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▶Ep 2 · 4:00
We certainly know what drives our thinking about pediatric obesity treatment um from the standpoint of, of aggressive treatment like surgery, and it's classically been described as, uh, as clinically severe obesity, where obesity is actually causing um uh some um health consequences or behavioral consequences, uh, impairments in quality of life for um teenagers.
I do believe um it's, it's not. Uh, we say, we often say it's not all about the weight, um, but it, it is about the weight, and I think that when we can get them to these, to the lower BMIs, perhaps by operating, uh, uh, earlier after the diagnosis of severe obesity, uh, the better they're gonna be long term.
quoteWe certainly know what drives our thinking about pediatric obesity treatment um from the standpoint of, of aggressive treatment like surgery, and it's classically been described as, uh, as clinically severe obesity, where obesity is actually causing um uh some um health consequences or behavioral consequences, uh, impairments in quality of life for um teenagers.↗
▶Ep 2 · 4:00
host_summaryCardiovascular mortality begins to climb in the overweight range and increases definitively for adolescents at or above the 95th percentile BMI, leading to early cardiovascular death.↗
▶Ep 2 · 8:00
clinicalFAS-5 study achieved 81% participation (58 of 74 eligible) at 8-year follow-up, mostly with in-person research visits.↗
quoteWhat we see on average at eight years is a BMI decline of, of 29%.↗
▶Ep 2 · 13:00
clinicalAt 8-year mean follow-up, gastric bypass patients had a mean BMI decline of 29%.↗
▶Ep 2 · 15:00
clinicalBaseline BMI strongly correlates (R=0.75) with follow-up BMI: patients starting with BMI in the 60s end above 40, while those starting in the 40s reach near-normal BMI.↗
▶Ep 2 · 17:00
clinicalRemission rates at 8 years: 88% for diabetes, 64% for dyslipidemia, 75% for hypertension.↗
▶Ep 2 · 18:00
clinicalAmong those without baseline comorbidities, incidence rates were 0% for diabetes, 50% for dyslipidemia (small denominator), and 3 of 29 developed hypertension.↗
▶Ep 2 · 20:00
clinicalFollow-up BMI predicts probability of hypertension, dyslipidemia, high CRP, high insulin, insulin resistance, and low HDL; higher residual BMI is metabolically harmful.↗
▶Ep 2 · 21:00
quoteWe see that there's a definite relationship. So where the BMI ended up matters.↗
▶Ep 2 · 21:10
quoteDoes it really matter? Are, is everything gonna be, you know, peaches and cream or gravy or the bad examples, but uh uh uh bad things. But uh is everything gonna be good with your health, um, now that you've had surgery, no matter what your BMI? And the answer to that seems to be no.↗
▶Ep 2 · 23:00
clinicalAt 8 years, FAS-5 cohort showed low iron stores with anemia, elevated PTH, and low vitamin D in substantial numbers.↗
▶Ep 2 · 25:00
host_summaryIn AMOS study, non-surgical controls with severe obesity gained weight over 5 years (BMI 42→45).↗
▶Ep 2 · 26:00
host_summaryAMOS gastric bypass patients had dramatic BMI reduction from 45 to 30, stable at 5 years, similar to adult controls and SOS cohort.↗
▶Ep 2 · 28:00
host_summaryAMOS showed 83% dyslipidemia remission, 12 of 12 hypertension cases resolved, and 75% inflammation (CRP) resolved.↗
▶Ep 2 · 29:00
clinicalAMOS had high internal hernia rates due to unclosed mesenteric defects at laparoscopic gastric bypass; closing defects prevents this complication.↗
▶Ep 2 · 29:00
quoteI think that, uh, we have, uh, uh, been Teaching for some time that these defects have to be closed or they will lead to uh internal hernias and incarceration and uh general misery.↗
▶Ep 2 · 30:00
host_summaryIn AMOS, low vitamin D was found in >50% of gastric bypass patients and also in controls; low B12 and iron deficiency anemia were noted.↗
▶Ep 2 · 31:00
clinicalTeen Labs enrolled 242 adolescents (161 bypass, 67 sleeve, 14 band) at 5 centers; median age now 24, with 203 completing 5-year visits (72% in-clinic, 17% field).↗
▶Ep 2 · 32:00
clinicalAdding 33 sleeve gastrectomy patients to Teen Labs will provide 80% power to compare bypass vs. sleeve for outcomes including blood pressure, PTH, HDL, and BMI.↗
▶Ep 2 · 32:17
clinicalThe 33 new sleeve patients can be enrolled within a year from consortium sites with ongoing clinical follow-up, enabling long-term comparisons.↗
▶Ep 2 · 32:47
clinicalFAS-5 study had a residual mean BMI of 38 at 8 years, with many patients remaining severely obese; this residual obesity is metabolically harmful.↗
▶Ep 2 · 32:47
opinionOperating earlier after diagnosis of severe obesity may yield lower residual BMI and better long-term metabolic outcomes.↗
▶Ep 2 · 32:47
quoteI do believe um it's, it's not. Uh, we say, we often say it's not all about the weight, um, but it, it is about the weight, and I think that when we can get them to these, to the lower BMIs, perhaps by operating, uh, uh, earlier after the diagnosis of severe obesity, uh, the better they're gonna be long term.↗
▶Ep 2 · 34:00
clinicalSeverely obese patients have greater bone mineral density due to loading; rapid weight loss after bariatric surgery drops bone mass, raising the question of whether it stabilizes or continues to decline (bariatric bone disease).↗
