Adolescent Alcoholic Liver Disease.

Alcohol use is common during adolescence. Adolescent alcohol use is a global problem. The risk of alcohol dependence increases based on genetic and psychosocial factors. If a provider is concerned about use of alcohol, screening is recommended. From a public health perspective, alcohol abuse should be addressed.

Identifying and Preventing Eating Disorders in Adolescent Patients with Obesity.

Adolescents with obesity are not immune to developing disordered eating and eating disorders. They most commonly present with atypical or subthreshold criterion due to excess body weight or questions regarding the presence of a distorted body image. Patients with premorbid overweight/obesity and subsequent achievement of weight loss may lead to delays in the recognition and treatment of disordered eating and eating disorders. In fact, disordered eating and eating disorders tend to be higher in those undergoing weight management. This article describes risk factors for the development of eating disorders, common features of eating disorders in adolescents with obesity, and provides recommendations for prevention strategies. [Pediatr Ann. 2018;47(6):e232-e237.].

Diagnostic Evaluation, Comorbidity Screening, and Treatment of Polycystic Ovary Syndrome in Adolescents in 3 Specialty Clinics.

STUDY OBJECTIVE: A polycystic ovary syndrome (PCOS) diagnosis in adolescence can have significant long-term health implications. The criteria for its diagnosis in adolescents have been subject to much debate. In this study we aimed to characterize the variability in diagnosis and management among different pediatric specialties. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: This was a retrospective review of electronic medical records of female patients (11-21 years old) who presented to 3 specialties (adolescent medicine [ADO], pediatric endocrinology [ENDO], and gynecology [GYN]), with a postvisit diagnosis of PCOS, menstrual disorders, or hirsutism, at a large tertiary care center, from November 1, 2011 to October 31, 2012. Demographic, clinical, laboratory, and treatment data were abstracted. MAIN OUTCOME MEASURES: Testing for diagnosis of PCOS and its comorbidities, and treatment strategies in the 3 pediatric specialties. RESULTS: One hundred forty-one patients (50 ADO, 48 ENDO, and 43 GYN) were eligible. Testing for hyperandrogenemia (17-hydroxy-progesterone, dehydroepiandrosterone, estradiol), thyroxine, and use of pelvic ultrasound differed among specialties. Providers failed to document weight concerns in 28.3% (29 of 101) of overweight or obese patients. Patients seen by ENDO were most likely, and GYN least likely, to be identified as having elevated weight, and to be tested for glucose abnormalities, dyslipidemia, and liver disease. ENDO providers prescribed metformin more often and hormonal therapy less often than ADO and GYN. CONCLUSION: There is considerable variability across pediatric specialties in the evaluation of PCOS, with significant underassessment of comorbidities. Use of unified guidelines, including for the evaluation of comorbidities, would improve evidence-based management of adolescent PCOS.

Clinical outcomes of an inpatient pediatric obesity treatment program in the USA.

Background When treating recalcitrant and severe childhood obesity, pharmaceutical options are limited and few patients qualify for bariatric surgery. A prolonged inpatient program serves as an alternative treatment. The purpose of this project was to describe the development of a medically supervised inpatient weight management program and evaluate its effectiveness. Methods This is a retrospective chart review of 18 patients [4-18 years, mean body mass index (BMI) 50.2 kg/m2] admitted to an inpatient pediatric weight management program from October 2011 through December 31, 2012 to evaluate the biometric, laboratory, sleep and behavioral changes that occurred from admission to discharge from the program. Results Average weight loss was 15% (6.9%-21.5%, p = 0.0001), the decrease in BMI was 15.1% (1.61-21.57, p = 0.0001), systolic blood pressure and diastolic blood pressure decreased by 7.2% (p = 0.003) and 10.3% (p = 0.040), respectively. The reduction in heart rate was 15% (p = 0.013). Upon admission, nine patients had obstructive sleep apnea syndrome (OSAS), of which one was treated with tonsillectomy and six were not compliant with home positive airway pressure (PAP) therapy. At discharge, three patients no longer required PAP and five required decreased PAP settings. Upon admission, seven patients met the criteria for an internalizing disorder. At discharge, symptom reduction was noted. Conclusion An intensive pediatric inpatient weight management program leads to successful weight loss, improvement in hemodynamic parameters, reduction in OSA treatment requirements and symptom improvement in anxiety and depressive disorders in obese children.

Gastrointestinal Conditions in the Obese Patient.

Obesity in adolescents presents many challenges for the patient, family, and physician. The myriad problems involving the GI tract will be managed more effectively when the treating physician has an understanding of the presentations, pathophysiology, appropriate laboratory evaluation, and approaches to treatment for these complications. In addition to being familiar with the pharmacotherapeutic options available, having an approach to behavioral change, such as MI, can be an extremely useful tool.

Comprehensive obesity evaluation and treatment of three adolescents: a case series.

BACKGROUND: Adolescent obesity is a chronic disease that is impacted from each patient's biopsychosocial milieu. Successfully treating pediatric obesity requires long-term, innovative, systematic involvement to facilitate patient and family engagement and change. METHODS: Extensive chart review was done for three obese adolescents who underwent comprehensive weight management in an adolescent clinic seen within the past 5 years. The charts were reviewed starting from the time of initial contact through the last visit in the clinic. The patients are no longer receiving care within the clinic. RESULTS: The patients presented with BMI>99th percentile, family history of obesity, severe psychosocial stressors, and multiple obesity-related comorbidities. Their treatment involved comprehensive multidisciplinary intervention in an adolescent weight management clinic within a tertiary care center. In addition to rigorous support through frequent office visits, these patients all eventually required temporary, alternative living arrangements to successfully implement recommendations. One patient resided with another family member; two went to inpatient weight management program care for 2-3 months. All subjects successfully lost weight when away from their primary residence, and they demonstrated improvement or resolution of comorbidities. CONCLUSIONS: This case series of three adolescents who underwent comprehensive obesity evaluation and treatment demonstrates multidisciplinary care across interconnected treatment programs and active engagement of family. Those who maintained successful weight loss reduced sedentary time, demonstrated family support (e.g., key members attending follow-up visits), and altered their living environment and were committed to their own health goals.

A qualitative study of the day-to-day lives of obese Mexican-American adolescent females.

OBJECTIVE: In an effort to develop more effective weight-loss interventions, this study examined the daily experiences and personal struggles of Mexican-American adolescent females with morbid obesity. METHODS: Twenty self-identified, morbidly obese Mexican-American adolescent females and their families were interviewed about their food choices, personal and family barriers to weight loss, sources of support, previous weight-loss experience, and weight-related beliefs. Qualitative responses were coded by using framework analysis. RESULTS: Four themes emerged from the adolescent and family responses: the impact of normal adolescent development, multiple sources of excess calories, the physical and emotional burden of excess weight for the adolescent, and the magnitude of the family's personal struggle with weight management. Multiple subthemes were also identified. CONCLUSIONS: Responses by the adolescents and their families highlighted the intersection of adolescence and Mexican-American culture and the daily challenges of obesity. Recommendations for providers include incorporating knowledge of adolescent development and culturally sensitive care into treatment recommendations.

Waist circumference predicts increased cardiometabolic risk in normal weight adolescent males.

OBJECTIVE: The aims of the study were to establish waist circumference (WC) cut-off points that identify clustering of obesity-related conditions and determine if the cut-off points identified an increased risk of disease when used within BMI categories. METHODS: This is a secondary analysis of the Centers for Disease Control NHANES III complex, multistage probability weighted data set collected between 1988 and 1994 from multiple locations in the United States. There were 2003 adolescents ages 12-19 years. Main outcome measures were low (<2 risk factors) or high (≥2 risk factors) risk for cardiometabolic disease based on the number of abnormal serum measurements for fasting glucose, high-density lipoprotein (HDL), triglycerides, and blood pressure. Receiver-operating characteristic curve analysis created the WC cut-off points and logistic regression determined if cut-off points predicted of within BMI categories. RESULTS: Analysis identified cut-off points of ≥80.5 cm for males and ≥81 cm for females. Cut-off points predicted abnormal values for all outcome variables except fasting serum glucose in females, p < 0.05. Males with a normal BMI and elevated waist circumference were more likely to be high risk (OR = 5.23, CI = 1.79, 15.24, p < 0.013) and have increased odds of abnormal serum triglycerides, HDL and blood pressure. Overweight females (BMI ≥ 85-94%) with elevated waist circumference were more likely to have elevated blood pressure (OR = 9.05, 95% CI: 1.44, 56.83). CONCLUSION: WC within BMI categories may identify those who have cardiometabolic disease risk factors despite having normal or overweight BMI.