Patient Attendance and Outcomes in a Structured Weight Management Program.

OBJECTIVES: To determine service utilization and identify patient characteristics associated with service utilization in youth with obesity presenting for structured weight management, and to explore weight-related outcomes associated with service utilization. STUDY DESIGN: In this retrospective study conducted between January 2008 and December 2013, we examined variables associated with the care of 2089 patients aged 2-18 years presenting for an initial visit to 2 tertiary care-based, multidisciplinary structured weight management clinics. RESULTS: Only 53% of patients returned for a second visit, 29% returned for a third visit, and virtually none (0.5%) completed the recommended 6 visits within 6 months. Patients who were Hispanic, government-insured, and whose parent/s spoke Spanish were more likely to return to clinic. Of those patients who returned for at least a second visit, 70% demonstrated a reduction in or maintenance of body mass index z-score. CONCLUSIONS: Patient retention remains a significant barrier to effective pediatric weight management. Structured weight management programs should increase their efforts to engage patients and families at the initial visit and identify and address barriers to follow up.

Healthy eating decisions require efficient dietary self-control in children: A mouse-tracking food decision study.

Learning how to make healthy eating decisions, (i.e., resisting unhealthy foods and consuming healthy foods), enhances physical development and reduces health risks in children. Although healthy eating decisions are known to be challenging for children, the mechanisms of children's food choice processes are not fully understood. The present study recorded mouse movement trajectories while eighteen children aged 8-13 years were choosing between eating and rejecting foods. Children were inclined to choose to eat rather than to reject foods, and preferred unhealthy foods over healthy foods, implying that rejecting unhealthy foods could be a demanding choice. When children rejected unhealthy foods, mouse trajectories were characterized by large curvature toward an eating choice in the beginning, late decision shifting time toward a rejecting choice, and slowed response times. These results suggested that children exercised greater cognitive efforts with longer decision times to resist unhealthy foods, providing evidence that children require dietary self-control to make healthy eating-decisions by resisting the temptation of unhealthy foods. Developmentally, older children attempted to exercise greater cognitive efforts for consuming healthy foods than younger children, suggesting that development of dietary self-control contributes to healthy eating-decisions. The study also documents that healthy weight children with higher BMIs were more likely to choose to reject healthy foods. Overall, findings have important implications for how children make healthy eating choices and the role of dietary self-control in eating decisions.

Late-onset ornithine transcarbamylase deficiency: treatment and outcome of hyperammonemic crisis.

Hyperammonemic crises in ornithine transcarbamylase deficiency (OTC) can be associated with devastating cerebral edema resulting in severe long-term neurologic impairment and death. We present an 8-year-old boy who had late-onset OTC deficiency in which early and aggressive management of hyperammonemia and associated cerebral edema, including therapeutic hypothermia and barbiturate-induced coma, resulted in favorable neurologic outcome. Our patient presented with vomiting and altered mental status, and was found to have a significantly elevated serum ammonia level of 1561 µmol/L. Hyperammonemia was managed with hemodialysis, 10% sodium phenylacetate, 10% sodium benzoate, L-arginine, intravenous 10% dextrose, intralipids, and protein restriction. He developed significant cerebral edema with intracranial pressures >20 mm Hg, requiring treatment with 3% saline and mannitol. Despite this treatment our patient continued to have elevated intracranial pressures, which were treated aggressively with non-conventional modalities including therapeutic hypothermia, barbiturate-induced coma, and external ventricular drainage. This therapy resulted in stabilization of hyperammonemia and resolution of cerebral edema. Molecular testing later revealed a hemizygous mutation within the OTC gene. Neuropsychological testing 1 year after discharge showed normal intelligence with no visual-motor deficits, minor deficits in working memory and processing speed, and slightly below average processing speed and executive functioning.