Objective
This study aimed to examine whether 1‐month BMI improvement is predictive of superior 6‐ and 12‐month BMI changes in a national sample of youth in pediatric weight management treatment.
...Methods
Participants were 4‐ to 18‐year‐olds from the Pediatric Obesity Weight Evaluation Registry, a prospective study collecting data from 31 pediatric weight management programs across the United States. Response at 1 month was defined as ≥ 3% BMI reduction; success at 6 and 12 months was defined as ≥ 5% BMI reduction from baseline. Analyses used linear and logistic regression with robust variance estimation.
Results
Primary analyses were completed with 687 participants (mean age 12.2 years). One‐month responders demonstrated significant improvements in BMI compared with nonresponders at 6 months (BMI, −2.05 vs. 0.05; %BMI, −5.81 vs. 0.23; P < 0.001 for all) and 12 months (BMI, −1.87 vs. 0.30; %BMI, −5.04 vs. 1.06; P < 0.001 for all). The odds of success for 1‐month responders were 9.64 (95% CI: 5.85‐15.87; P < 0.001) times that of nonresponders at 6 months and 5.24 (95% CI: 2.49‐11.02; P < 0.001) times that of nonresponders at 12 months.
Conclusions
In treatment‐seeking youth with obesity, early BMI reduction was significantly associated with greater long‐term BMI reduction. Nonresponders may benefit from early treatment redirection or intensification.
Youth with classical congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency exhibit an increased prevalence of obesity, early adiposity rebound, and increased abdominal adiposity ...compared to unaffected youth. Current obesity management in CAH largely focuses on lifestyle modifications. There is evidence that topiramate therapy is effective in reducing body mass index (BMI), as well as visceral adipose tissue (VAT), in unaffected adolescents with exogenous obesity. However, little is known about the efficacy of topiramate in patients with classical CAH. We report on a 17-year-old female with severe obesity and salt-wasting CAH due to 21-hydroxylase deficiency, who demonstrated reductions in BMI, as well as abdominal visceral and subcutaneous adipose tissue (SAT) while on topiramate therapy. The patient was diagnosed with classical CAH as a newborn with a 17-hydroxyprogesterone 11,000 ng/dL. She had a BMI over the 95
percentile at 3 years of age, followed by unremitting obesity. At 17 years old, she was started on topiramate to treat chronic migraines. Following three years of topiramate therapy, her BMI z-score decreased from +2.6 to +2.1. After four years of therapy, her waist circumference decreased from 110 to 101 cm, abdominal VAT decreased substantially by 34.2%, and abdominal SAT decreased by 25.6%. Topiramate therapy was associated with effective weight loss and reduced central adiposity in an adolescent with classical CAH and severe obesity, without any side effects. Further study is warranted regarding topiramate therapy in obese youth with classical CAH and increased central adiposity, who are at higher risk for significant morbidity.
Purpose: Although human trafficking has been ongoing for millennia, there has only recently been more public awareness and concern over the problem of trafficking, especially of youth. An ...understanding of trafficking on a more granular level, especially in a metropolitan area such as Los Angeles, where trafficking is a prevalent but underdetected issue, is paramount to recognizing victims and addressing the problem. This is even more essential in youth victims of trafficking; there is a critical need for more information regarding the specific needs of this vulnerable population. This study aims to (1) better understand the unique characteristics and risk factors of the trafficked youth population in a major metropolitan area, (2) explore how youth victims are recruited into trafficking, and (3) further understand aspects surrounding the trafficking experience. Methods: In partnership with the Coalition to Abolish Slavery and Trafficking (CAST), a retrospective chart review of trafficked youth seeking services and support was performed. The study population included approximately 125 foreign and domestic youth ages 15-24 years old involved in labor trafficking, sex trafficking or both, who engaged in services with CAST from 2015 through 2017. An analysis of prevalence, means, medians, and ranges was performed on the data collected. Results: Of the 125 trafficked youth, the majority of survivors identified as female, 9% (11) were male and 3% (4) were transgender female. 88% (110) were sex trafficked,10% (12) were labor trafficked, and 2% (3) were both labor and sex trafficked. Although Los Angeles is predominantly Caucasian and Hispanic, trafficked youth victims were disproportionately Hispanic (35%) or African American (40%). 25% (11) previously had an individual educational plan in school, 9% (4) reported having a developmental disability, and 2% (1) had a physical disability. Two-thirds of victims state that they had seen a medical provider less than one year ago while being trafficked. 86% (101) were domestically recruited into trafficking. The mean age at first trafficking was 17 years old. Recruitment methods may be grouped into two larger categories: through relationships and through deception about false opportunities. Most (69%) were predominantly recruited through relational interactions. Parents (29%), relatives (23%), and friends (26%) were identified as support systems for survivors. Conclusions: This study illustrates that the problem of youth trafficking mainly occurs domestically to older youth and can include victims who are of male gender, persons of color, and gender minorities. Those with chronic medical conditions or developmental disabilities are potentially at-risk groups as well, and it is paramount to keep a broad perspective about who may be a victim of trafficking when caring for patients. All providers have a role in identifying youth who may currently be or at-risk of being trafficked, educating patients, families and other providers about the problem of youth trafficking, and in supporting youth to establish safe and healthy relationships.
To report on long-acting reversible contraception (LARC) experience and continuation rates in the Adolescent Medicine LARC Collaborative.
LARC insertion data (682 implants and 681 intrauterine ...devices IUDs) were prospectively collected from January 1, 2017, through December 31, 2019, across 3 Adolescent Medicine practices. Follow-up data through December 31, 2020, were included to ensure at least 1 year of follow-up of this cohort. Continuation rates were calculated at 1, 2, and 3 years, overall and by Adolescent Medicine site, as were descriptive statistics for LARC procedural complications and patient experience.
Implant and IUD insertion complications were uncommon and largely self-limited, with no IUD-related uterine perforations. Uterine bleeding was the most frequently reported concern at follow-up (35% implant, 25% IUD), and a common reason for early device removal (45% of implant removals, 32% of IUD removals). IUD malposition or expulsion occurred following 6% of all insertions. The pooled implant continuation rate at 1 year was 87% (range, 86%-91% across sites; P = .63), 66% at 2 years (range, 62%-84%; P = .01), and 42% at 3 years (range, 36%-60%; P = .004). The pooled IUD continuation rate at 1 year was 88% (range, 87%-90% across sites; P = .82), 77% at 2 years (range, 76%-78%; P = .94), and 60% at 3 years (range, 57%-62%; P = .88).
LARC is successfully provided in Adolescent Medicine clinical settings, with continuation rates analogous to those of well-resourced clinical trials. Uterine bleeding after LARC insertion is common, making counselling imperative. Future analyses will assess whether the medical management of LARC-related nuisance bleeding improves continuation rates in our Adolescent Medicine patient population.
Summary
Background
Multiple organizations have published guidelines for the screening and treatment of obesity and related comorbidities in youth, including the use of anti‐obesity medications (AOM). ...This study aimed to determine which paediatric patients: (1) receive a diagnostic code for obesity; (2) are most likely to be screened for hyperlipidaemia, non‐alcoholic fatty liver disease, and type 2 diabetes mellitus; and (3) are most likely to be prescribed AOM.
Methods
A cohort of 35 898 patients 9 years 4 months to 17 years 6 months of age with a BMI > 30 or greater than the 95th% on three separate outpatient encounters was generated using the TriNetX database. Logistic regression models were used to estimate the associations between demographics in the study population and the likelihood of diagnosis of obesity, screening for comorbidities, and prescription of AOMs.
Results
Asian, Black, and Hispanic youths had increased odds of having a diagnosis of obesity and being screened for all three comorbidities. Documentation of obesity was associated with increased odds of screening for all comorbidities. Female sex, documentation of obesity, and higher BMIs were associated with increased odds of being prescribed AOMs. Black and Native American races decreased the likelihood of being prescribed AOM.
Conclusions
Management of obesity in terms of documentation of disease, screening for comorbidities, and initiation of AOM continues to fall short of the guidelines put forth by multiple organizations. Race/ethnicity, sex, and BMI correlate with differences in care provided to obese paediatric patients. Further research is needed to identify the barriers to and causes of these disparities.
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