Key takeaways:
- Clinicians can use way of life modifications, drugs and surgical procedure to deal with weight problems in youngsters
- New pediatric tips encourage all pediatric clinicians to be conversant in these strategies.
Pediatric dermatologists should play an lively function in treating weight problems in youngsters, in accordance with a presenter on the Society for Pediatric Dermatology Annual Assembly.
As of 2018, 15% of youngsters have been identified with weight problems — up from 5% in 1960, in accordance with the Robert Wooden Johnson Basis’s 2022 State of Childhood Weight problems Report. At this price, specialists estimate that greater than half of youngsters in 2050 could have weight problems, Alaina Vidmar, MD, director of weight problems drugs and bariatric surgical procedure at Youngsters’s Hospital Los Angeles and affiliate professor of endocrinology on the Keck College of Medication of USC, stated throughout a presentation. “Pediatric weight problems is a posh persistent illness,” Vidmar informed Healio. “It’s an interaction between biology, genetics and the surroundings that has led to … elevated adiposity. Treating this situation has nothing to do with the quantity on the dimensions or the dimensions of the physique, however as a substitute, stopping life-limiting situations over time.”
There are lots of comorbidities that accompany weight problems, together with dermatologic situations similar to hidradenitis suppurativa, psoriasis and acanthosis nigricans, placing dermatologists in a needed place to deal with this situation, Vidmar stated.
Vidmar spoke with Healio about how dermatologists can higher make the most of the increasing armamentarium of therapy choices for pediatric weight problems.
Treating weight problems requires a multimodal strategy
In 2023, the American Academy of Pediatrics up to date its 2007 pediatric weight problems tips, shifting away from a staged therapy strategy towards a multimodal strategy.
“As a result of weight problems is a posh persistent illness, it’s a must to deal with it primarily based on the severity of the illness, similar to you’ll some other complicated persistent situation,” Vidmar stated. “It isn’t that each single affected person goes by way of stage one, stage two, stage three, in a chronologic strategy. As a substitute, you could use no matter therapy you want primarily based on the affected person in entrance of you at that second.”
There are three therapy approaches for weight problems: intensive well being and conduct way of life therapy, weight problems pharmacotherapy and bariatric surgical procedure. Way of life modification includes making dietary and bodily exercise adjustments at dwelling or together with an intensive care program. This strategy usually leads to a 3% discount in BMI, Vidmar stated.
Weight problems pharmacotherapy can drive weight lack of 5% to as a lot as 15% with the most recent accredited drugs. For choose adolescents, bariatric surgical procedure can result in as a lot as a 30% discount in BMI.
Though the standard staged mannequin would require sufferers modify their way of life earlier than making an attempt medical or surgical routes, the 2023 tips suggest choosing one or a number of of those approaches primarily based on the affected person’s wants.
“If I meet you on day one and also you want bariatric surgical procedure on day one, that must be launched to you as the very best strategy,” Vidmar stated. “Try to be launched to all three phases without delay primarily based on what you require at the moment.”
Which medicine to prescribe
Within the occasion that pharmacotherapy is important, there are a number of regimens, each accredited and off-label, which have proven efficacy for treating weight problems in youngsters and adolescents:
- metformin, usually prescribed for individuals with kind 2 diabetes;
- orlistat, accredited in 2000 for youngsters and adults aged 12 years and older;
- topiramate, an anticonvulsant proven to trigger weight reduction
- exenatide, the primary GLP-1 receptor agonist accredited by the FDA;
- liraglutide, a once-daily GLP-1 receptor agonist accredited for youngsters and adults aged 12 years and older;
- setmelanotide (Imcivree, Rhythm Prescribed drugs), accredited in 2020 for youngsters and adults aged 12 years and older with weight problems as a result of sure genetic situations in addition to youngsters aged 2 years and older with Bardet-Biedl syndrome;
- lisdexamfetamine, a drugs prescribed for binge consuming dysfunction and ADHD;
- bupropion/naltrexone, a mix drug accredited for weight administration in adults
- phentermine/topiramate, accredited for youngsters and adults aged 12 years and older; and
- semaglutide (Wegovy, Novo Nordisk), with an expanded indication for youngsters and adults aged 12 years and older accredited by the FDA in 2022.
The most typical drugs at the moment prescribed for youngsters are phentermine, topiramate and semaglutide, Vidmar stated, who famous that GLP-1s are the best medication for weight administration and may, when potential, be prescribed forward of different choices. Nonetheless, Vidmar emphasised the significance of contemplating sufferers’ dwelling conditions, together with medical insurance coverage, when deciding between these drugs.
“As with all medicine, there are at all times qualifying standards in addition to contraindications,” Vidmar stated. “Entry to those brokers is absolutely variable primarily based on the state you’re employed in and insurance coverage protection. Every clinician wants to know that and decide what entry their affected person has.”
Surgical procedure an underutilized device
In extreme instances of weight problems, bariatric surgical procedure needs to be launched instantly, Vidmar stated.
“Surgical procedure is the best underutilized device on this house,” Vidmar stated. “The extra that we are able to educate mother and father and households about it as a useful resource … the extra they will study and actually perceive that strategy.”
Bariatric surgical procedure is secure, Vidmar stated, who famous critical problems are uncommon.
If a dermatologist is treating a affected person that ought to endure bariatric surgical procedure, referring to an endocrinologist first is important, Vidmar stated. Nonetheless, candidates for bariatric surgical procedure needs to be positioned on a drugs routine whereas they wait for his or her surgical procedure date as a result of the method, together with presurgery schooling, can take time.
All clinicians should ‘do their half,’ together with dermatologists
Endocrinologists are hopeful that they will change the trajectory of pediatric weight problems as a result of developments in weight problems therapy and elevated understanding of the illness, Vidmar stated. Nonetheless, they can’t do it alone.
“Whereas the hope can be that everybody has entry to seek advice from an endocrinologist that does weight problems drugs and seek advice from a complete weight problems program, that is simply not the truth,” Vidmar stated. “There aren’t sufficient packages throughout the nation to match demand. All of us should do our half.”
Vidmar stated dermatologists “completely needs to be” prescribing weight reduction drugs to sufferers who want them. The 2023 therapy tips are written in such a means that every one suppliers caring for youngsters will be outfitted to deal with weight problems, Vidmar stated.
“The brand new medical follow tips are written with the intention that this work now not be centered to 1 group of individuals, as a result of the scope of this illness entity is so broad and so broad that, if we do this, we’re actually not going to have the ability to adequately take care of this illness entity,” Vidmar stated. “All well being care clinicians that take care of younger individuals with extra weight needs to be outfitted to prescribe these brokers.”
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For extra info:
Alaina Vidmar, MD, will be reached at dermatology@healio.com.
