Curbside Consultation in Pediatric Obesity: 49 Clinical Questions

Dedication 
Acknowledgments 
About the Editor 
Contributing Authors 
Introduction 

SECTION I EPIDEMIOLOGY 
Question 1 Obesity in Children Seems to Be Common. Is This an Epidemic? Is This True Outside of the United States? 
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? 
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? 
Brian K. Kit, MD, MPH and Katherine M. Flegal, PhD

 
SECTION II PATHOPHYSIOLOGY/DEVELOPMENT OF CHILDHOOD OBESITY 
Question 4 What Body Systems Affect the Development of Obesity? 
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? 
Patrika Tsai, MD
Question 6 What Major Social Factors Contribute to Childhood Obesity, and How Can Clinicians and Caregivers Alter Their Impact? 
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? 
Andrea J. Sharma, PhD and Stefanie N. Hinkle, PhD
Question 8 Is There Any Relationship Between Sleep and the Development and Prevention of Obesity? 
David Gozal, MD

SECTION III ENVIRONMENT 
Question 9 How Does the Environment Contribute to the Development of Childhood Obesity? How Do Community Influences Affect Childhood Obesity Risk? 
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? 
Richard L. Atkinson, MD

SECTION IV PHYSICAL ACTIVITY 
Question 11 I Often Recommend Increased Physical Activity to Combat Obesity. What Are the Various Benefits of Increased Physical Activity? 
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? 
Brian Dauenhauer, MEd
Question 13 When Developing an Exercise Program for an Obese Child, What Are the Restrictions or Guidelines to Keep in Mind? 
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? 
Xiaofen Deng Keating, PhD and Rulan Shangguan, PhD

SECTION V COMORBIDITIES 
Question 15 What Malnutrition Issues Should I Consider in the Obese Child? 
Denise Purdie, MD and Mary Abigail S. Garcia, MD
Question 16 What Are the Common Gastrointestinal Diseases Associated With Childhood Obesity? 
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? 
Kimberly P. Newton, MD and Jeffrey B. Schwimmer, MD
Question 18 What Is the Relationship Between Diabetes and Pediatric Obesity?
Andrei Fodoreanu, MD and Michael Gottschalk, MD, PhD
Question 19 What Are the Common Orthopedic Issues in the Obese Child? 
Heather M. Kong, MD and Sanjeev Sabharwal, MD, MPH
Question 20 Does Obesity Affect Reproduction? How? 
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? 
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? 
Paul W. Franks, Bsc(Hons), MS, MPhil (Cantab), PhD (Cantab), FTOS
and Angela Estampador, BS, MPH
Question 23 Is Pediatric Obesity Associated With Cancer? 
Krista Beth Highland, PhD and Kenneth P. Tercyak, PhD
Question 24 What Are the Bone Health Considerations in the Obese Child? 
Heather M. Kong, MD and Sanjeev Sabharwal, MD, MPH
Question 25 Is There Any Relationship Between Obesity and Oral Health in Children? 
Raymond J. Tseng, DDS, PhD
Question 26 Some of My Obese Patients Complain About Being Bullied. What Should I Say to These Patients and Families? What Is My Responsibility? 
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? 
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? 
Lee Ann E. Conard, RPh, DO, MPH and Frank M. Biro, MD

SECTION VI TREATMENT 
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? 
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?” 
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? 
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? 
Sandra Hassink, MD, FAAP
Question 33 What Is Motivational Interviewing, and How Can I Use It to Help Motivate My Patients to Lose Weight? 
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? 
Stavra A. Xanthakos, MD, MS
Question 35 How Do I Get Reimbursed for Delivery of Weight Management Therapies in the Office? 
Christopher F. Bolling, MD, FAAP
Question 36 Are There Any Effective Technologies (Current Apps and Sensors) Available to Help Pediatric Patients Lose Weight? 
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?
John R. Sirard, PhD and Jeanette M. Garcia, MS
Question 38 What Are Parent-Only Interventions for Childhood Obesity, and Are They Effective? 
Kerri N. Boutelle, PhD and Stephanie Knatz, PhD
Question 39 What Public Policies Have Been Effective for the Prevention of Childhood Obesity? 
Sandra Hassink, MD, FAAP
Question 40 What Do I Need to Accommodate the Obese Child and Family in the Clinical Office in Regard to Furniture and Equipment? 
Victor E. Uko, MD, MRCPCH (UK) and Kimberly P. Newton, MD
Question 41 Do I Dose Medications the Same for an Obese Child as for a Normal Weight Child? 
Jennifer Le, PharmD, MAS, BCPS-ID, FCCP, FCSHP
Question 42 What Are Some of the Particular Risks for My Obese Patients Who Are Undergoing Surgery? What Strategies Should Be Considered to Minimize These Risks? 
Stavra A. Xanthakos, MD, MS
Question 43 I Want to Set Up My Office to Optimize Obesity Screening and Weight Management. How Would I Set About Doing This? 
Linda L. Hill, MD, MPH
Question 44 How Does Treatment of Obesity Differ According to Age? 
Stephanie Knatz, PhD and Kerri N. Boutelle, PhD
Question 45 What Are the Special Challenges of Managing Obesity in the Child With Autism? 
Colleen Taylor Lukens, PhD
Question 46 What Drugs Are Available to Treat Obesity in Children? 
Kirsten La, PharmD, BCPS and
Jennifer Le, PharmD, MAS, BCPS-ID, FCCP, FCSHP
Question 47 There Are a Number of Commercial Weight Loss Programs. Which Are Safe, Effective, and Appropriate to Recommend to Obese or Overweight Children? 
Rohit Gupta, MD, PhD and David L. Suskind, MD

SECTION VII OTHER 
Question 48 What Are the Health Care and Economic Costs of Pediatric Obesity? 
Leonardo Trasande, MD, MPP and Tamasyn Nelson, DO
Question 49 How Should Physicians Advocate for Pediatric Obesity? How Does One Get Started? 
Christine Wood, MD, FAAP, CLE

Financial Disclosures 
Index 

Jeannie S. Huang, MD, MPH obtained her BS from Brown University in Providence, RI and received her medical degree from the Johns Hopkins School of Medicine in Baltimore, MD. Her postdoctoral training included a pediatric residency at the Children’s Hospital of Los Angeles in California and fellowship in the Combined Program in pediatric gastroenterology and nutrition at Boston Children’s Hospital and Massachusetts General Hospital. She obtained a Master’s of Public Health at the Harvard University School of Public Health, Boston, MA, in Clinical Effectiveness. She is currently Program Director of the Pediatric Gastroenterology, Hepatology and Nutrition fellowship program at the University of California San Diego (UCSD) and an associate professor of Pediatrics at UCSD. She is an active member of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN); she previously chaired the NASPGHAN Task Force on Obesity and currently leads quality improvement projects providing maintenance of certification credit in obesity as well as pediatric gastroenterology for both NASPGHAN and the American Academy of Pediatrics. Active in patient-oriented research, her main areas of interest are wide ranging but have primarily addressed how technology can be used to improve patient care and outcomes. She is the author of book chapters, review articles, and peer-reviewed manuscripts addressing pediatric obesity, among other topics related to pediatric care.