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Exciting times for Pediatric Obesity treatment!

7,326 Views | 99 Replies | Last: 1 yr ago by agracer
KidDoc
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AG
If your teens are struggling with weight, Wegovy was just approved for 12+ yesterday for weight loss 12+. The data is very promising and it is exciting to finally have something beyond diet & exercise to manage this very common problem.

Quote:


Finally, there remains "ongoing weight bias and stigma among the public, and in particular, among healthcare providers, with the misconception that obesity is a personal failing or matter of willpower, or ultimately a fault of the child and parent," Armstrong said.

However, that is simply not the case, she noted, pointing out that obesity needs to be treated via the same model as other chronic diseases, accounting for remissions, relapses, monitoring, and ongoing care.


AAP Guidelines: 'Watchful Waiting' No Longer the Right Call for Child Obesity | MedPage Today

Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity | Pediatrics | American Academy of Pediatrics (aap.org)

Wegovy was life changing to me as a 50 year who was a fat little kid. I believe in this treatment so much I bought stock in Novo nordisk. Now the big fight will be getting the price down and getting insurance to cover it. Right now medicare/medicaid refuse to cover any medication for weight loss period as they think it is cosmetic only. Commercial insurance is hit or miss depending on the details of each policy.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
BCOBQ98
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AG
I guess nothing is our fault anymore? I'm glad my cardiologist's philosophy is about pushing me to make lifestyle changes and eliminating medications.

Personally, I know for me being at a healthy weight is 100% about willpower and making good diet and exercise choices.
double aught
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AG
So how do you recommend helping the people who don't have the willpower or don't make good choices?
Builder93
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AG
Out of curiosity,. What was your diet like as a kid?
ukbb2003
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double aught said:

So how do you recommend helping the people who don't have the willpower or don't make good choices?


Are you seriously advocating for medication over adopting a healthier lifestyle?
MouthBQ98
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AG
My diet wasn't great but wasn't terrible. I also wasn't allowed to sit inside watching TV or gaming all day or drink nothing but cokes and pound down junk food all day. We actually went outside and did stuff, usually hours a day weather permitting. Obese parents tend to raise obese kids and condition their minds and bodies to overeat, and eat crap, and they become sedentary, and probably have all sorts of metabolic and glandular issues and can't get their desire and habit to eat suppressed due to cortisol and other stuff, and even if they do, their parents usually reinforce bad habits.

Maybe they can benefit from something to break them out before they become lifelong slaves to their appetites and die from heart disease or sugar foot.
double aught
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AG
ukbb2003 said:

double aught said:

So how do you recommend helping the people who don't have the willpower or don't make good choices?


Are you seriously advocating for medication over adopting a healthier lifestyle?
Pretty sure I didn't say that. Obviously, eating well and being active are the best treatment. But there are millions of people who for various reasons can't or won't do those things. You can educate or shame them all you want; it won't change anything for most of them. So the problem still exists.

If there's a way to treat these people and maybe prevent diabetes, heart disease, and whatever else, then you treat them. You don't just dismiss medication that could help due to notions about personal responsibility or willpower.
JeepWaveEarl
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AG
Just curious -- when you were 12, how did you get to the store to make selections of groceries as well as purchase them (and with that money) without adult supervision? Also, I'd like to know your workout regimen at 12 years old!

There are a plethora of physiological issues, underlying hereditary issues, and autoimmune disorders that often go undiagnosed, making the "100% willpower" thing not applicable for many individuals, particularly those overweight and obese. Not everything has to be "someone's fault...." IMO.
bam02
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AG
Oh please. Auto-immune conditions and genetic disorders didn't cause our populace to go from healthy to obese in three generations.
Aggie369
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AG
Kinda sad we "need" this

Put down the soda and pizza....go outside.
Ragoo
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AG
AGGODDESS said:

Just curious -- when you were 12, how did you get to the store to make selections of groceries as well as purchase them (and with that money) without adult supervision? Also, I'd like to know your workout regimen at 12 years old!

There are a plethora of physiological issues, underlying hereditary issues, and autoimmune disorders that often go undiagnosed, making the "100% willpower" thing not applicable for many individuals, particularly those overweight and obese. Not everything has to be "someone's fault...." IMO.
riding bikes
Swimming the river
Walking 36 holes
Basketball
Football
Soccer

No one needs a workout routine just some ambition and encouragement.
2girlsdad
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While not all kids of obese parents are fat, you rarley see an overweight kid with average to fit parents.
ukbb2003
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double aught said:

ukbb2003 said:

double aught said:

So how do you recommend helping the people who don't have the willpower or don't make good choices?


Are you seriously advocating for medication over adopting a healthier lifestyle?
Pretty sure I didn't say that. Obviously, eating well and being active are the best treatment. But there are millions of people who for various reasons can't or won't do those things. You can educate or shame them all you want; it won't change anything for most of them. So the problem still exists.

If there's a way to treat these people and maybe prevent diabetes, heart disease, and whatever else, then you treat them. You don't just dismiss medication that could help due to notions about personal responsibility or willpower.


You didn't say it, but it was implied in your original question and again in the response above.

I think your "millions" is a little exaggerated. Are there people with genetic/physiological issues that require medication? Sure, but the vast majority could better their lives by exercising and eating healthier. No one is shaming anybody. Who wouldn't want a happy, healthier life for anyone without the use of medication.

Every decision we make has consequences whether you like it or not. So, yes there is personal responsibility for everyone. You can either help line the pockets of pharma and insurance or live a better life without medication and other side effects.
94chem
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Is it nature, nurture, or free will? The answer is yes.
94chem,
That, sir, was the greatest post in the history of TexAgs. I salute you. -- Dough
1988PA-Aggie
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2girlsdad said:

While not all kids of obese parents are fat, you rarley see an overweight kid with average to fit parents.
In general I agree with you. But I noticed something over the years where I used to live in south central PA (York county). It was somewhat rural, college education was not super common, so young adults who stayed in the area tended to get married and likely have kids at a younger age. So seeing several generations of kids/moms/grandparents together at a store perhaps was fairly common. It was very obvious that the moms were the biggest (20-35 yrs old). And the kids were on the same track. Likely the older generation worked different jobs, maybe a blue collar type job that required much more movement, less crappy food available, etc.

I believe our food nutritionally has been changing for the worse for many decades. But when you add on the sedentary lifestyle (phones, computer based work, etc) it seems just in the last generation or so there has been a large increase in weight percentage wise.

Nutrition/food is 80-85% of weight control or loss. We need to educate our young (and middle aged?). How do we go about doing that? Drugs are not the answer IMO. But sadly, our need to solve a problem and innovate frequently occurs in a laboratory where millions are made rather than the kitchen or grocery store.
MouthBQ98
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AG
Our branded prepared foods are effectively engineered to be as appealing, gratifying, and addictive as possible. That has to be kept in mind.
befitter
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KidDoc said:

If your teens are struggling with weight, Wegovy was just approved for 12+ yesterday for weight loss 12+. The data is very promising and it is exciting to finally have something beyond diet & exercise to manage this very common problem.

Quote:


Finally, there remains "ongoing weight bias and stigma among the public, and in particular, among healthcare providers, with the misconception that obesity is a personal failing or matter of willpower, or ultimately a fault of the child and parent," Armstrong said.

However, that is simply not the case, she noted, pointing out that obesity needs to be treated via the same model as other chronic diseases, accounting for remissions, relapses, monitoring, and ongoing care.


AAP Guidelines: 'Watchful Waiting' No Longer the Right Call for Child Obesity | MedPage Today

Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity | Pediatrics | American Academy of Pediatrics (aap.org)

Wegovy was life changing to me as a 50 year who was a fat little kid. I believe in this treatment so much I bought stock in Novo nordisk. Now the big fight will be getting the price down and getting insurance to cover it. Right now medicare/medicaid refuse to cover any medication for weight loss period as they think it is cosmetic only. Commercial insurance is hit or miss depending on the details of each policy.
You are kidding right?
Hoosegow
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The first rule they teach you in medical school is that the first person you cure is the first customer you lose. It is very profitable to push drugs and constant medical monitoring. It creates a reoccurring source of income for doctors and drug companies.

NoahAg
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Y'all are saying everything I wanted to type when I saw this yesterday. I guess there's not much big pharma money in:

Put the fork down
Go outside
Unplug
Let's go, Brandon!
TXTransplant
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I'm curious what percentage of obese kids see a doctor regularly enough to even get a prescription for this, and how many of those have insurance that will cover it.

I'm not sure this will move the needle as much as some people think it will.
KidDoc
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AG
Doctors have been encouraging lifestyle changes for obesity for over 40 years. It is clear it is not working. Read the study that got this approved. Both groups had dietary and lifestyle coaching but the treatment group lost weight and the placebo did not.

The status quo for obesity treatment is clearly failing. Anyone who considers medications has already tried, usually for years, to lose weight through behavioral modifications and have failed.

Insurance coverage is going to be an interesting battle for sure.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
JeremiahJohnson
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AG
Or just teach kids to be healthy and the repercussions for being fat and unhealthy.

Better off prosecuting parents for child abuse. They are the reason the kid is obese.
10andBOUNCE
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One thing I have found interesting in the past is the number of mainstream foods we see in our grocery stores in America than have been banned in Europe or other countries. I wouldn't propose more regulation but it's interesting to think about. More credence to the idea that the FDA is worthless when it comes to our health.
Sponge
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AG
Not nearly enough kids have regular wellness exams for healthy lifestyle changes to be pushed. Change needs to be pushed by family or school. And if parents are obese, mainly school. Of course you get schools trying to get rid of sodas and push costlier, healthier meals then "big go'ment" people get all up in arms and that gets dropped. And all advertising on TV is garbage fast food which is the only message kids hear.
Builder93
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AG
Almost every single person who does a keto diet loses significant weight and feels great. Maybe because a keto diet is real food.
KidDoc
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Here is the first ever treatment guideline from AAP. I like it.

AAP Obesity Treatment flow

Here is the full article if you really want to dig in.

https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2022-060640/190443/Clinical-Practice-Guideline-for-the-Evaluation-and?autologincheck=redirected&mkt_tok=OTM4LUhESC01NTIAAAGJYC7ZrinS6gvQaQ8VG1c2q1U4Sor1p2ASNdk6TLbChTOpSv1QYL2R51Y2b0Z1e_iO9rWaXW-Q8KD5H3Bm7tpfdALFQPOZEv88kxryKkfwB4fxyw
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MouthBQ98
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Fast food can be reasonably healthy in proper portions. Nobody eats proper portions when many of the offerings are easily half a days' worth of calories for an inactive person, and a meal with a large drink might be enough for an entire day, but without most of the good nutritional content needed.

A 400 calorie hamburger and 350 calories of fries and a glass of ice water or unsweet tea isn't going to be the same problem that a 800 calorie double cheeseburger with all the unhealthy topping selections and a 600 calorie large fries with "dipping sauce" and 500 calories worth of supersize coke might be.

The biggest offenders may well be drinks: a damn Starbucks "coffee" might be 500 to 1000 calories with all the extravagant adds in a large size. A super size fountain drink is like eating 30 sugar packets.

htxag09
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AG
I guess it's inevitable, but I really don't understand the thread derail....

Do I eat "healthy"? Yes. Could I do better? Absolutely, but we try to limit all processed foods, cook every day, avoid fast food, limit sugars/treats, etc. We also do what we can to instill this into our kid. He eats what we eat, last night that was salmon, kale, and rice (we added tomatoes to his plate because the kid could eat 2 pounds a day....).

But, it's pretty damn obvious that this approach isn't working on a macro/society level. The population, including kids, seem to be getting more and more obese and more and more unhealthy. Something else needs to be attempted at this point. We can't just keep beating the "put down the fork and go for a run" drum.
FratboyLegend
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KidDoc said:

If your teens are struggling with weight, Wegovy was just approved for 12+ yesterday for weight loss 12+. The data is very promising and it is exciting to finally have something beyond diet & exercise to manage this very common problem.

Quote:


Finally, there remains "ongoing weight bias and stigma among the public, and in particular, among healthcare providers, with the misconception that obesity is a personal failing or matter of willpower, or ultimately a fault of the child and parent," Armstrong said.

However, that is simply not the case, she noted, pointing out that obesity needs to be treated via the same model as other chronic diseases, accounting for remissions, relapses, monitoring, and ongoing care.


AAP Guidelines: 'Watchful Waiting' No Longer the Right Call for Child Obesity | MedPage Today

Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity | Pediatrics | American Academy of Pediatrics (aap.org)

Wegovy was life changing to me as a 50 year who was a fat little kid. I believe in this treatment so much I bought stock in Novo nordisk. Now the big fight will be getting the price down and getting insurance to cover it. Right now medicare/medicaid refuse to cover any medication for weight loss period as they think it is cosmetic only. Commercial insurance is hit or miss depending on the details of each policy.


Do you know the cash cost of a script? I assume it remains patent protected.
#CertifiedSIP
File5
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AG
We should prescribe that thing in the hunger games where people just throw up what they just ate so they can eat more without feeling full.

But seriously, I'm torn on this one. On one hand we have the need for people to take back their lives and learn personal responsibility. On the other hand we have food industry providing crap food and society pushing a sedentary lifestyle on everyone that is hacking human psyche to our detriment.

It's like all the junk boomers have - their parents didn't have a lot so they never let go what they do have. Intensely psychological.

Not sure where I fall on this one, although my strong instinct is that it would do much more harm than good to teach people that their poor choices can be negated with a few pills.
agdoc2001
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AG
KidDoc said:

If your teens are struggling with weight, Wegovy was just approved for 12+ yesterday for weight loss 12+. The data is very promising and it is exciting to finally have something beyond diet & exercise to manage this very common problem.

Finally, there remains "ongoing weight bias and stigma among the public, and in particular, among healthcare providers, with the misconception that obesity is a personal failing or matter of willpower, or ultimately a fault of the child and parent," Armstrong said.


"misconception"
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
KidDoc
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AG
FratboyLegend said:

KidDoc said:

If your teens are struggling with weight, Wegovy was just approved for 12+ yesterday for weight loss 12+. The data is very promising and it is exciting to finally have something beyond diet & exercise to manage this very common problem.

Quote:


Finally, there remains "ongoing weight bias and stigma among the public, and in particular, among healthcare providers, with the misconception that obesity is a personal failing or matter of willpower, or ultimately a fault of the child and parent," Armstrong said.

However, that is simply not the case, she noted, pointing out that obesity needs to be treated via the same model as other chronic diseases, accounting for remissions, relapses, monitoring, and ongoing care.


AAP Guidelines: 'Watchful Waiting' No Longer the Right Call for Child Obesity | MedPage Today

Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity | Pediatrics | American Academy of Pediatrics (aap.org)

Wegovy was life changing to me as a 50 year who was a fat little kid. I believe in this treatment so much I bought stock in Novo nordisk. Now the big fight will be getting the price down and getting insurance to cover it. Right now medicare/medicaid refuse to cover any medication for weight loss period as they think it is cosmetic only. Commercial insurance is hit or miss depending on the details of each policy.


Do you know the cash cost of a script? I assume it remains patent protected.
$1600 a month. It is crazy.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
gigemJTH12
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AG
KidDoc said:

Doctors have been encouraging lifestyle changes for obesity for over 40 years. It is clear it is not working. Read the study that got this approved. Both groups had dietary and lifestyle coaching but the treatment group lost weight and the placebo did not.

The status quo for obesity treatment is clearly failing. Anyone who considers medications has already tried, usually for years, to lose weight through behavioral modifications and have failed.

Insurance coverage is going to be an interesting battle for sure.
I hope insurance doesnt pay a dime.
Lavender Gooms
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AG
Hoosegow said:

The first rule they teach you in medical school is that the first person you cure is the first customer you lose. It is very profitable to push drugs and constant medical monitoring. It creates a reoccurring source of income for doctors and drug companies.




Funny, I've worked with numerous Physicians over the past 4+ years in family practice and not once have I heard this mentioned in any way, shape, or form. In fact, it's been the exact opposite, with patients being celebrated for taking control of their health through lifestyle changes. Also, despite have countless patients on Rx meds, I haven't gotten any checks from pharm companies...weird. And my compensation isn't tied to any metric that includes number of meds prescribed.

KidDoc, thanks for the article. Clearly something isn't working with current guidelines so I'm interested to see how much of an effect it will have. I'm in a rural clinic with probably 80% Medicaid population on the peds side so unlikely to see any kind of change here.
bam02
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AG
I agree. There is no shortage of patients for good doctors to keep a busy practice. There is a minority of doctors, though, that do have a $ first mindset that makes them think that way. I don't think it's a tiny minority, but I definitely think it's a minority.

Taking good care of patients and having good outcomes is the best thing a doctor can do for their financial well-being, though, and I think most strive for that.
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