scholarly journals Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline

2017 ◽  
Vol 102 (3) ◽  
pp. 709-757 ◽  
Author(s):  
Dennis M. Styne ◽  
Silva A. Arslanian ◽  
Ellen L. Connor ◽  
Ismaa Sadaf Farooqi ◽  
M. Hassan Murad ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Clinical Practice ◽  
Pediatric Obesity ◽  
Lifestyle Modification ◽  
Task Force ◽  
Childhood And Adolescence ◽  
Biological Factors ◽  
Endocrine Society ◽  
Treatment And Prevention

Abstract Cosponsoring Associations: The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society. Objective: To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity. Participants: The participants include an Endocrine Society–appointed Task Force of 6 experts, a methodologist, and a medical writer. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline. Conclusion: Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.

scholarly journals Response to Letter: “Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline”

2017 ◽  
Vol 102 (6) ◽  
pp. 2123-2124 ◽  
Author(s):  
Dennis M. Styne ◽  
Silva A. Arslanian ◽  
Ellen L. Connor ◽  
Ismaa Sadaf Farooqi ◽  
M. Hassan Murad ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Pediatric Obesity ◽  
Endocrine Society ◽  
Treatment And Prevention

scholarly journals Endocrine and Nutritional Management of the Post-Bariatric Surgery Patient: An Endocrine Society Clinical Practice Guideline

2010 ◽  
Vol 95 (11) ◽  
pp. 4823-4843 ◽  
Author(s):  
David Heber ◽  
Frank L. Greenway ◽  
Lee M. Kaplan ◽  
Edward Livingston ◽  
Javier Salvador ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Regain ◽  
Task Force ◽  
Care Physician ◽  
Nutritional Deficiencies ◽  
Future Research ◽  
Endocrine Society ◽  
Surgery Patient ◽  
Corporate Funding ◽  
Specific Disorders

Objective: We sought to provide guidelines for the nutritional and endocrine management of adults after bariatric surgery, including those with diabetes mellitus. The focus is on the immediate postoperative period and long-term management to prevent complications, weight regain, and progression of obesity-associated comorbidities. The treatment of specific disorders is only summarized. Participants: The Task Force was composed of a chair, five additional experts, a methodologist, and a medical writer. It received no corporate funding or remuneration. Conclusions: Bariatric surgery is not a guarantee of successful weight loss and maintenance. Increasingly, patients regain weight, especially those undergoing restrictive surgeries such as laparoscopic banding rather than malabsorptive surgeries such as Roux-en-Y bypass. Active nutritional patient education and clinical management to prevent and detect nutritional deficiencies are recommended for all patients undergoing bariatric surgery. Management of potential nutritional deficiencies is particularly important for patients undergoing malabsorptive procedures, and strategies should be employed to compensate for food intolerance in patients who have had a malabsorptive procedure to reduce the risk for clinically important nutritional deficiencies. To enhance the transition to life after bariatric surgery and to prevent weight regain and nutritional complications, all patients should receive care from a multidisciplinary team including an experienced primary care physician, endocrinologist, or gastroenterologist and consider enrolling postoperatively in a comprehensive program for nutrition and lifestyle management. Future research should address the effectiveness of intensive postoperative nutritional and endocrine care in reducing morbidity and mortality from obesity-associated chronic diseases.

Trends in pediatric obesity management, a survey from the Pediatric Endocrine Society Obesity Committee

2020 ◽  
Vol 33 (4) ◽  
pp. 469-472 ◽  
Author(s):  
Ashley H. Shoemaker ◽  
Stephanie T. Chung ◽  
Amy Fleischman ◽  
_ _
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Pediatric Obesity ◽  
Online Survey ◽  
Treatment Options ◽  
The United States ◽  
Pediatric Endocrinology ◽  
Lifestyle Modifications ◽  
Endocrine Society ◽  
Weight Loss Medications

AbstractBackgroundIn the United States, 18.5% of children are obese. Dietary and lifestyle modifications are key, but often ineffective. There are limited approved pediatric pharmacotherapies. The objective of this study was to evaluate current treatment practices for pediatric obesity among members of the Pediatric Endocrine Society (PES, n = 1300) and the Pediatric Obesity Weight Evaluation Registry (POWER, n = 42) consortium.MethodsA 10-question online survey on treatment of children with obesity in clinical practice was conducted.ResultsThe response rates were 19% for PES and 20% for POWER members. The majority were female (65%) and board certified in pediatric endocrinology (81%). Most practitioners saw 5–10 patients with obesity/week and 19% prescribed weight-loss medications. POWER participants were more likely to prescribe weight-loss medications than PES participants (46% vs. 18%, p =  0.02). Metformin was the most commonly prescribed medication. Response to medication was poor. Use of dietary non-pharmacological treatment options was uncommon. Over half of the respondents (56%) referred patients for bariatric surgery and 53% had local access to pediatric bariatric surgery.ConclusionsMetformin was the most common drug prescribed among respondents, but successful weight-loss responses were uncommon. Among practitioners who are using pharmacological interventions, therapeutic strategies vary widely. Targeted research in pharmacologic and surgical treatment for pediatric obesity is urgently needed.

scholarly journals Applications of Different Biomarkers in the Diagnosis of Drug-induced Liver Injury

2019 ◽  
Vol 9 (1) ◽  
pp. 55-61
Author(s):  
Monika Sharma ◽  
Ishita Yadav ◽  
Chandra K. Sharma
Keyword(s):  
Clinical Practice ◽  
Safety Assessment ◽  
Basic Research ◽  
Biological Processes ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Significant Function ◽  
Treatment And Prevention ◽  
Day By Day

Biomarkers perform a significant function in the process of drug development. Biomarkers have been utilized in the safety assessment of drugs in clinical practice and also for personalization of medicines. To recognize the relation among considerable biological processes as well as clinical outcomes, it is important to increase our potential of treatments for all ailments, in addition to our understanding of normal and healthy physiology. Since the 1980s, using biomarkers is essential for substitutional results in long term assessments of main maladies, for example, cancer, as well as illness related to the heart. Now a days, biomarkers are highly important for unifying discovery of the drug and day by day improvements. The importance of biomarkers is increasing gradually with the advancement of novel therapeutics for the treatment and prevention of a broad range of diseases in order to overcome hepatotoxicity. These biomarkers are extensively used for the identification of disease and the field of medical research. The use of biomarkers in clinical as well as basic research has been promoted rapidly by the different drug regulation authorities for better outcomes in the future.

scholarly journals The Endocrine Society's Clinical Practice Guideline on endocrine and nutritional management of the post-bariatric surgery patient: Commentary from a European Perspective

2011 ◽  
Vol 165 (2) ◽  
pp. 171-176 ◽  
Author(s):  
Antonio J Torres ◽  
Miguel A Rubio
Keyword(s):  
Bariatric Surgery ◽  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Postoperative Management ◽  
Evidence Based ◽  
Endocrine Society ◽  
Surgery Patient ◽  
European Experience ◽  
Post Bariatric Surgery

Bariatric and metabolic surgery is experiencing a noteworthy increase worldwide in recent years, but protocols and consensus published in the past decade have not yet established clear evidence-based clinical recommendations. The Endocrine Society, with the participation of theEuropean Society of Endocrinology, has promoted the creation of an expert panel to propose a clinical practice guideline for postoperative management of patients, candidates to bariatric surgery, that places a particular emphasis on evidence-based medical aspects. The main arguments reflected in those recommendations are set out in this article and are subject to analysis and discussion from the specific viewpoint of the current European experience.

scholarly journals Testosterone Therapy in Men With Hypogonadism: An Endocrine Society* Clinical Practice Guideline

2018 ◽  
Vol 103 (5) ◽  
pp. 1715-1744 ◽  
Author(s):  
Shalender Bhasin ◽  
Juan P Brito ◽  
Glenn R Cunningham ◽  
Frances J Hayes ◽  
Howard N Hodis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Practice ◽  
Adverse Effects ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Task Force ◽  
Specific Antigen ◽  
Androgen Deficiency ◽  
Testosterone Therapy ◽  
Endocrine Society

Abstract Objective To update the “Testosterone Therapy in Men With Androgen Deficiency Syndromes” guideline published in 2010. Participants The participants include an Endocrine Society–appointed task force of 10 medical content experts and a clinical practice guideline methodologist. Evidence This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus Process One group meeting, several conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees and members and the cosponsoring organization were invited to review and comment on preliminary drafts of the guideline. Conclusions We recommend making a diagnosis of hypogonadism only in men with symptoms and signs consistent with testosterone (T) deficiency and unequivocally and consistently low serum T concentrations. We recommend measuring fasting morning total T concentrations using an accurate and reliable assay as the initial diagnostic test. We recommend confirming the diagnosis by repeating the measurement of morning fasting total T concentrations. In men whose total T is near the lower limit of normal or who have a condition that alters sex hormone–binding globulin, we recommend obtaining a free T concentration using either equilibrium dialysis or estimating it using an accurate formula. In men determined to have androgen deficiency, we recommend additional diagnostic evaluation to ascertain the cause of androgen deficiency. We recommend T therapy for men with symptomatic T deficiency to induce and maintain secondary sex characteristics and correct symptoms of hypogonadism after discussing the potential benefits and risks of therapy and of monitoring therapy and involving the patient in decision making. We recommend against starting T therapy in patients who are planning fertility in the near term or have any of the following conditions: breast or prostate cancer, a palpable prostate nodule or induration, prostate-specific antigen level > 4 ng/mL, prostate-specific antigen > 3 ng/mL in men at increased risk of prostate cancer (e.g., African Americans and men with a first-degree relative with diagnosed prostate cancer) without further urological evaluation, elevated hematocrit, untreated severe obstructive sleep apnea, severe lower urinary tract symptoms, uncontrolled heart failure, myocardial infarction or stroke within the last 6 months, or thrombophilia. We suggest that when clinicians institute T therapy, they aim at achieving T concentrations in the mid-normal range during treatment with any of the approved formulations, taking into consideration patient preference, pharmacokinetics, formulation-specific adverse effects, treatment burden, and cost. Clinicians should monitor men receiving T therapy using a standardized plan that includes: evaluating symptoms, adverse effects, and compliance; measuring serum T and hematocrit concentrations; and evaluating prostate cancer risk during the first year after initiating T therapy.

scholarly journals Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: An Endocrine Society* Clinical Practice Guideline

2019 ◽  
Vol 104 (9) ◽  
pp. 3939-3985 ◽  
Author(s):  
James L Rosenzweig ◽  
George L Bakris ◽  
Lars F Berglund ◽  
Marie-France Hivert ◽  
Edward S Horton ◽  
...  
Keyword(s):  
Physical Activity ◽  
Clinical Practice ◽  
Primary Prevention ◽  
Health Care Providers ◽  
Lifestyle Modification ◽  
Primary Care Providers ◽  
Atherosclerotic Cardiovascular Disease ◽  
Metabolic Risk ◽  
Care Providers ◽  
Endocrine Society

Abstract Objective To develop clinical practice guidelines for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM) in individuals at metabolic risk for developing these conditions. Conclusions Health care providers should incorporate regular screening and identification of individuals at metabolic risk (at higher risk for ASCVD and T2DM) with measurement of blood pressure, waist circumference, fasting lipid profile, and blood glucose. Individuals identified at metabolic risk should undergo 10-year global risk assessment for ASCVD or coronary heart disease to determine targets of therapy for reduction of apolipoprotein B–containing lipoproteins. Hypertension should be treated to targets outlined in this guideline. Individuals with prediabetes should be tested at least annually for progression to diabetes and referred to intensive diet and physical activity behavioral counseling programs. For the primary prevention of ASCVD and T2DM, the Writing Committee recommends lifestyle management be the first priority. Behavioral programs should include a heart-healthy dietary pattern and sodium restriction, as well as an active lifestyle with daily walking, limited sedentary time, and a structured program of physical activity, if appropriate. Individuals with excess weight should aim for loss of ≥5% of initial body weight in the first year. Behavior changes should be supported by a comprehensive program led by trained interventionists and reinforced by primary care providers. Pharmacological and medical therapy can be used in addition to lifestyle modification when recommended goals are not achieved.

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