MedWorm: Pediatrics

Ethical issues in pediatric bariatric surgery

Seminars in Pediatric Surgery — Wed, 01 Jul 2009 15:51:32 +0100

Performance of bariatric surgery in pediatric patients carries profound ethical burdens for all stakeholders: morbidly obese children and adolescents, their parents and families, pediatric physicians and surgeons, pediatric health care institutions, and society. The decision to proceed with a bariatric intervention should be made only after it is established that the patient's comorbidities could not be treated with less invasive means, the patient has a favorable risk/benefit profile, the patient and her/his family have received extensive preoperative counseling and given informed consent, and the pediatric bariatric team has a comprehensive system of short- and long-term care. The patient and her/his family should be counseled about the innovative aspects of the bariatric intervention, i...

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How young for bariatric surgery in children?

Seminars in Pediatric Surgery — Wed, 01 Jul 2009 15:51:32 +0100

This article discusses the problems obesity presents to children and their families, highlights the unique aspects of treating obesity in children, reviews the currently utilized bariatric surgical procedures, and introduces those bariatric procedures that are under development. When considering whether to use bariatric surgical procedures in a multidisciplinary weight management program for children, the special needs and characteristics of children with a severe weight problem must be considered. Development of bariatric surgical techniques and devices and implementation of these tools in multidisciplinary weight management programs need greater attention. This will require the combined efforts of the pediatric health care providers from many specialties and partnerships with industry to...

Medical versus surgical interventions for the metabolic complications of obesity in children

Seminars in Pediatric Surgery — Wed, 01 Jul 2009 15:51:32 +0100

The global epidemic of obesity has not spared children. Although prevention of obesity is commendable, we cannot hide from the pressing need to identify, assess, and actively manage children seriously afflicted by obesity and its associated conditions. Sustained weight loss (or, for children, lowering of body mass index standard deviation score) delivers major health benefit, but in children has been difficult to achieve. In adults, the success of the diabetes prevention programs using practical lifestyle interventions is indisputable. Medical therapy, although currently limited in it scope, provides some promise for older children. There is now accumulating evidence, generally of poor quality that surgical interventions (laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass...

Weighing risk: the Expert Committee's recommendations in practice

Seminars in Pediatric Surgery — Wed, 01 Jul 2009 15:51:31 +0100

This article reviews recommendations on assessment of BMI, nutrition and activity, and obesity-related comorbidities. Principles of obesity prevention and treatment are discussed and high-risk eating and activity behaviors are addressed. Prevention and treatment of obesity are reviewed as set in the context of the Medical Home using the principles of the chronic disease model. The stepwise approach to obesity treatment and prevention is reviewed along with specific evidence-based/informed strategies. The skills needed to implement the recommendations, such as integration of the care team, roles and training, links to the health care system, connection to the community, and the role of the subspecialist, are discussed. (Source: Seminars in Pediatric Surgery)

Diet, exercise, behavior: the promise and limits of lifestyle change

Seminars in Pediatric Surgery — Wed, 01 Jul 2009 15:51:31 +0100

The prevalent surge in childhood and adolescent obesity within the past 3 decades poses a significant challenge for many pediatric clinicians who are charged with treating this condition. Comprehensive, research-based pediatric obesity treatment programs are essential to addressing this problem and preventing the transition of obesity and its many comorbidities into adulthood. This paper will identify dietary, physical activity, and behavioral approaches to lifestyle change and describe how they are incorporated as part of multidisciplinary treatment interventions in youth. Specific tailoring of treatment programs to address age and varying degrees of overweight and obesity will also be presented along with recommendations for future research. (Source: Seminars in Pediatric Surgery)

Diagnosis and treatment of pediatric nonalcoholic steatohepatitis and the implications for bariatric surgery

Seminars in Pediatric Surgery — Wed, 01 Jul 2009 15:51:31 +0100

This review focuses on the diagnosis, risk factors, prevalence, pathogenesis and treatment of pediatric nonalcoholic steatohepatitis (NASH). NASH is a progressive form of nonalcoholic fatty liver disease (NAFLD), the most common cause of chronic liver disease in children. The factors that account for differences between children with NASH and children with milder forms of NAFLD are unclear. The diagnosis of NASH requires interpretation of liver histology because no noninvasive markers predict the presence or severity of NASH. There is no proven treatment for NASH. Several clinical trials for NAFLD are in progress; however, clinical trials focusing on NASH are needed. Heightened physician awareness of NAFLD, NASH, and associated risk factors is important to identify and treat affected child...

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Use of the metabolic syndrome in pediatrics: a blessing and a curse

Seminars in Pediatric Surgery — Wed, 01 Jul 2009 15:51:31 +0100

The clustering of traditional cardiovascular disease risk factors is known as the metabolic syndrome. The metabolic syndrome was first characterized as a distinct entity by Dr. Gerald Reaven in 1988. The intent was to identify individuals at greatest risk for cardiovascular disease mortality and those in urgent need of lifestyle intervention. Since then the metabolic syndrome has evolved into a diagnosable entity recognized by the National Cholesterol Education Program, Adult Treatment Panel III, World Health Organization, and the International Diabetes Foundation. However, the metabolic syndrome as a diagnosis faces considerable controversy, particularly when applied to the pediatric population. Due to the changes in growth and development, the adult criteria for the metabolic syndrome ca...

Changes in physiology with increasing fat mass

Seminars in Pediatric Surgery — Wed, 01 Jul 2009 15:51:31 +0100

Obesity has reached epidemic proportions in the USA with a nearly fourfold rise in the prevalence of childhood obesity. There are many possible etiologies of obesity as the adipose tissue plays a significant, complex role in the physiology of fuel metabolism and hormone regulation. The development of obesity represents a pathophysiologic increase in fat mass in which multiple metabolic pathways are deranged. The consequences of these metabolic derangements, including insulin resistance and inflammation, are reflected in obesity-related comorbidities and can be seen in the setting of pediatric obesity. Obese adolescents demonstrate increased rates of early maturation, orthopedic growth abnormalities, diabetes mellitus, obstructive sleep apnea, hypertension, steatosis, and polycystic ovarian...

Preface

Seminars in Pediatric Surgery — Wed, 01 Jul 2009 15:51:31 +0100

Although the overall health status of the pediatric population in the United States has improved, the last quarter century has witnessed a dramatic rise in the prevalence of childhood obesity and its associated comorbid conditions. Specifically, the medical community is witnessing a steady and alarming rise in the prevalence of chronic diseases among obese children, including diabetes, hypertension, obstructive sleep apnea, hyperlipidemia, and cardiovascular disease. (Source: Seminars in Pediatric Surgery)

Seminars in Pediatric Surgery — Wed, 01 Jul 2009 15:51:31 +0100

(Source: Seminars in Pediatric Surgery)

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