ASMBS pediatric committee best practice guidelines

Department of Pediatric Surgery, Center for Healthy Weight and Nutrition, Nationwide Children’s Hospital, Ohio State University College of Medicine, 700 Children’s Drive, Suite ED379, Columbus, OH 43205, USA.
Surgery for Obesity and Related Diseases (Impact Factor: 4.94). 01/2012; 8(1):1-7. DOI: 10.1016/j.soard.2011.09.009
Source: PubMed
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    ABSTRACT: It is the position of the Academy of Nutrition and Dietetics that prevention and treatment of pediatric overweight and obesity require systems-level approaches that include the skills of registered dietitians, as well as consistent and integrated messages and environmental support across all sectors of society to achieve sustained dietary and physical-activity behavior change. This position paper provides guidance and recommendations for levels of intervention targeting overweight and obesity prevention and treatment from preschool age through adolescence. Methods included a review of the literature from 2009 to April 2012, including the Academy's 2009 evidence analysis school-based reviews. Multicomponent interventions show the greatest impact for primary prevention; thus, early childhood and school-based interventions should integrate behavioral and environmental approaches that focus on dietary intake and physical activity using a systems-level approach targeting the multilevel structure of the socioecological model as well as interactions and relationships between levels. Secondary prevention and tertiary prevention/treatment should emphasize sustained family-based, developmentally appropriate approaches that include nutrition education, dietary counseling, parenting skills, behavioral strategies, and physical-activity promotion. For obese youth with concomitant serious comorbidities, structured dietary approaches and pharmacologic agents should be considered, and weight-loss surgery can be considered for severely obese adolescents. Policy and environmental interventions are recommended as feasible and sustainable ways to support healthful lifestyles for children and families. The Academy supports commitment of resources for interventions, policies, and research that promote healthful eating and physical-activity behaviors to ensure that all youth have the opportunity to achieve and maintain a weight that is optimal for health.
    Journal of the American Academy of Nutrition and Dietetics 10/2013; 113(10):1375-94. DOI:10.1016/j.jand.2013.08.004 · 2.44 Impact Factor
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    ABSTRACT: Objective Adolescents seeking weight loss surgery (WLS) frequently encounter obstacles obtaining treatment authorization from insurance carriers. This study identified factors influencing authorization for adolescents with clinical indications for WLS.MethodsA retrospective review was conducted for adolescents with clinical indications for WLS at five adolescent centers. This cohort represented a consecutive series of adolescents with insurance benefits for WLS for whom insurance authorization was sought between 2009 and 2011. Outcomes included number and timing of insurance authorizations for surgery, denials, and appeals.ResultsRecords from 57 adolescents (74% female; mean age 16 (range: 12-17) years; mean BMI 51.3 kg/m2) were reviewed. Of these, only 47% were approved with the original request. Eighty percent of those denied were approved on appeal, while 11% never obtained authorization for surgery. Age less than 18 years and proposed procedure were the most common reasons for denial.Conclusions Less than half of adolescents with clinical indications for surgery received approval for the procedure on the first request. The appeal process typically resulted in overturning of denials, so that surgical care could be delivered.
    Obesity 09/2014; DOI:10.1002/oby.20898 · 4.39 Impact Factor
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    ABSTRACT: Bariatric surgery is becoming more appealing as an option in addressing adolescent obesity. Concerns that may be encountered status postbariatric surgery include complications and failure to lose weight. The aim of our study is to describe safety and effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients between the ages of 17 and 19.
    Obesity Surgery 07/2014; DOI:10.1007/s11695-014-1386-8 · 3.74 Impact Factor