examining medication use at 6 months or later are too late; data strongly suggest starting medications earlier and being more aggressive. — Stephanie Walsh (opinion) [Ep 3 · 15:25](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=925)
- For adolescents with type 2 diabetes, there is no reason to wait for BMI 35 when diabetes will not improve differently at BMI 32. — Karen (opinion) [Ep 3 · 15:50](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=950)
- The longer adolescents with type 2 diabetes are on insulin, the less likely intervention will help their diabetes. — Stephanie Walsh (clinical) [Ep 3 · 16:05](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=965)
- In the Children's Hospital Association database from 2010 to 2022, sleeve gastrectomy has become the dominant procedure with very few bypasses performed by 2022. — Thomas Inge (epidemiological) [Ep 2 · 2:00](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=120)
- The Teen-LABS study recruited 242 subjects who underwent surgery, with 219 still active and retention rate of approximately 85%. — Thomas Inge (epidemiological) [Ep 2 · 4:00](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=240)
- Weight loss after gastric bypass is equivalent in teenagers and adults at approximately 26-29% at 5 years. — Thomas Inge (clinical) [Ep 2 · 5:00](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=300)
- At 5 years post-gastric bypass, 86% of teenagers achieved diabetes remission compared to only 53% of adults. — Thomas Inge (clinical) [Ep 2 · 5:45](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=345)
- At 5 years post-gastric bypass, teenagers had 68% hypertension remission rate compared to 41% in adults. — Thomas Inge (clinical) [Ep 2 · 6:05](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=365)
- At 10 years post-surgery in Teen-LABS, average BMI reduction was 21% with nadir of 33% at 1 year, showing very gentle weight regain over time. — Thomas Inge (clinical) [Ep 2 · 8:20](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=500)
- Latent class modeling at 10 years identified distinct outcome groups: approximately 11% gained weight, approximately 20% achieved 44% weight loss, with others falling in between, demonstrating significant heterogeneity. — Thomas Inge (clinical) [Ep 2 · 9:00](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=540)
- By 8 years post-surgery, a minority of Teen-LABS patients had not experienced alcohol use, with most having some experience. — Thomas Inge (epidemiological) [Ep 2 · 10:20](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=620)
- The cumulative incidence of alcohol-related problems approaches half of patients by 8.5 years post-surgery in both sleeve and bypass groups. — Thomas Inge (epidemiological) [Ep 2 · 10:40](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=640)
- The pharmacokinetics of alcohol are much faster after gastric bypass and probably sleeve gastrectomy, with alcohol hitting the system more rapidly. — Thomas Inge (clinical) [Ep 2 · 9:40](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=580)
- Normative controls adopt alcohol use earlier and at higher frequency than Teen-LABS patients based on previously published data. — Thomas Inge (epidemiological) [Ep 2 · 10:50](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=650)
- There were 14 deaths in the Teen-LABS cohort, with the first death occurring at 3.3 years post-surgery and others occurring at 7, 10, and 14 years post-surgery. — Thomas Inge (epidemiological) [Ep 2 · 12:00](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=720)
- A number of the deaths in Teen-LABS were associated with multi-substance use, though this data is not yet published. — Thomas Inge (epidemiological) [Ep 2 · 12:40](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=760)
- Meg Zeller recruited approximately 81 severely obese teenagers (not as obese as Teen-LABS subjects) who did not have surgery, and preliminary comparison suggests the mortality signal may be related to severe adolescent obesity itself rather than surgery. — Thomas Inge (epidemiological) [Ep 2 · 16:40](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=1000)
- For sleeve gastrectomy, an anatomy-based approach is recommended to prevent reflux by avoiding leaving a pouch at the top and avoiding a dumbbell-shaped stomach. — Thomas Inge (clinical) [Ep 2 · 14:40](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=880)
- Patients must take vitamins like medicines rather than supplements, which should be emphasized preoperatively and postoperatively to prevent micronutrient deficiencies. — Thomas Inge (guideline) [Ep 2 · 15:10](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=910)
- Teen-LABS patients may be developmentally delayed in adopting risky behaviors like alcohol use due to social isolation related to severe obesity, potentially just delaying rather than avoiding these behaviors. (opinion) [Ep 2 · 11:23](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=683)
- Approximately 0.05% of children who need bariatric surgery receive it, a rate well below adult treatment rates — Evan Nadler (epidemiological) [Ep 4 · 0:34](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=34)
- MBSAQIP requirements for verified surgeon at freestanding children's hospital are 100 lifetime cases (75 can be as fellow) and 20 stapled cases per year — Evan Nadler (guideline) [Ep 4 · 2:00](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=120)
- The 2019 AAP clinical guidelines did not have an age cutoff, but the newer guidelines introduced a cutoff of 13 years, representing a backward step — Evan Nadler (guideline) [Ep 4 · 4:00](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=240)
- In MBSAQIP data of approximately 4800 teens and 50 preteens, preteens undergoing surgery had higher rates of insulin-dependent diabetes and sleep apnea compared to teens — Evan Nadler (epidemiological) [Ep 4 · 5:00](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=300)
- Safety outcomes in preteens were the same or better than teens, following the pattern that younger patients have better outcomes — Evan Nadler (clinical) [Ep 4 · 6:20](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=380)
- Decrease in BMI was the same between preteens and teens in propensity-matched MBSAQIP data — Evan Nadler (clinical) [Ep 4 · 7:00](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=420)
- The youngest patients operated on were two 4-year-olds: one homozygous for MC4R receptor deficiency and one with Rohhad syndrome — Evan Nadler (clinical) [Ep 4 · 7:30](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=450)
- Using percentiles instead of straight BMI values in insurance submissions can help with approval because insurance companies find percentiles confusing — Evan Nadler (opinion) [Ep 4 · 8:01](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=481)
- In the DC area, there are no age cutoffs for bariatric surgery in most Medicaid programs after years of education, and approximately 90% of young patient cases are insurance approved — Evan Nadler (clinical) [Ep 4 · 8:26](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=506)
- The ideal age to operate is somewhere between 12 and 14 because those kids still listen to their parents, are still developing habits, and do better than other age groups (opinion) [Ep 4 · 10:09](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=609)
- 10 and 11 year olds may do even better than 12-14 year olds because they go through puberty at normal or lower weight, listen to parents, and cannot access food without parental help — Evan Nadler (opinion) [Ep 4 · 10:44](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=644)
- Off-label use of medications including phentermine, topiramate, Vyvanse, and GLP-1 agonists has been standard practice for years in young patients because the disease needs to be treated — Evan Nadler (clinical) [Ep 4 · 11:10](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=670)
- Medications may be no safer than surgery, with less long-term data in children, similar gallstone risk, and likely higher weight regain due to medication cessation — Evan Nadler (opinion) [Ep 4 · 13:13](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=793)
- Phentermine has less addictive properties than ADD medications — Evan Nadler (clinical) [Ep 4 · 14:18](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=858)
- Younger patients in non-surgical weight management clinics are better at following instructions and have mental health issues addressed more appropriately, making post-surgical management easier (clinical) [Ep 4 · 15:11](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=911)
- In a cohort of 490 patients from 2018-2022, 34 had special healthcare needs including autism spectrum disorder, intellectual/developmental disabilities, Trisomy 21, and Prader-Willi syndrome — Evan Nadler (epidemiological) [Ep 4 · 17:04](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1024)
- Patients with special healthcare needs lost weight after bariatric surgery, though not quite as well as typically developing patients — Evan Nadler (clinical) [Ep 4 · 19:10](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1150)
- When separated into autism spectrum disorder (16 patients) and intellectual/developmental disabilities (13 patients), autism spectrum kids may do better than IDD kids, though numbers were too low for statistical significance except at 6-month excess weight loss — Evan Nadler (clinical) [Ep 4 · 20:00](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1200)
- Males tend to do better with obesity surgery than females — Evan Nadler (clinical) [Ep 4 · 20:00](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1200)
- Some autism spectrum disorder patients are very black-and-white thinkers who follow post-operative rules extremely well — Evan Nadler (clinical) [Ep 4 · 20:50](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1250)
- Patients with autism spectrum disorder and selective eating did better with their selective eating after surgery because post-operative requirements (protein, water, multivitamin) fit into their brain function as a new form of selective eating — Evan Nadler (clinical) [Ep 4 · 23:41](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1421)
- Not all patients with special healthcare needs have high-functioning families with resources; some had parents who could barely care for their child, and surgery made care easier — Evan Nadler (clinical) [Ep 4 · 23:41](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1421)
- Prader-Willi patients do not do as well with bariatric surgery but do better than if not operated on — Evan Nadler (clinical) [Ep 4 · 25:38](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1538)
- Syndromic genetic obesity patients need everything: medications, surgery, and continued medications post-operatively — Evan Nadler (opinion) [Ep 4 · 25:48](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1548)
- One surgical operation costs approximately $50,000, equivalent to 3-4 years of GLP-1 agonist therapy at current prices — Evan Nadler (epidemiological) [Ep 4 · 28:58](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1738)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- In heterogeneous outcome data, one subgroup shows only 12% weight loss at 10-year follow-up while other groups are highly successful. — Stephanie Walsh summarizing the discussion [Ep 3 · 2:45](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=165)
- An unpublished study by Tom showed improvement in weight loss outcomes with phentermine and topiramate use post-operatively in approximately 12 patients. — Stephanie Walsh summarizing the discussion [Ep 3 · 9:15](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=555)
- An unpublished study by Evan showed that adolescents who lose weight successfully also lose weight well with medications, but the benefit for the highest-BMI subgroups remains unclear. — Stephanie Walsh summarizing the discussion [Ep 3 · 9:50](https://qa.library.globalcastmd.com/watch/stephanie-walsh-md-2024-pediatric-bariatric-surgery-update-course-7963?t=590)
- Multiple long-term studies (AMOS from Sweden, FBS Five from Cincinnati, studies from Saudi Arabia and Miami) show hypertension remission rates of 58-100% after adolescent bariatric surgery. — Thomas Inge summarizing a resource [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=420)
- Type 2 diabetes remission rates across multiple long-term adolescent bariatric surgery studies range from 72-100%. — Thomas Inge summarizing a resource [Ep 2 · 7:40](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=460)
- The Fontaine JAMA data from the early 2000s showed years of life lost due to being severely obese as a teenager. — Thomas Inge summarizing a resource [Ep 2 · 17:20](https://qa.library.globalcastmd.com/watch/thomas-inge-md-2024-pediatric-bariatric-surgery-update-course-7962?t=1040)
- Epic real-world clinical data showed that a large number of patients after GLP-1 cessation actually do not regain their weight — Evan Nadler summarizing a resource [Ep 4 · 15:58](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=958)
- According to Steven Myers's paper, biliopancreatic diversion is the best operation for Prader-Willi patients — The host summarizes what Dr. Evan Nadler said [Ep 4 · 26:37](https://qa.library.globalcastmd.com/watch/evan-nadler-md-2024-pediatric-bariatric-surgery-update-course-7966?t=1597)

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