Justin Ryder

164 statements · 4 topics

Liver Tumors (Hepatoblastoma/HCC) · guest expert

Featured statements

We can't randomize kids to lifestyle because that's just unethical.
quote · Pediatric Obesity
The guidelines describe a non-linear continuum of care starting with intensive health, behavior, and lifestyle treatment involving more than 26 contact hours over a 3 to 12-month period.
guideline · Liver Tumors (Hepatoblastoma/HCC)
Bariatric surgery should be considered for those over the age of 13 years old with a BMI 1.2 times the 95th percentile.
guideline · Liver Tumors (Hepatoblastoma/HCC)
Treatment should be offered to all children above the 85th percentile, and there should be no more watchful waiting.
guideline · Obesity
Obesity is influenced by numerous factors including genetics, epigenetics, appetite and satiety hormone dysregulation, stress, economics, adverse life experiences, and environmental factors like calorically dense foods and sedentary lifestyles.
clinical · Obesity
Weight regain is driven by a complex interplay between behaviors like physical activity and energy intake, and biological factors like energy expenditure and appetite and satiety hormones that regulate how full you feel.
clinical · Pediatric Obesity

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Justin's statements about Liver Tumors (Hepatoblastoma/HCC) 40 statements

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Pediatric Obesity Is a Disease: Treatment, Medications, Surgery & Equity in Care with Dr. Justin Ryder

Statement Obesity is a disease impacted by behavior and represents a multifactorial disease impacted by a robust gene-environment interaction. Open
Quotation The data clearly supports that obesity is a disease impacted by behavior. Open
Quotation The big picture view is that it's a multifactorial disease impacted by a robust gene-environment interaction. Open
Statement Obesity is influenced by numerous factors including genetics, epigenetics, appetite and satiety hormone dysregulation, stress, economics, adverse life experiences, and environmental factors like calorically dense foods and sedentary lifestyles. Open
Quotation Historically, about 90% of our efforts over the past 50 years have been on prevention of childhood obesity. Open
Statement Historically, about 90% of efforts over the past 50 years have been on prevention of childhood obesity. Open
Statement The new AAP clinical practice guidelines clearly state that obesity is a disease. Open
Quotation They clearly state that obesity is a disease. Open
Quotation The key takeaway is that the treatment should be offered to all children above the 85th percentile, and there should be no more watchful waiting. Open
Statement Treatment should be offered to all children above the 85th percentile, and there should be no more watchful waiting. Open
Statement The guidelines describe a non-linear continuum of care starting with intensive health, behavior, and lifestyle treatment involving more than 26 contact hours over a 3 to 12-month period. Open
Statement Pharmacotherapy is FDA labeled for adolescents above the age of 12. Open
Statement Currently, there are 5 medications that are FDA approved for the treatment of adolescents with obesity. Open
Statement Bariatric surgery should be considered for those over the age of 13 years old with a BMI 1.2 times the 95th percentile. Open
Statement Wegovy, a GLP-1 receptor agonist, causes about 17% weight loss and is FDA approved in adolescents. Open
Statement Data in adults on tirzepatide shows significant change in body weight compared to placebo. Open
Statement Oral GLP-1 medications are on the way in a few short years. Open
Statement Bariatric surgery studies show sustained weight loss in both adults and adolescent cohorts over several years. Open
Statement There is no difference between Roux-en-Y gastric bypass and vertical sleeve gastrectomy in terms of percent BMI change from baseline over a 10-year period. Open
Statement There is significant heterogeneity in response to bariatric surgery, and weight regain is a significant problem. Open
Statement Bariatric surgery produces substantial improvements in conditions that commonly occur with obesity, like hypertension, diabetes, and high lipids. Open
Statement Weight regain is driven by a complex interplay between behaviors like physical activity and energy intake, and biological factors like energy expenditure and appetite and satiety hormones that regulate how full you feel. Open
Statement Weight regain factors are all influenced by genetics and the environment, including puberty, race, and socioeconomic status. Open
Statement It is much easier to lose weight than to keep it off, which is demonstrated across many studies. Open
Quotation It is much easier to lose weight than to keep it off, which is demonstrated across many studies. Open
Statement Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent pediatric liver disease. Open
Statement Obesity is a significant risk factor for MASLD. Open
Statement About 20% of youth in the United States have obesity, which is roughly 15 million children. Open
Statement Approximately 5 million children have both obesity and MASLD. Open
Statement Between 250,000 and 1 million children with obesity and MASLD will progress to cirrhosis and needing a liver transplant or having hepatocellular carcinoma. Open
Statement There are racial and ethnic differences in MASLD prevalence. Open
Statement The rates of severe forms of obesity are only increasing. Open
Statement Obesity affects at least 35% of adults and 20% of children in Illinois alone. Open
Statement Obesity significantly increases the risk of long-term health problems and early death. Open
Statement The economic impact of obesity is substantial, with reductions in GDP and increases in state spending. Open
Quotation Crucially, we need to reiterate that obesity is a disease driven by biology and that it is no one's fault. Open
Statement Obesity is a disease driven by biology and it is no one's fault. Open
Statement Access to effective obesity medications is a health equity issue. Open
Statement Obesity disproportionately affects people of color and those living in poverty. Open
Statement Organizations like the Stop Obesity Alliance are working to analyze how states are covering obesity medications in Medicaid programs, and there is significant variation across the country. Open
Justin's statements about Obesity 40 statements

Open the Obesity collection →

Pediatric Obesity Is a Disease: Treatment, Medications, Surgery & Equity in Care with Dr. Justin Ryder

Statement Obesity is a disease impacted by behavior and represents a multifactorial disease impacted by a robust gene-environment interaction. Open
Quotation The data clearly supports that obesity is a disease impacted by behavior. Open
Quotation The big picture view is that it's a multifactorial disease impacted by a robust gene-environment interaction. Open
Statement Obesity is influenced by numerous factors including genetics, epigenetics, appetite and satiety hormone dysregulation, stress, economics, adverse life experiences, and environmental factors like calorically dense foods and sedentary lifestyles. Open
Statement Historically, about 90% of efforts over the past 50 years have been on prevention of childhood obesity. Open
Quotation Historically, about 90% of our efforts over the past 50 years have been on prevention of childhood obesity. Open
Statement The new AAP clinical practice guidelines clearly state that obesity is a disease. Open
Quotation They clearly state that obesity is a disease. Open
Statement Treatment should be offered to all children above the 85th percentile, and there should be no more watchful waiting. Open
Quotation The key takeaway is that the treatment should be offered to all children above the 85th percentile, and there should be no more watchful waiting. Open
Statement The guidelines describe a non-linear continuum of care starting with intensive health, behavior, and lifestyle treatment involving more than 26 contact hours over a 3 to 12-month period. Open
Statement Pharmacotherapy is FDA labeled for adolescents above the age of 12. Open
Statement Currently, there are 5 medications that are FDA approved for the treatment of adolescents with obesity. Open
Statement Bariatric surgery should be considered for those over the age of 13 years old with a BMI 1.2 times the 95th percentile. Open
Statement Wegovy, a GLP-1 receptor agonist, causes about 17% weight loss and is FDA approved in adolescents. Open
Statement Data in adults on tirzepatide shows significant change in body weight compared to placebo. Open
Statement Oral GLP-1 medications are on the way in a few short years. Open
Statement Bariatric surgery studies show sustained weight loss in both adults and adolescent cohorts over several years. Open
Statement There is no difference between Roux-en-Y gastric bypass and vertical sleeve gastrectomy in terms of percent BMI change from baseline over a 10-year period. Open
Statement There is significant heterogeneity in response to bariatric surgery, and weight regain is a significant problem. Open
Statement Bariatric surgery produces substantial improvements in conditions that commonly occur with obesity, like hypertension, diabetes, and high lipids. Open
Statement Weight regain is driven by a complex interplay between behaviors like physical activity and energy intake, and biological factors like energy expenditure and appetite and satiety hormones that regulate how full you feel. Open
Statement Weight regain factors are all influenced by genetics and the environment, including puberty, race, and socioeconomic status. Open
Quotation It is much easier to lose weight than to keep it off, which is demonstrated across many studies. Open
Statement It is much easier to lose weight than to keep it off, which is demonstrated across many studies. Open
Statement Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent pediatric liver disease. Open
Statement Obesity is a significant risk factor for MASLD. Open
Statement About 20% of youth in the United States have obesity, which is roughly 15 million children. Open
Statement Approximately 5 million children have both obesity and MASLD. Open
Statement Between 250,000 and 1 million children with obesity and MASLD will progress to cirrhosis and needing a liver transplant or having hepatocellular carcinoma. Open
Statement There are racial and ethnic differences in MASLD prevalence. Open
Statement The rates of severe forms of obesity are only increasing. Open
Statement Obesity affects at least 35% of adults and 20% of children in Illinois alone. Open
Statement Obesity significantly increases the risk of long-term health problems and early death. Open
Statement The economic impact of obesity is substantial, with reductions in GDP and increases in state spending. Open
Quotation Crucially, we need to reiterate that obesity is a disease driven by biology and that it is no one's fault. Open
Statement Obesity is a disease driven by biology and it is no one's fault. Open
Statement Access to effective obesity medications is a health equity issue. Open
Statement Obesity disproportionately affects people of color and those living in poverty. Open
Statement Organizations like the Stop Obesity Alliance are working to analyze how states are covering obesity medications in Medicaid programs, and there is significant variation across the country. Open
Justin's statements about Pediatric Obesity 62 statements

Open the Pediatric Obesity collection →

Justin Ryder, MD- 2024 Pediatric Bariatric Surgery Update Course

Quotation I'm gonna cover three research hot topics that I think are on the horizon. Open
Statement Ten-year Teen Labs latent class analysis identified four phenotypes of bariatric surgery responders. Open
Statement Superior responders (18% of cohort) lost about 45% weight at nadir and maintained that weight loss out to 10 years. Open
Statement A second response group lost about 35% weight at nadir and kept over 25% off at 10 years. Open
Statement 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. Open
Quotation And while it doesn't, you know, appear to be great, as it was alluded to earlier, that's about what we're seeing with Somaglatide as a mean response in adolescence at 1 year. And so even at 10 years, that blue group, while it's not an ideal response, is still going to kick somaglatide's butt in terms of in terms of response. Open
Statement A fourth group (poor responders) did not lose ideal weight, returned to baseline by 4 years, and overshot their starting weight. Open
Quotation What's going on with these individuals? Do they have underlying syndromatic obesity, genetic causes of obesity? We really don't know. Open
Statement 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. Open
Quotation Nothing other than six month change was predictive of this response. Open
Statement At 2 years, weight loss is about 30% in both sleeve gastrectomy and Roux-en-Y gastric bypass in Teen Labs 10-year data. Open
Statement No difference was found between Roux-en-Y gastric bypass and sleeve gastrectomy out to 10 years in Teen Labs. Open
Statement Tirzepatide (dual GLP-1/GIP receptor agonist) shows 25% weight loss at 72 weeks, similar to 2-year surgical outcomes. Open
Quotation We're always going to get a grade of C for bariatric surgery from these, these policymakers and these advocacy organizations until we have true randomized trials of surgery versus an alternative therapy that has the potential to have the same benefit. Open
Statement Bariatric surgery receives a grade of C from policymakers and advocacy organizations due to lack of randomized trials versus alternative therapies. Open
Quotation We can't randomize kids to lifestyle because that's just unethical. Open
Statement Randomizing children to lifestyle intervention alone would be unethical. Open
Statement Bariatric surgery is more effective when performed at younger ages. Open
Quotation It can't simply be that it's duration of disease driven. Open
Statement The superior effectiveness of bariatric surgery in adolescents versus adults cannot be explained by duration of disease alone. Open
Quotation And so that's like 3 $15 million dollar ideas. So you're welcome. Open
Statement Drug companies prioritize timeline over quality in clinical trial diversity. Open

Pediatric Obesity Is a Disease: Treatment, Medications, Surgery & Equity in Care with Dr. Justin Ryder

Quotation The data clearly supports that obesity is a disease impacted by behavior. Open
Statement Obesity is a disease impacted by behavior and represents a multifactorial disease impacted by a robust gene-environment interaction. Open
Quotation The big picture view is that it's a multifactorial disease impacted by a robust gene-environment interaction. Open
Statement Obesity is influenced by numerous factors including genetics, epigenetics, appetite and satiety hormone dysregulation, stress, economics, adverse life experiences, and environmental factors like calorically dense foods and sedentary lifestyles. Open
Statement Historically, about 90% of efforts over the past 50 years have been on prevention of childhood obesity. Open
Quotation Historically, about 90% of our efforts over the past 50 years have been on prevention of childhood obesity. Open
Statement The new AAP clinical practice guidelines clearly state that obesity is a disease. Open
Quotation They clearly state that obesity is a disease. Open
Quotation The key takeaway is that the treatment should be offered to all children above the 85th percentile, and there should be no more watchful waiting. Open
Statement Treatment should be offered to all children above the 85th percentile, and there should be no more watchful waiting. Open
Statement The guidelines describe a non-linear continuum of care starting with intensive health, behavior, and lifestyle treatment involving more than 26 contact hours over a 3 to 12-month period. Open
Statement Pharmacotherapy is FDA labeled for adolescents above the age of 12. Open
Statement Currently, there are 5 medications that are FDA approved for the treatment of adolescents with obesity. Open
Statement Bariatric surgery should be considered for those over the age of 13 years old with a BMI 1.2 times the 95th percentile. Open
Statement Wegovy, a GLP-1 receptor agonist, causes about 17% weight loss and is FDA approved in adolescents. Open
Statement Data in adults on tirzepatide shows significant change in body weight compared to placebo. Open
Statement Oral GLP-1 medications are on the way in a few short years. Open
Statement Bariatric surgery studies show sustained weight loss in both adults and adolescent cohorts over several years. Open
Statement There is no difference between Roux-en-Y gastric bypass and vertical sleeve gastrectomy in terms of percent BMI change from baseline over a 10-year period. Open
Statement There is significant heterogeneity in response to bariatric surgery, and weight regain is a significant problem. Open
Statement Bariatric surgery produces substantial improvements in conditions that commonly occur with obesity, like hypertension, diabetes, and high lipids. Open
Statement Weight regain is driven by a complex interplay between behaviors like physical activity and energy intake, and biological factors like energy expenditure and appetite and satiety hormones that regulate how full you feel. Open
Statement Weight regain factors are all influenced by genetics and the environment, including puberty, race, and socioeconomic status. Open
Statement It is much easier to lose weight than to keep it off, which is demonstrated across many studies. Open
Quotation It is much easier to lose weight than to keep it off, which is demonstrated across many studies. Open
Statement Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent pediatric liver disease. Open
Statement Obesity is a significant risk factor for MASLD. Open
Statement About 20% of youth in the United States have obesity, which is roughly 15 million children. Open
Statement Approximately 5 million children have both obesity and MASLD. Open
Statement Between 250,000 and 1 million children with obesity and MASLD will progress to cirrhosis and needing a liver transplant or having hepatocellular carcinoma. Open
Statement There are racial and ethnic differences in MASLD prevalence. Open
Statement The rates of severe forms of obesity are only increasing. Open
Statement Obesity affects at least 35% of adults and 20% of children in Illinois alone. Open
Statement Obesity significantly increases the risk of long-term health problems and early death. Open
Statement The economic impact of obesity is substantial, with reductions in GDP and increases in state spending. Open
Quotation Crucially, we need to reiterate that obesity is a disease driven by biology and that it is no one's fault. Open
Statement Obesity is a disease driven by biology and it is no one's fault. Open
Statement Access to effective obesity medications is a health equity issue. Open
Statement Obesity disproportionately affects people of color and those living in poverty. Open
Statement Organizations like the Stop Obesity Alliance are working to analyze how states are covering obesity medications in Medicaid programs, and there is significant variation across the country. Open
Justin's statements about Type 2 Diabetes 22 statements

Open the Type 2 Diabetes collection →

Justin Ryder, MD- 2024 Pediatric Bariatric Surgery Update Course

Quotation I'm gonna cover three research hot topics that I think are on the horizon. Open
Statement Ten-year Teen Labs latent class analysis identified four phenotypes of bariatric surgery responders. Open
Statement Superior responders (18% of cohort) lost about 45% weight at nadir and maintained that weight loss out to 10 years. Open
Statement A second response group lost about 35% weight at nadir and kept over 25% off at 10 years. Open
Statement 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. Open
Quotation And while it doesn't, you know, appear to be great, as it was alluded to earlier, that's about what we're seeing with Somaglatide as a mean response in adolescence at 1 year. And so even at 10 years, that blue group, while it's not an ideal response, is still going to kick somaglatide's butt in terms of in terms of response. Open
Statement A fourth group (poor responders) did not lose ideal weight, returned to baseline by 4 years, and overshot their starting weight. Open
Quotation What's going on with these individuals? Do they have underlying syndromatic obesity, genetic causes of obesity? We really don't know. Open
Statement 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. Open
Quotation Nothing other than six month change was predictive of this response. Open
Statement No difference was found between Roux-en-Y gastric bypass and sleeve gastrectomy out to 10 years in Teen Labs. Open
Statement At 2 years, weight loss is about 30% in both sleeve gastrectomy and Roux-en-Y gastric bypass in Teen Labs 10-year data. Open
Statement Tirzepatide (dual GLP-1/GIP receptor agonist) shows 25% weight loss at 72 weeks, similar to 2-year surgical outcomes. Open
Statement Bariatric surgery receives a grade of C from policymakers and advocacy organizations due to lack of randomized trials versus alternative therapies. Open
Quotation We're always going to get a grade of C for bariatric surgery from these, these policymakers and these advocacy organizations until we have true randomized trials of surgery versus an alternative therapy that has the potential to have the same benefit. Open
Quotation We can't randomize kids to lifestyle because that's just unethical. Open
Statement Randomizing children to lifestyle intervention alone would be unethical. Open
Statement Bariatric surgery is more effective when performed at younger ages. Open
Quotation It can't simply be that it's duration of disease driven. Open
Statement The superior effectiveness of bariatric surgery in adolescents versus adults cannot be explained by duration of disease alone. Open
Quotation And so that's like 3 $15 million dollar ideas. So you're welcome. Open
Statement Drug companies prioritize timeline over quality in clinical trial diversity. Open