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Justin Ryder, MD- 2024 Pediatric Bariatric Surgery Update Course
With Dr. Justin Ryder
Chapter 1 of 4 · Fundamentals
Speaker introduction
Introduction of Justin Ryder
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Ten-year Teen Labs latent class analysis identified four phenotypes of bariatric surgery responders.
Superior responders (18% of cohort) lost about 45% weight at nadir and maintained that weight loss out to 10 years.
A second response group lost about 35% weight at nadir and kept over 25% off at 10 years.
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.
A fourth group (poor responders) did not lose ideal weight, returned to baseline by 4 years, and overshot their starting weight.
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.
At 2 years, weight loss is about 30% in both sleeve gastrectomy and Roux-en-Y gastric bypass in Teen Labs 10-year data.
No difference was found between Roux-en-Y gastric bypass and sleeve gastrectomy out to 10 years in Teen Labs.
Tirzepatide (dual GLP-1/GIP receptor agonist) shows 25% weight loss at 72 weeks, similar to 2-year surgical outcomes.
Bariatric surgery receives a grade of C from policymakers and advocacy organizations due to lack of randomized trials versus alternative therapies.
Randomizing children to lifestyle intervention alone would be unethical.
Bariatric surgery is more effective when performed at younger ages.
The superior effectiveness of bariatric surgery in adolescents versus adults cannot be explained by duration of disease alone.
Oncology colleagues began using genetics for precision medicine about 30 years ago, with 20-30 years required for patient impact.
Metabolic pathways perturbed by obesity may be relevant to treatment response independent of genetic origins.
A DC pediatric bariatric cohort is approximately 60-66% Black, 20% Hispanic, and 20% white or other.
Tirzepatide and semaglutide drug trials are approximately 70% or more white participants and not conducted in urban settings.
Anti-obesity medications do not work in real-world urban populations as effectively as shown in clinical trials.
Drug companies prioritize timeline over quality in clinical trial diversity.