Substance use, mental health and weight-related behaviours during the COVID-19 pandemic in people with obesity.

Studies have shown the negative impact of COVID-19 lockdown orders on mental health and substance use in the general population. The aim of this study was to examine the impact of the COVID-19 pandemic onsubstance use, mental health and weight-related behaviors in a sample of adults with obesity after lockdown orders were lifted (June-September 2020). A retrospective medical chart review identified patients with obesity from one university-based obesity medicine clinic, and two metabolic and bariatric surgery (MBS) practices. Patients who completed an online survey from June 1, 2020 to September 30, 2020 were included. The primary outcome measure was substance use (various drugs, alcohol, tobacco). Substance use and mental health survey questions were based on standardized, validated instruments. A total of 589 patients (83.3% female, mean age 53.6 years [SD 12.8], mean BMI 35.4 [SD 9.1], 54.5% Non-Hispanic white, 22.3% post-MBS) were included. Seventeen patients (2.9%) tested positive for SARS-CoV-2 and 13.5% reported symptoms. Nearly half (48.4%) of the sample reported recreational substance use and 9.8% reported increased use since the start of the pandemic. There was substantial drug use reported (24.3% opioids, 9.5% sedative/tranquilizers, 3.6% marijuana, and 1% stimulants). Patients who reported stockpiling food more (adjusted Odds Ratio [aOR] 1.50, 95% CI 1.03-2.18), healthy eating more challenging (aOR 1.47, 95% CI 1.01-2.16), difficulty falling asleep (aOR 1.64, 95% CI 1.14-2.34), and anxiety (aOR 1.47, 95% CI 1.01-2.14) were more likely to report substance use versus non-users. Results here show that the COVID-19 pandemic is having a deleterious impact on substance use, mental health and weight-related health behaviors in people with obesity regardless of infection status.

Pediatrician Communication About High Blood Pressure in Children With Overweight/Obesity During Well-Child Visits.

OBJECTIVE: Despite recognition that hypertension is associated with childhood obesity, data suggest that high blood pressure (BP) is infrequently diagnosed in children. This study sought to examine provider communication with overweight school-age children regarding BP measurements that were high at well-child visits. METHODS: Cross-sectional mixed-methods analysis of audio-recorded communication from well-child visits with overweight 6-12-year-olds. Data from the subset of children with elevated BPs were used for this study. Three BP measures obtained at the audio-recorded visit were averaged, paired with historical BPs stored in the health record, and compared to contemporary/Fourth-Report thresholds to determine if children had elevated/hypertensive BPs only at the audio-recorded visit or met hypertension-diagnostic criteria (hypertension-level BP ≥3 separate visits). Two reviewers used visit transcripts to categorize communication about BP as "absent," "unclear," or "direct." Provider use of a billing diagnosis for elevated BP/hypertension in visits with direct-BP-communication was explored. RESULTS: In 36 of 126 (29%) visit-audio-recordings, children had elevated/hypertensive BPs. Thirty-three of the 36 eligible (92%) had intelligible audio-recordings. Of these, 9 (25%) were overweight and 24 (75%) had obesity. Seventeen (52%) had elevated BPs, and 16 (48%) hypertensive BPs. Ten (30%) met criteria for hypertension diagnosis. BP communication was absent in 20 visits (61%), unclear in 8 (24%), and direct in 5 visits (15%). Billing diagnoses for elevated BP/hypertension were entered at 4 of 5 (80%) visits with direct-BP communication. CONCLUSIONS: Most overweight children with elevated BPs did not receive communication that BP is high at well-child visits. Relevant billing diagnoses may indicate direct-BP communication.

Does Age Affect Surgical Outcomes After Ileal Pouch-Anal Anastomosis in Children?

BACKGROUND: Younger children are referred for surgical intervention in the treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Outcome data in this population after a laparoscopic restorative proctocolectomy and Ileal pouch-anal anastomosis (LRS-IPAA) are limited. We reviewed our experience to determine if younger children would have similar functional outcomes. METHODS: After institutional review board approval, a review of children with FAP and UC undergoing LRS-IPAA at a children's hospital from 2002 to 2017 occurred. The study groups were defined based on age: young group (YG; 5-12 y) and older group (OG; 13-18 y). Data points included demographics, postprocedure course, and outcomes. Statistical analysis was performed. RESULTS: Sixty-five children were identified and grouped by age: YG (n = 22, average age 9 y) and OG (n = 43, average age 15.4 y). Thirteen children in YG had UC, and nine had FAP. Twenty-eight children in OG were diagnosed with UC, and 15 with FAP. After LRS-IPAA, continence, appetite recovery, and use of antidiarrheal medications were not significantly different between groups. The incidence of pouch stricture, diagnosis of pouchitis, and complications were also not significantly different. Two children (YG), aged 11 and 12 y at the time of colectomy, were initially diagnosed with UC and then reassigned as having Crohn's disease because of persistent symptoms. One child, who underwent colectomy at 17 y for FAP, had invasive rectal cancer and died 3 y later from metastatic disease. Time of follow-up for OG is 8-61 mo (average: 37 mo). Period of follow-up for YG is 11-73 mo (average: 43 mo). CONCLUSIONS: There are no significant differences in the functional outcomes between groups after LRS-IPAA. Although numbers are small, these data suggest younger age should not be a deterrent when contemplating LRS-IPAA in the treatment of UC and FAP in the pediatric population. Younger patients with FAP may benefit from early intervention.