Evan Nadler

58 statements · 2 topics · summaries given as host listed separately

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the younger the better

quote · Obesity

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

clinical · Obesity

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

clinical · Type 2 Diabetes

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

clinical · Type 2 Diabetes

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Evan's statements about Obesity 29 statements

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Evan Nadler, MD - 2024 Pediatric Bariatric Surgery Update Course

Quotation I could operate all day every day cause I don't use the robot. I still never, um, I would still never make any dent in the overall population problem Open

Statement Approximately 0.05% of children who need bariatric surgery receive it, a rate well below adult treatment rates Open

Statement 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 Open

Statement 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 Open

Statement 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 Open

Statement Safety outcomes in preteens were the same or better than teens, following the pattern that younger patients have better outcomes Open

Quotation the younger the better Open

Statement Decrease in BMI was the same between preteens and teens in propensity-matched MBSAQIP data Open

Statement The youngest patients operated on were two 4-year-olds: one homozygous for MC4R receptor deficiency and one with Rohhad syndrome Open

Statement Using percentiles instead of straight BMI values in insurance submissions can help with approval because insurance companies find percentiles confusing Open

Statement 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 Open

Statement 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 Open

Statement 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 Open

Quotation we should be doing all of it. We should be trying all of it Open

Quotation I would argue that meds are no safer than surgery. And in fact, we have less long term data on these medications in children Open

Statement 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 Open

Statement Phentermine has less addictive properties than ADD medications Open

Quotation the joke used to be that statins should be in the water cause we all could use a little bit. I think that's the same is true for Vyvanse Open

Statement 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 Open

Statement Patients with special healthcare needs lost weight after bariatric surgery, though not quite as well as typically developing patients Open

Statement Males tend to do better with obesity surgery than females Open

Statement 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 Open

Statement Some autism spectrum disorder patients are very black-and-white thinkers who follow post-operative rules extremely well Open

Statement 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 Open

Statement 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 Open

Quotation I've always been willing to try anything on anyone because the alternative is so crappy Open

Statement Prader-Willi patients do not do as well with bariatric surgery but do better than if not operated on Open

Statement Syndromic genetic obesity patients need everything: medications, surgery, and continued medications post-operatively Open

Statement One surgical operation costs approximately $50,000, equivalent to 3-4 years of GLP-1 agonist therapy at current prices Open

Evan's statements about Type 2 Diabetes 29 statements

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