Stephanie Walsh
80 statements · 3 topics · summaries given as host listed separately
Featured statements
one of the things I love about Vyvanse is that for whatever reason, I had a cohort of patients who did not get satiety from their sleeve, uh, no matter, you know, and I obviously do the same. Amount of resection each time. So, those patients, we start on 2 weeks, 2 weeks post-op.
quote ·
Obesity
all the, all the studies, including my own, looking at 6 months or later time points, they're gonna be great, but they're actually way too late. The, the, the data strongly suggest starting earlier and being more aggressive.
quote ·
Obesity
How do we also make sure that if we're giving them something that decreases their hunger, when we've also given them a surgery that decreases their hunger to make sure they're still eating what they need to eat.
quote ·
Type 2 Diabetes
we offer medications at 3 months for less than 10% total body weight loss and at 6 months for less than 15%. Um, those are very conservative given the teen labs data
quote ·
Type 2 Diabetes
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Stephanie's statements about Obesity 41 statements
Introduction - 2024 Pediatric Bariatric Surgery Update Course
Statement
Stephanie Walsh now works with Evan Nadler at ProCare Consultants to help programs develop, grow, and become accredited.
Open
Quotation
we're looking to help programs develop, grow, and become accredited so we can get some of these really good programs out there across the country.
Open
Statement
Stephanie Walsh practiced as a pediatrician doing pediatric weight management at Children's Healthcare Atlanta for 15+ years.
Open
Stephanie Walsh, MD - 2024 Pediatric Bariatric Surgery Update Course
Statement
Expected weight loss after pediatric bariatric surgery is typically quoted as 25-35% total body weight loss.
Open
Quotation
what is adequate weight loss? And again, going back to when I know when I tell the kids and I see them, I'm always like, OK, 25 to 35%. But then looking at some of the stuff that Tom just showed us in, in the next couple of slides is how much are, are people actually losing it? And what does adequate mean? And the reality is that that's Actually very subjective for some of these kids.
Open
Statement
Kids who can lose weight usually lose weight, and kids who cannot do not—this group requires focused intervention.
Open
Quotation
what we do know is the kids that can lose weight usually lose weight, and the kids who can't don't, and that's really that group we need to look at because what are we, what are we doing for those kids?
Open
Quotation
I actually have a saying that I put in mind, like if some of these kids, you know, they get their license over the course of this. And they have what I call the Starbucks phenomenon. And all of a sudden Frappuccino is like, you know, part of their daily diet.
Open
Statement
When adolescents start drinking sugar after bariatric surgery, it is usually because they are not eating food and the sugar makes them feel better.
Open
Quotation
I also noticed when they start to drink sugar, it's usually cause they're not eating food. And, you know, they're starting to feel bad and the sugar makes them feel a little bit better.
Open
Statement
Physical activity in adolescent girls is lower than in boys, and is predominantly influenced by their mothers' activity levels.
Open
Quotation
the girls and physical activity for girls is always lower than boys. So anything we can do to get that up and That physical activity for kids is predominantly influenced by their moms.
Open
Quotation
I've actually really been using some of the bupropion post-op. Again, they have supposed to be 18, but if we can get a form, that seems to help with some of that mood piece that we see afterwards, as well as sort of just giving them that little extra bit heading towards weight loss.
Open
Statement
Bupropion post-operatively helps with mood and provides additional weight loss benefit, though it is labeled for age 18 and older.
Open
Statement
Pre-operative anti-obesity medications can provide psychological benefit by helping adolescents stabilize or lose weight, keeping them engaged in the program.
Open
Quotation
The reality is, almost all my kids can only take phentermine and Topamax. I don't really have access to GLP ones for, for most of my bariatric patients at all.
Open
Statement
Most pediatric bariatric patients can only access phentermine and topiramate; GLP-1 agonists are not available for most patients.
Open
Quotation
How do we also make sure that if we're giving them something that decreases their hunger, when we've also given them a surgery that decreases their hunger to make sure they're still eating what they need to eat.
Open
Statement
When using medications that decrease hunger post-operatively after a surgery that also decreases hunger, clinicians must ensure patients are still eating adequate nutrition.
Open
Statement
Medication availability is almost entirely determined by insurance coverage and supply constraints.
Open
Statement
In Atlanta, phentermine is only available in 15 mg capsule form, which cannot be split.
Open
Quotation
It's so funny to me that I have families who are very, like, let's get the surgery and let's be done. But when it comes to medications, a lot of families are a little hesitant.
Open
Statement
Many families are hesitant about long-term medication use despite accepting bariatric surgery.
Open
Quotation
There almost seems to be like different camps. Like there's camps of people who very much like, I'll never do surgery. I want medications. And then there's another camp that's like, I want nothing with long-term medications. I want surgery.
Open
Quotation
the people at Nova Nordics that I've talked to, they, they're sending out the 1.7 and 2.4, but there, there's very, very little of the, the lower doses. Um, they're just prioritizing the people who are trying to maintain. That we're already on it.
Open
Statement
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.
Open
Statement
As of last year, 1.7 mg semaglutide is considered a maintenance dose, which should reduce insurance coverage barriers.
Open
Quotation
the 1.7 is considered now a maintenance dose, so there should be less issue about insurers paying for 1.7.
Open
Quotation
You should use the lowest dose that your patient, you know, one, they can tolerate and that's effective, um, and that's gonna be different for every patient.
Open
Statement
Clinicians should use the lowest medication dose that the patient can tolerate and that is effective, which varies by individual.
Open
Statement
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.
Open
Quotation
we offer medications at 3 months for less than 10% total body weight loss and at 6 months for less than 15%. Um, those are very conservative given the teen labs data
Open
Quotation
in our 750 patients, we've looked at the modeling and if you don't have, uh, if you're off the curve at 3 months, you're never, you're never back on that curve.
Open
Statement
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.
Open
Quotation
one of the things I love about Vyvanse is that for whatever reason, I had a cohort of patients who did not get satiety from their sleeve, uh, no matter, you know, and I obviously do the same. Amount of resection each time. So, those patients, we start on 2 weeks, 2 weeks post-op.
Open
Statement
A cohort of sleeve gastrectomy patients did not achieve satiety despite standard resection; these patients were started on Vyvanse at 2 weeks post-operatively.
Open
Quotation
all the, all the studies, including my own, looking at 6 months or later time points, they're gonna be great, but they're actually way too late. The, the, the data strongly suggest starting earlier and being more aggressive.
Open
Statement
Studies examining medication use at 6 months or later are too late; data strongly suggest starting medications earlier and being more aggressive.
Open
Quotation
if you think about, you know, if then they're on insulin, I mean, the longer they're on insulin, the less likely you are to help their diabetes.
Open
Statement
The longer adolescents with type 2 diabetes are on insulin, the less likely intervention will help their diabetes.
Open
Stephanie's statements about Pediatric Obesity 1 statement
Open the Pediatric Obesity collection →
Welcome & Introduction: Pediatric Obesity 2017
Quotation
Yes, I, I'm super excited. This is our 5th 1, and I think this lineup is spectacular.
Open
Stephanie's statements about Type 2 Diabetes 38 statements
Open the Type 2 Diabetes collection →
Stephanie Walsh, MD - 2024 Pediatric Bariatric Surgery Update Course
Statement
Expected weight loss after pediatric bariatric surgery is typically quoted as 25-35% total body weight loss.
Open
Quotation
what is adequate weight loss? And again, going back to when I know when I tell the kids and I see them, I'm always like, OK, 25 to 35%. But then looking at some of the stuff that Tom just showed us in, in the next couple of slides is how much are, are people actually losing it? And what does adequate mean? And the reality is that that's Actually very subjective for some of these kids.
Open
Quotation
what we do know is the kids that can lose weight usually lose weight, and the kids who can't don't, and that's really that group we need to look at because what are we, what are we doing for those kids?
Open
Statement
Kids who can lose weight usually lose weight, and kids who cannot do not—this group requires focused intervention.
Open
Quotation
I actually have a saying that I put in mind, like if some of these kids, you know, they get their license over the course of this. And they have what I call the Starbucks phenomenon. And all of a sudden Frappuccino is like, you know, part of their daily diet.
Open
Statement
When adolescents start drinking sugar after bariatric surgery, it is usually because they are not eating food and the sugar makes them feel better.
Open
Quotation
I also noticed when they start to drink sugar, it's usually cause they're not eating food. And, you know, they're starting to feel bad and the sugar makes them feel a little bit better.
Open
Statement
Physical activity in adolescent girls is lower than in boys, and is predominantly influenced by their mothers' activity levels.
Open
Quotation
the girls and physical activity for girls is always lower than boys. So anything we can do to get that up and That physical activity for kids is predominantly influenced by their moms.
Open
Quotation
I've actually really been using some of the bupropion post-op. Again, they have supposed to be 18, but if we can get a form, that seems to help with some of that mood piece that we see afterwards, as well as sort of just giving them that little extra bit heading towards weight loss.
Open
Statement
Bupropion post-operatively helps with mood and provides additional weight loss benefit, though it is labeled for age 18 and older.
Open
Statement
Pre-operative anti-obesity medications can provide psychological benefit by helping adolescents stabilize or lose weight, keeping them engaged in the program.
Open
Quotation
The reality is, almost all my kids can only take phentermine and Topamax. I don't really have access to GLP ones for, for most of my bariatric patients at all.
Open
Statement
Most pediatric bariatric patients can only access phentermine and topiramate; GLP-1 agonists are not available for most patients.
Open
Quotation
How do we also make sure that if we're giving them something that decreases their hunger, when we've also given them a surgery that decreases their hunger to make sure they're still eating what they need to eat.
Open
Statement
When using medications that decrease hunger post-operatively after a surgery that also decreases hunger, clinicians must ensure patients are still eating adequate nutrition.
Open
Statement
Medication availability is almost entirely determined by insurance coverage and supply constraints.
Open
Statement
In Atlanta, phentermine is only available in 15 mg capsule form, which cannot be split.
Open
Quotation
It's so funny to me that I have families who are very, like, let's get the surgery and let's be done. But when it comes to medications, a lot of families are a little hesitant.
Open
Statement
Many families are hesitant about long-term medication use despite accepting bariatric surgery.
Open
Quotation
There almost seems to be like different camps. Like there's camps of people who very much like, I'll never do surgery. I want medications. And then there's another camp that's like, I want nothing with long-term medications. I want surgery.
Open
Quotation
the people at Nova Nordics that I've talked to, they, they're sending out the 1.7 and 2.4, but there, there's very, very little of the, the lower doses. Um, they're just prioritizing the people who are trying to maintain. That we're already on it.
Open
Statement
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.
Open
Statement
As of last year, 1.7 mg semaglutide is considered a maintenance dose, which should reduce insurance coverage barriers.
Open
Quotation
the 1.7 is considered now a maintenance dose, so there should be less issue about insurers paying for 1.7.
Open
Statement
Clinicians should use the lowest medication dose that the patient can tolerate and that is effective, which varies by individual.
Open
Quotation
You should use the lowest dose that your patient, you know, one, they can tolerate and that's effective, um, and that's gonna be different for every patient.
Open
Statement
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.
Open
Quotation
we offer medications at 3 months for less than 10% total body weight loss and at 6 months for less than 15%. Um, those are very conservative given the teen labs data
Open
Quotation
in our 750 patients, we've looked at the modeling and if you don't have, uh, if you're off the curve at 3 months, you're never, you're never back on that curve.
Open
Statement
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.
Open
Quotation
one of the things I love about Vyvanse is that for whatever reason, I had a cohort of patients who did not get satiety from their sleeve, uh, no matter, you know, and I obviously do the same. Amount of resection each time. So, those patients, we start on 2 weeks, 2 weeks post-op.
Open
Statement
A cohort of sleeve gastrectomy patients did not achieve satiety despite standard resection; these patients were started on Vyvanse at 2 weeks post-operatively.
Open
Statement
Studies examining medication use at 6 months or later are too late; data strongly suggest starting medications earlier and being more aggressive.
Open
Quotation
all the, all the studies, including my own, looking at 6 months or later time points, they're gonna be great, but they're actually way too late. The, the, the data strongly suggest starting earlier and being more aggressive.
Open
Statement
The longer adolescents with type 2 diabetes are on insulin, the less likely intervention will help their diabetes.
Open
Quotation
if you think about, you know, if then they're on insulin, I mean, the longer they're on insulin, the less likely you are to help their diabetes.
Open
Summaries Stephanie gave as host · 6 summaries
Recaps of other experts' statements, not Stephanie's own clinical position.
Summaries Stephanie gave as host · Obesity 3 summaries
Stephanie Walsh, MD - 2024 Pediatric Bariatric Surgery Update Course
Host summary
Stephanie Walsh summarizing the discussion: In heterogeneous outcome data, one subgroup shows only 12% weight loss at 10-year follow-up while other groups are highly successful.
Open
Host summary
Stephanie Walsh summarizing the discussion: An unpublished study by Tom showed improvement in weight loss outcomes with phentermine and topiramate use post-operatively in approximately 12 patients.
Open
Host summary
Stephanie Walsh summarizing the discussion: 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.
Open
Summaries Stephanie gave as host · Type 2 Diabetes 3 summaries
Open the Type 2 Diabetes collection →
Stephanie Walsh, MD - 2024 Pediatric Bariatric Surgery Update Course
Host summary
Stephanie Walsh summarizing the discussion: In heterogeneous outcome data, one subgroup shows only 12% weight loss at 10-year follow-up while other groups are highly successful.
Open
Host summary
Stephanie Walsh summarizing the discussion: An unpublished study by Tom showed improvement in weight loss outcomes with phentermine and topiramate use post-operatively in approximately 12 patients.
Open
Host summary
Stephanie Walsh summarizing the discussion: 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.
Open