Curbside Consultation in Pediatric Obesity: 49 Clinical Questions

250 Pages·2014·8.19 MB·English

by  Jeannie S. Huang (ed.)

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Are you looking for concise, practical answers to those questions that are often left unanswered by traditional pediatric
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obesity references? Are you seeking brief, evidence-based advice for complicated cases or controversial decisions? u
Curbside Consultation in Pediatric Obesity: 49 Clinical Questions provides quick answers to the tricky questions most l
commonly posed during a “curbside consultation” between pediatricians. t iinn PPeeddiiaattrriicc OObbeessiittyy
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Dr. Jeannie S. Huang has designed this unique reference, which offers expert advice, preferences, and opinions on tough t
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clinical questions commonly associated with pediatric obesity. The unique Q&A format provides quick access to current o
information related to pediatric obesity with the simplicity of a conversation between two colleagues. Numerous images, n
diagrams, and references allow readers to browse large amounts of information in an expedited fashion.
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Some of the questions that are answered: 49 Clinical Questions

(cid:129) How can a primary care practitioner manage obesity? P
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(cid:129) My patients often ask me about fad diets for weight loss. What is the bottom line about fad diets? Are they benign,
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or do some have associated adverse risks?
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(cid:129) What are some of the behavioral programs available for obese children, and how do I choose which would be the
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most appropriate for my obese patients? r
(cid:129) I am often asked about bariatric surgery. What are the different weight loss surgeries for pediatric patients? i
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What are the important considerations, associated complications, and effectiveness of each type of surgery?
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(cid:129) How do I get reimbursed for delivery of weight management therapies in the offi ce?
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(cid:129) Are there any effective technologies (current apps and sensors) available to help pediatric patients lose weight?
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Curbside Consultation in Pediatric Obesity: 49 Clinical Questions provides information basic enough for residents s
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while also incorporating expert advice that even high-volume pediatricians will appreciate. Pediatricians, nurse t
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practitioners, physician assistants, and family practitioners will benefit from the user-friendly, casual format and the
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expert advice contained within.
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Contributors Include: Richard L. Atkinson (cid:129) Frank M. Biro (cid:129) Christopher F. Bolling (cid:129) Kerri N. Boutelle (cid:129)
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Abby L. Braden (cid:129) Lillian J. Choi (cid:129) Alison M. Coates (cid:129) Lee Ann E. Conard (cid:129) Ellen L. Connor (cid:129) Brian Dauenhauer (cid:129)
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Christopher Davis (cid:129) Angela Estampador (cid:129) Katherine M. Flegal (cid:129) Andrei Fodoreanu (cid:129) Paul W. Franks (cid:129) i
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Jeanette M. Garcia (cid:129) Mary Abigail S. Garcia (cid:129) Dara Garner-Edwards (cid:129) Michael Gottschalk (cid:129) David Gozal (cid:129) ic Jeannie S. Huang
H. Mollie Grow (cid:129) Rohit Gupta (cid:129) Sarah Hampl (cid:129) Sandra Hassink (cid:129) Kimberly Henrichs (cid:129) Krista Beth Highland (cid:129)
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Linda L. Hill (cid:129) Stefanie N. Hinkle (cid:129) Nancy Hoo (cid:129) Sherry Huang (cid:129) Xiaofen Deng Keating (cid:129) Jacqueline Kerr (cid:129)
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Brian K. Kit (cid:129) Stephanie Knatz (cid:129) Heather M. Kong (cid:129) Kirsten La (cid:129) Jennifer Le (cid:129) Colleen Taylor Lukens (cid:129)
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Kimberly Montez (cid:129) Tamasyn Nelson (cid:129) Kimberly P. Newton (cid:129) Kevin Patrick (cid:129) Denise Purdie (cid:129) Kyung E. Rhee (cid:129) Series Editor
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Sanjeev Sabharwal (cid:129) Jeffrey B. Schwimmer (cid:129) Rulan Shangguan (cid:129) Andrea J. Sharma (cid:129) John R. Sirard (cid:129)
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Joseph A. Skelton (cid:129) Karen Stephens (cid:129) David L. Suskind (cid:129) Kenneth P. Tercyak (cid:129) Leonardo Trasande (cid:129) Patrika Tsai (cid:129) s Lisa B. Zaoutis
Raymond J. Tseng (cid:129) Margarita D. Tsiros (cid:129) Victor E. Uko (cid:129) Christine Wood (cid:129) Stavra A. Xanthakos t
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SLACK® SIN
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I N C O R P O R A T E D CO
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MEDICAL/Pediatrics KAT SLACK Incorporated
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Curbside Consultation in Pediatrics
Series
Series Editor, Lisa B. Zaoutis

Editor
Jeannie S. Huang, MD, MPH
University of California San Diego
Rady Children’s Hospital
San Diego, California
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Library of Congress Cataloging-in-Publication Data
Curbside consultation in pediatric obesity : 49 clinical questions / editor, Jeannie S. Huang.
p. ; cm. -- (Curbside consultation in pediatrics series)
Includes bibliographical references and index.
ISBN 978-1-61711-612-4 (paperback)
I. Huang, Jeannie, editor of compilation. II. Series: Curbside consultation in pediatrics series.
[DNLM: 1. Obesity. 2. Child. 3. Infant. 4. Pediatrics--methods. WD 210]
RJ206
618.92'398--dc23
2013044793
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Dedication
I would like to dedicate this book to my parents, Song and Ann Huang, for giving me the foun-
dation upon which to build a life and career; to my husband, Nat Chuang, for his constant support
and love; to my three sons, Ethan, Jonah, and Benjamin, for giving me purpose for everything
that I do; and finally, to my patients and families for challenging me as a clinician to address the
things that matter and to improve my practice of medicine every day.

Contents
Dedication ...................................................................................................................................................v
Acknowledgments ......................................................................................................................................xi
About the Editor ......................................................................................................................................xiii
Contributing Authors ...............................................................................................................................xv
Introduction .............................................................................................................................................xxi
Section I Epidemiology .............................................................................1
Question 1 Obesity in Children Seems to Be Common. Is This an Epidemic? Is This True
Outside of the United States? .......................................................................................3
Sherry Huang, MD and Nancy Hoo, MD
Question 2 Obesity in Children Seems to Be Common. Are the Current Definitions of
Obesity Accurate, and What Are They Based On? ..................................................5
Brian K. Kit, MD, MPH and Katherine M. Flegal, PhD
Question 3 Obesity in Children Seems to Be More Common in Non-White Racial Groups.
What Racial Groups Are at Particular Risk, and What Considerations Are
Important for Each? .......................................................................................................7
Brian K. Kit, MD, MPH and Katherine M. Flegal, PhD
Section II Pathophysiology/Development of Childhood Obesity ....11
Question 4 What Body Systems Affect the Development of Obesity? .....................................13
Patrika Tsai, MD
Question 5 Obesity Seems to Run in Families. What Genetic Factors Contribute to the
Development of Obesity? When Should I Send an Overweight Child for
Evaluation for a Genetic Syndrome? .........................................................................17
Patrika Tsai, MD
Question 6 What Major Social Factors Contribute to Childhood Obesity, and How Can
Clinicians and Caregivers Alter Their Impact? ......................................................21
Abby L. Braden, PhD and Kyung E. Rhee, MD, MSc, MA
Question 7 How Does the Mother’s Nutritional Status During Pregnancy Contribute to or
Prevent the Development of Obesity? .......................................................................25
Andrea J. Sharma, PhD and Stefanie N. Hinkle, PhD
Question 8 Is There Any Relationship Between Sleep and the Development and Prevention
of Obesity? .....................................................................................................................29
David Gozal, MD
Section III Environment .............................................................................33
Question 9 How Does the Environment Contribute to the Development of Childhood
Obesity? How Do Community Influences Affect Childhood Obesity Risk? .....35
Jacqueline Kerr, PhD
Question 10 I Have Heard About Links Between Obesity and Infectious Agents. How Do
Virus Infections Affect the Development of Obesity in Children? How Do
Bacteria in the Gut Affect the Development of Obesity in Children? .................39
Richard L. Atkinson, MD
viii　　Contents
Section IV Physical Activity ....................................................................45
Question 11 I Often Recommend Increased Physical Activity to Combat Obesity. What Are
the Various Benefits of Increased Physical Activity? .............................................47
Xiaofen Deng Keating, PhD and Rulan Shangguan, PhD
Question 12 How Do You Craft a New Exercise Regimen for Obese Children? What Is a Good
Starting Point, and How Does One Advance the Program? .................................51
Brian Dauenhauer, MEd
Question 13 When Developing an Exercise Program for an Obese Child, What Are the
Restrictions or Guidelines to Keep in Mind? ..........................................................55
Xiaofen Deng Keating, PhD and Rulan Shangguan, PhD
Question 14 What Solutions Have Been Found to Help Children Who Live in Unsafe
Neighborhoods or Who Are Home Alone and Cannot Go Out to Play to Increase
Their Physical Activity? ..............................................................................................59
Xiaofen Deng Keating, PhD and Rulan Shangguan, PhD
Section V Comorbidities ..........................................................................63
Question 15 What Malnutrition Issues Should I Consider in the Obese Child? .....................65
Denise Purdie, MD and Mary Abigail S. Garcia, MD
Question 16 What Are the Common Gastrointestinal Diseases Associated With Childhood
Obesity? ..........................................................................................................................69
Lillian J. Choi, MD and Kimberly Montez, MD
Question 17 What Should I Do With an Obese Child Who Has an Elevated Liver Function
Test? ................................................................................................................................77
Kimberly P. Newton, MD and Jeffrey B. Schwimmer, MD
Question 18 What Is the Relationship Between Diabetes and Pediatric Obesity?...................83
Andrei Fodoreanu, MD and Michael Gottschalk, MD, PhD
Question 19 What Are the Common Orthopedic Issues in the Obese Child? .........................85
Heather M. Kong, MD and Sanjeev Sabharwal, MD, MPH
Question 20 Does Obesity Affect Reproduction? How? ...............................................................91
Kimberly Henrichs, MD and Ellen L. Connor, MD
Question 21 Many of My Pediatric Patients Complain About Fatigue. What Conditions
Should I Be Especially Concerned About in My Obese Patients? ........................95
Christopher Davis, MD, PhD
Question 22 Obesity Is Associated With Cardiovascular Disease in Adults. Is This True in
Children? How Would I Diagnose Cardiovascular Complications in the Obese
Child? .............................................................................................................................97
Paul W. Franks, Bsc(Hons), MS, MPhil (Cantab), PhD (Cantab), FTOS
and Angela Estampador, BS, MPH
Question 23 Is Pediatric Obesity Associated With Cancer? ......................................................103
Krista Beth Highland, PhD and Kenneth P. Tercyak, PhD
Question 24 What Are the Bone Health Considerations in the Obese Child? .......................107
Heather M. Kong, MD and Sanjeev Sabharwal, MD, MPH
Question 25 Is There Any Relationship Between Obesity and Oral Health in Children? ...111
Raymond J. Tseng, DDS, PhD
Contents　　ix
Question 26 Some of My Obese Patients Complain About Being Bullied. What Should I Say
to These Patients and Families? What Is My Responsibility?.............................115
Joseph A. Skelton, MD, MS and Dara Garner-Edwards, MSW, LCSW
Question 27 Are Quality of Life and Self-Esteem Altered in Obese Children? Are Psychiatric
Disorders More Common in Obese Children? .....................................................121
Margarita D. Tsiros, PhD and Alison M. Coates, PhD
Question 28 Does Pediatric Obesity Predict Adult Obesity? Does Being Overweight or Obese
as a Child Reduce One’s Lifespan Expectancy? ....................................................127
Lee Ann E. Conard, RPh, DO, MPH and Frank M. Biro, MD
Section VI Treatment ...............................................................................131
Question 29 What Are Some Behavioral Programs Available for Obese Children, and How Do
I Choose Which Would Be the Most Appropriate for My Obese Patients? .......133
H. Mollie Grow, MD, MPH
Question 30 There Are Many Diets out There to “Treat” Obesity. Which One(s) Should I
Recommend? Which Have Demonstrated Effectiveness?” .................................137
Karen Stephens, MS, RD, CSP, LD and Sarah Hampl, MD
Question 31 My Patients Often Ask Me About Fad Diets for Weight Loss. What Is the Bottom
Line About Fad Diets? Are They Benign, or Do Some Have Associated Adverse
Risks? ............................................................................................................................141
Rohit Gupta, MD, PhD and David L. Suskind, MD
Question 32 How Can a Primary Care Practitioner Manage Obesity? What Specialists Are
Available to Help, and When Should Referral Be Considered? ..........................145
Sandra Hassink, MD, FAAP
Question 33 What Is Motivational Interviewing, and How Can I Use It to Help Motivate My
Patients to Lose Weight? ...........................................................................................151
Kyung E. Rhee, MD, MSc, MA and Abby L. Braden, PhD
Question 34 I Am Often Asked About Bariatric Surgery. What Are the Different Weight
Loss Surgeries for Pediatric Patients? What Are the Important Considerations,
Associated Complications, and Effectiveness of Each Type of Surgery? ..........155
Stavra A. Xanthakos, MD, MS
Question 35 How Do I Get Reimbursed for Delivery of Weight Management Therapies in the
Office? ..........................................................................................................................161
Christopher F. Bolling, MD, FAAP
Question 36 Are There Any Effective Technologies (Current Apps and Sensors) Available to
Help Pediatric Patients Lose Weight? .....................................................................167
Kevin Patrick, MD, MS
Question 37 Sometimes Interventions That Do not Overtly Target Obesity (Stealth
Interventions) Can Be Effective in Reducing Weight in Children. What Are
Examples of Effective Stealth Interventions That Have Been Used for Reducing
or Managing Weight in Childhood Obesity, and How Can We Better Use This
Modality to Achieve Better Weight and Health in Children? ............................171
John R. Sirard, PhD and Jeanette M. Garcia, MS