scholarly journals Management of severe pediatric obesity

2021 ◽  
Vol 64 (6) ◽  
pp. 416-424
Author(s):  
Lindsey Yoojin Chung ◽  
Young-Jun Rhie
Keyword(s):  
Metabolic Syndrome ◽  
Pediatric Obesity ◽  
Eating Behaviors ◽  
Severe Obesity ◽  
Lifestyle Modification ◽  
Treatment Options ◽  
Public Health Problem ◽  
Alcoholic Fatty Liver ◽  
Treatment Of Obesity ◽  
Metabolic And Bariatric Surgery

Background: Pediatric obesity has increased over the decades, and in particular, severe pediatric obesity has become a serious public health problem. A concern has arisen that the COVID-19 pandemic may exacerbate the incidence of childhood obesity.Current Concepts: The consequences of severe pediatric obesity are more devastating than those of moderate obesity. Children with severe obesity are at a greater risk for hypertension, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, atherosclerosis, and adult obesity. Correct assessment and diagnosis of a child with severe obesity is key to successful therapy. A thorough history and physical examination are important in identifying monogenic obesity or metabolic syndrome. Eating behaviors and psychosocial factors should be assessed to improve weight management outcomes. Treatment options for severe pediatric obesity include lifestyle modification, pharmacotherapy, and metabolic and bariatric surgery. Even though progress has been made with regard to the treatment of obesity, safe and effective treatment of severe pediatric obesity is challenging.Discussion and Conclusion: More efforts and innovations are needed to find a solution for the huge medical and emotional burden the children with severe obesity and their families are enduring.

scholarly journals In search of an ideal drug for safer treatment of obesity: The false promise of pseudoephedrine

2021 ◽  
Author(s):  
Antonio Munafò ◽  
Stefano Frara ◽  
Norberto Perico ◽  
Rosaria Di Mauro ◽  
Monica Cortinovis ◽  
...  
Keyword(s):  
Adverse Events ◽  
Treatment Options ◽  
Public Health Problem ◽  
Cardiovascular Death ◽  
Regulation Of Transcription ◽  
Major Public Health Problem ◽  
Obese Patients ◽  
Ephedra Sinica ◽  
The Central Nervous System ◽  
Treatment Of Obesity

AbstractObesity is a major public health problem worldwide. Only relatively few treatment options are, at present, available for the management of obese patients. Furthermore, treatment of obesity is affected by the widespread misuse of drugs and food supplements. Ephedra sinica is an old medicinal herb, commonly used in the treatment of respiratory tract diseases. Ephedra species contain several alkaloids, including pseudoephedrine, notably endowed with indirect sympathomimetic pharmacodynamic properties. The anorexigenic effect of pseudoephedrine is attributable primarily to the inhibition of neurons located in the hypothalamic paraventricular nucleus (PVN), mediating satiety stimuli. Pseudoephedrine influences lipolysis and thermogenesis through interaction with β3 adrenergic receptors and reduces fat accumulation through down-regulation of transcription factors related to lipogenesis. However, its use is associated with adverse events that involve to a large extent the cardiovascular and the central nervous system. Adverse events of pseudoephedrine also affect the eye, the intestine, and the skin, and, of relevance, sudden cardiovascular death related to dietary supplements containing Ephedra alkaloids has also been reported. In light of the limited availability of clinical data on pseudoephedrine in obesity, along with its significantly unbalanced risk/benefit profile, as well as of the psychophysical susceptibility of obese patients, it appears reasonable to preclude the prescription of pseudoephedrine in obese patients of any order and degree.

OXM-104, a potential candidate for the treatment of obesity, NASH and type 2 diabetes

2021 ◽  
Author(s):  
Ashref Kayed ◽  
Simone Melander ◽  
Kim Andreassen ◽  
Morten Karsdal ◽  
Kim Henriksen
Keyword(s):  
Type 2 Diabetes ◽  
Receptor Agonist ◽  
Therapeutic Option ◽  
Treatment Options ◽  
Potential Candidate ◽  
Alcoholic Fatty Liver ◽  
Glucagon Like Peptide 1 ◽  
Treatment Of Obesity ◽  
Long Acting

Abstract Obesity-related metabolic disorders, including non-alcoholic fatty liver disease and its more progressive form non-alcoholic steatohepatitis, are causing an increased health burden, especially due to the lack of approved treatment options. Using preclinical models of NASH, obesity, and type 2 diabetes, we investigated the effects of a long-acting glucagon-like peptide-1(GLP-1) and glucagon (GCG) receptor agonist OXM-104 head to head with once-daily GLP-1/GCG receptor agonist cotadutide and once-weekly GLP-1 receptor agonist semaglutide. OXM-104, cotadutide, and semaglutide elicited marked reductions in body weight and improved glucose control. In contrast, hepatoprotective effects, i.e., reductions in steatosis and fibrosis, as well as liver fibrosis biomarkers, were more prominent with OXM-104 and cotadutide than effects seen with semaglutide. This is demonstrated by improved NAFLD activity score (NAS) by OXM-104 and cotadutide which underlines the importance of the GCG receptor. Thus, these results underline the potential of OXM-104 as a promising therapeutic option for the resolution of NASH, but also as a therapeutic option for type 2 diabetes and obesity.

Obesity Reduction Through Lifestyle Modification

2000 ◽  
Vol 25 (1) ◽  
pp. 1-18 ◽  
Author(s):  
Robert Ross ◽  
Ian Janssen ◽  
Angelo Tremblay
Keyword(s):  
Lifestyle Modification ◽  
Current Knowledge ◽  
Treatment Strategies ◽  
Public Health Problem ◽  
Lifestyle Changes ◽  
Pharmacological Intervention ◽  
Healthy Weight ◽  
Diet And Exercise ◽  
Treatment Of Obesity ◽  
Review Current

Obesity is a worldwide public health problem. One in three Canadians is overweight, a prevalence that is already high and increasing. Moreover, 54% of men and 37% of Canadian women are characterized as abdominally obese, the phenotype that is strongly associated with cardiovascular disease and type II diabetes. These observations underscore the importance of considering the efficacy of methods commonly used to reduce total and abdominal obesity. These strategies include a decrease in energy intake (diet), an increase in energy expenditure (exercise), or pharmacological intervention. The combination of diet and exercise is more commonly prescribed, with pharmacological intervention suggested only when lifestyle changes fail to achieve weight loss.The aim of this report is to review current knowledge regarding the influence of diet and exercise as treatment strategies for obesity reduction and provide recommendations for attaining and maintaining a healthy weight. The importance of diet composition in the treatment of obesity is also considered. Key words: body fat, weight loss, exercise, diet

scholarly journals Precision medicine in adult and pediatric obesity: a clinical perspective

2019 ◽  
Vol 10 ◽  
pp. 204201881986302 ◽  
Author(s):  
Eric M. Bomberg ◽  
Justin R. Ryder ◽  
Richard C. Brundage ◽  
Robert J. Straka ◽  
Claudia K. Fox ◽  
...  
Keyword(s):  
Weight Loss ◽  
Precision Medicine ◽  
Pediatric Obesity ◽  
Lifestyle Modification ◽  
Clinical Perspective ◽  
Treatment Type ◽  
Treatment Plans ◽  
Obesity Interventions ◽  
Metabolic And Bariatric Surgery ◽  
Obesity Treatments

It remains largely unknown as to why some individuals experience substantial weight loss with obesity interventions, while others receiving these same interventions do not. Person-specific characteristics likely play a significant role in this heterogeneity in treatment response. The practice of precision medicine accounts for an individual’s genes, environment, and lifestyle when deciding upon treatment type and intensity in order to optimize benefit and minimize risk. In this review, we first discuss biopsychosocial determinants of obesity, as understanding the complexity of this disease is necessary for appreciating how difficult it is to develop individualized treatment plans. Next, we present literature on person-specific characteristics associated with, and predictive of, weight loss response to various obesity treatments including lifestyle modification, pharmacotherapy, metabolic and bariatric surgery, and medical devices. Finally, we discuss important gaps in our understanding of the causes of obesity in relation to the suboptimal treatment outcomes in certain patients, and offer solutions that may lead to the development of more effective and targeted obesity therapies.

scholarly journals Aversion to Off-Label Prescribing in Clinical Pediatric Weight Management: The Quintessential Double Standard

2021 ◽  
Author(s):  
Christine B San Giovanni ◽  
Brooke Sweeney ◽  
Joseph A Skelton ◽  
Megan M Kelsey ◽  
Aaron S Kelly
Keyword(s):  
Weight Management ◽  
Pediatric Obesity ◽  
Pediatric Patients ◽  
Lifestyle Modification ◽  
Treatment Options ◽  
Double Standard ◽  
Case Description ◽  
Off Label ◽  
Novel Treatments ◽  
Pediatric Weight Management

Abstract Context Pediatric obesity is now recognized as a chronic disease; yet few treatment options exist besides lifestyle modification therapy and bariatric surgery. We describe the limited availability of FDA-approved anti-obesity medications for adolescents and compare this to what is available for adults. We offer a rationale for off-label prescribing to assist with lifestyle modification therapy. We also highlight the need for more pharmacotherapy options and additional research into novel treatments for pediatric obesity. Case Description We describe a patient who is struggling with managing her weight and starting to develop complications of obesity. We offer a framework in which off-label prescribing may be beneficial to patients who have been engaging in lifestyle modification therapy yet fail to see improvement. Conclusion Lifestyle modification therapy is necessary but often insufficient in stimulating clinically meaningful weight loss when used alone in children and adolescents who struggle with weight management. Until more FDA-approved anti-obesity medications are available, pediatricians may be able to help more patients achieve weight reduction goals by familiarizing themselves with the responsible use of off-label medications and implementing these tools to improve clinical outcomes. There is a critical need for more pharmacotherapy options to help pediatric patients in managing their weight and preventing or improving the insidious complications resulting from untreated obesity.

scholarly journals Risk Factors of Non-Alcoholic Fatty Liver Disease in Bangladeshi Population

2014 ◽  
Vol 14 (2) ◽  
pp. 143-148
Author(s):  
Mostafa Kamal ◽  
Fazal Karim ◽  
Md.Robed Amin ◽  
MH Sarder ◽  
KAK Azad
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Significant Proportion ◽  
Public Health Problem ◽  
College Hospital ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

Background: Non-alcoholic fatty liver disease (NAFLD) is becoming a public health problem with increasing incidence and it has been shown to be associated with diabetes, dyslipidemia, obesity and metabolic syndrome and ultimately puts more than half the world’s population at risk of developing NAFLD/NASH/cirrhosis in the coming decades. The importance of detection of patients with NAFLD is to intervene the associated factors and avoid transformation to more severe forms of the disease.Methods: An observational case control study was carried out at Medicine Department, Dhaka Medical College Hospital (DMCH), Dhaka, during the period of August, 2011 to June, 2012. A total number of 100 consecutive patients and 100 healthy controls was approaches DMCH were enrolled in this study. Out of 100 NAFLD patients only 20 patients gave consent for liver biopsy to see the extent of liver damage.Result: Less physical activity, Obesity, mean blood pressure, Diabetes, TG, TC were significantly (P<0.05) higher in NAFLD. Metabolic syndrome was 64% in NAFLD. According to NASH Activity Scoring system definite NASH (score >5) was found in 9(45%) of the NAFLD group.Conclusion: Significant proportion of NAFLD patient suffers from NASH which is alarming and they have potential for the development of advanced liver disease. So recognition of these risk factors in patients of NAFLD can help in early implementation of strategies that halt the progression of this disease. DOI: http://dx.doi.org/10.3329/jom.v14i2.19665 J Medicine 2013, 14(2): 143-148

Dysmetabolic Iron Overload in Metabolic Syndrome

2020 ◽  
Vol 26 (10) ◽  
pp. 1019-1024 ◽  
Author(s):  
Alexandros Sachinidis ◽  
Michael Doumas ◽  
Konstantinos Imprialos ◽  
Konstantinos Stavropoulos ◽  
Alexandra Katsimardou ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Iron Overload ◽  
Cell Function ◽  
Lifestyle Modification ◽  
Polycystic Ovary ◽  
Alcoholic Fatty Liver ◽  
Unhealthy Diet ◽  
Visceral Adipose ◽  
Diet And Lifestyle

Background: We sought to determine the association of dysmetabolic iron overload syndrome (DIOS) with metabolic syndrome (MetS). Methods: Several studies have shown that DIOS is associated with Mets, mainly through the pathogenesis of its components: type 2 diabetes mellitus (T2DM), essential hypertension, non-alcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (POS). Results: Serum ferritin levels increase proportionally according to the degree of insulin resistance (IR) and the number of components of Mets. Moreover, DIOS predicts the onset of T2DM and NAFLD. Dysregulation of iron metabolism in DIOS is due to a multifactorial and dynamic process triggered by an unhealthy diet, facilitated by environmental and genetic cofactors, and resulting in a bidirectional relation between the liver and visceral adipose tissue (VAT). Iron removal combined with a healthy diet improved both insulin sensitivity and beta-cell function, but had no significant effect on blood glucose; however, phlebotomy therapy might be considered with conflicting results. Conclusion: Iron overload is closely associated with metabolic syndrome and its components; however, it remains under-appreciated in everyday clinical practice. Diet and lifestyle modification offer some clinical benefit; however, it is not adequate for successful management of the disease. The results of phlebotomy remain controversial, underlying the necessity of further efforts in this field.

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