Halloween Tips and Tricks to Minimize the Candy

With Halloween only one day away, let’s take a quick look at the advice pediatric obesity experts are giving to minimize — or at least control — the deluge of candy. Between the parties and trick-or-treating it’s very possible for parents and guardians to lose track of how much candy and processed, unhealthy food the kids are eating.

However, with these tips, parents streamline the fun without having kids overindulge. Yes, much of this advice is obvious — and it’s easier said than to follow — but it’s worth revisiting. In an interview with Fox News Digital, Dr. Dyan Hes, medical director at Concorde Pediatrics of Northwell Health in New York City, along with a few other experts, shared these tips.

Don’t banish all candy, set limits

Dr. Hes rightly pointed out that families that are overly strict about candy consumption can lead to kids sneaking “forbidden food.” Instead, set the limit on how many pieces of candy your child or children can have on Halloween night and any satellite events and parties.

The Fox News Digital article author, Lifestyle Reporter Angelica Stabile writes:

The American Heart Association recommends that kids don’t consume more than 25 grams of added sugar per day.

That’s the equivalent of about four to five mini Milky Ways, three fun-size Snickers or three bags of M&Ms, according to registered dietitian nutritionist Ilana Muhlstein.

“Knowing there’s a clear and fair allotment ahead of time will minimize any friction later on,” the Los Angeles-based expert told Fox News Digital.

“It will also encourage them to prioritize their favorite candies, eat them more slowly and savor them more mindfully,” she went on.

“It’s a great opportunity to demonstrate moderation and balance.”

Dr. Hes also suggests storing leftover candy out of sight after Halloween and give out only two treats max per day (the fewer the better). Even better, donate the candy.

Serve balanced meals

Before trick-or-treating, serve your kids healthy, nutritious food with plenty of veggies, protein, and fiber. You can have fun with it, too, by keeping the Halloween theme throughout. Muhlstein told Stabile:

This will help the kids feel full, balance their blood sugar levels, improve their energy and reduce the likelihood of overindulging in candy later on.

“Treats” don’t have to be just candy

Treats don’t equal only candy. Think about getting or giving out trinkets, stickers, temporary tattoos, toys, and other items.

Muhlstein said:

It’s a great way to help your kids foster a healthy relationship with the holidays, so they see that there are more ways to treat yourself and celebrate, beyond food.

Consider non-candy activities

Whether you are hosting or attending a party, instead of filling up on candy, think about activities that involve movement, like a dance party, a costume fashion show or a contest, or a scavenger hunt. Not into that? Suggest a DIY art project (the internet is full of themed suggestions, with printable instructions and handy materials).

To quote Muhlstein again:

Alternative celebrations like these also help prevent the risks of overindulging in sweets, including upset stomachs, hyperactivity and cavities.

Think about gut health

In his article for The Conversation, gastroenterologist and gut microbiome researcher at the University of Washington School of Medicine Christopher Damman also warns to stay away — or at least limit — sugar-laden treats, choosing more microbiome-friendly offerings:

Not all Halloween treats are created equal, especially when it comes to their nutritional value and effects on gut health. Sugar-coated nuts and fruit such as honey-roasted almonds and candy apples rank among the top, offering whole food benefits just beneath the sugary coating. Packed with fiber and polyphenols, they help support gut health and healthy metabolism.

On the opposite end of the spectrum are chewy treats such as candy corn, Skittles, Starbursts and Twizzlers. These sugar-laden confections are mostly made of high fructose corn syrup, saturated fat and additives. They can increase the unsavory bacterial species in your gut and lead to inflammation, making them one of the least healthy Halloween choices.

Pure chocolate candy, especially dark chocolate, are a better option than candy that contains only a small amount of chocolate (we’re looking at you, Twix, Three Musketeers and Milky Way).

Well, there you have it. Hopefully, armed with this expert advice, you’ll have a fun, safe Halloween! We’ve been discussing and doling out Halloween-related advice on this blog for years, so if you’re interested, just type “Halloween” on our homepage in the search box, and a treasure trove of posts dating years back is all yours!

Your responses and feedback are welcome!

Source: “Halloween candy overload: 5 ways to keep kids from overindulging,” Fox News Digital, 10/28/24
Source: “Halloween candy binges can overload your gut microbiome – a gut doctor explains how to minimize spooking your helpful bacteria,” The Conversation, 10/23/24
Image by Mary Jane Duford on Unsplash

How Thinking on Obesity Has Shifted Over Time

Over the years, the way society thinks about obesity has undergone a profound transformation. What was once viewed as a simple issue of personal responsibility has now evolved into a more nuanced understanding of a complex, chronic condition influenced by various factors beyond individual control. This shift in thinking has far-reaching implications for public health, healthcare, and the well-being of individuals living with obesity.

From personal failure to a complex condition

For much of recent history, obesity was seen as the result of poor lifestyle choices — too much food and too little exercise. It was commonly viewed as a moral or personal failing, with public health campaigns often focusing on slogans like the “war on obesity” or the “obesity epidemic.”

These messages reinforced harmful stereotypes of larger-bodied people as lazy or lacking self-control. As a result, many people with obesity experience stigma, discrimination, and shame, not only from society but also within the healthcare system. (We’ve written plenty about fat shaming alone over the years.)

This narrow view of obesity failed to consider the broader range of factors that contribute to weight gain. In recent years, research has increasingly shown that obesity is influenced by a variety of complex factors, including genetics, socioeconomic status, psychological well-being, medications, and the environment. While diet and physical activity remain important, they are only part of the puzzle.

Is the word “obesity” offensive?

A recent article for The Conversation, “How we think about ‘obesity’ and body weight is changing. Here’s why,” Executive Editor Stephen Khan used the word “obesity” with an asterisk (“ob*sity”) throughout his article, explaining,

Historical reflections on the word “obesity” reveal its offensive origins, with advocates suggesting the term ob*sity should be used with an asterisk to acknowledge this. To show our respect, we will adopt this language here.

He also noted that in 2014, the American Medical Association classified obesity as a chronic disease, sparking debate about whether this label pathologizes natural body changes and fuels discrimination.

Why we should fight stigma

A lengthy article by the American Psychological Association by Zara Abrams cites plenty of research to back up the notion that stigma can lead to serious consequences in the person’s physical and mental well-being, quoting a few experts, including Sarah Novak, Ph.D., an associate professor of psychology at Hofstra University in Hempstead, New York, who says,

There’s a perception that weight stigma might feel bad but [that] it’s tough love and it’s going to motivate people… But research shows that this isn’t true.

Citing this and this research on the subject, Abrams writes,

Like other forms of bias and discrimination, weight stigma, also called sizeism, leads to suffering and psychological distress. Sizeism increases a person’s risk for mental health problems such as substance use and suicidality.

Perception of sizeism has been difficult to change

Sizeism is one of the most deeply entrenched stigmas in today’s society, partly because of “sociocultural ideals tying thinness to core American values such as hard work and individualism.” Abrams also notes that “weight-based bullying is more common than bullying based on race, sexual orientation, or disability status” among children, according to some research results published in the Journal of Adolescence. Sadly, family members are “high on the list of perpetrators.”

Psychologists have tested various interventions to reduce sizeism, including empathy-building and education about body weight. However, these approaches have had little effect on anti-fat biases. Unlike racism and sexism, weight discrimination remains legal in most places, with only a few states and cities banning it. This lack of legal protection allows weight-based discrimination in hiring, promotions, and wages to persist. Though public support exists for stronger protections, policy changes have been slow.

Shifting public health approaches

As our understanding of obesity has grown, so too has the way public health professionals approach the issue. The previous weight-centric model — where weight loss was the primary health goal — has come under scrutiny. Many experts now believe that focusing solely on weight loss can lead to negative outcomes, including weight cycling (repeatedly losing and regaining weight), increased stigma, and negative mental and physical health effects.

In response, a new weight-inclusive approach to health has gained momentum. This perspective promotes healthy behaviors — such as balanced eating, regular physical activity, and mental well-being — regardless of whether they lead to weight loss. This approach aims to reduce the harm caused by weight stigma and support people in improving their overall health, rather than fixating on a number on the scale.

The role of healthcare providers

Healthcare providers play a critical role in how obesity is addressed in medical settings. Historically, larger-bodied patients often experienced weight bias, even from their doctors. This stigma can lead to worse health outcomes, as patients may avoid seeking care or feel blamed for their condition rather than supported.

Today, there is a growing recognition of the need for more compassionate and inclusive care. Health professionals are encouraged to use person-first language (e.g., “person living with obesity”) to avoid reducing individuals to their weight. Additionally, clinicians are urged to shift their focus from weight to health behaviors, helping patients set goals around physical activity, nutrition, and mental well-being without making weight loss the central objective.

Your responses and feedback are welcome!

Source: “How we think about ‘obesity’ and body weight is changing. Here’s why,” The Conversation, 9/18/24
Source: “The burden of weight stigma,” American Psychological Association, 3/1/22
Image by RDNE Stock project

How Are Weight Loss Medications Covered Globally?

We’ve been following the developments in the realm of GLP-1 agonists for a while now, including their potential to treat various conditions, risks, and availability. Let’s take a quick look at the recent headlines.

France is the latest European nation to decide against covering weight loss medications through its national insurance program. While the anti-obesity drug Wegovy is now available in the country, the French government is not offering enthusiastic support for it.

Novo Nordisk, the Danish pharmaceutical company that also manufactures the popular diabetes drug Ozempic, announced that Wegovy is now on sale in France for individuals struggling with obesity. According to a company representative, 10,000 people in France have already accessed the drug through an early access program.

Wegovy is expected to cost patients between €270 and €330 per month, but France’s national health insurance won’t cover the cost, meaning users will need to pay out-of-pocket. The drug is recommended only as a secondary option for those whose weight loss efforts through diet and exercise have failed.

Additionally, France’s drug safety agency mandates that initial prescriptions for Wegovy must come from an obesity specialist to prevent misuse, such as by individuals without weight-related health problems who may seek it for cosmetic purposes.

Elsewhere in Europe

Despite the widespread popularity of these anti-obesity drugs, which are predicted to generate global sales of $131 billion (€117.4 billion) by 2028, there have been shortages in the European Union since 2022. However, some experts, such as Dr. Jens-Christian Holm from Denmark’s University of Copenhagen, remain skeptical.

Dr. Holm said that the medications are “not the Holy Grail,” adding:

There are problems there. They cost a lot of money. There are side effects, and they are not working when you stop using them.

France is not alone in its cautious stance. For example, Germany’s national health system is prohibited by a 1980s law from covering drugs aimed at “lifestyle” conditions like obesity, smoking cessation, or hair loss. Therefore, while Wegovy has been available in Germany since 2023, only privately insured patients or those who pay out-of-pocket can access it, with the highest dose costing €302 per month.

In Denmark, where Novo Nordisk is based, the drug is also not typically covered. The Danish health authority has estimated that it would cost around 6 million Danish kroner (€805,000) to prevent a single cardiovascular event, a major factor in its decision not to cover the medication.

Meanwhile, in the United Kingdom, the health service recommends that Wegovy be used for a maximum of two years, refusing to fund longer-term use due to concerns about its cost-effectiveness. Given that many patients regain weight after stopping the medication, there is an ongoing debate among researchers, policymakers, and pharmaceutical companies about extending this usage period.

Wegovy is also available in other countries such as Norway, Spain, Switzerland, Italy, Iceland (where usage “increased by more than twenty-fold in five years,”) Australia, Brazil, Canada, Japan, the U.S., and the UAE, with further international launches planned.

Some nations are waiting to observe the effects of the drug before introducing it. For instance, while Wegovy is not yet available in the Netherlands, Dutch officials are already wary of the potential financial strain. Last year, Novo Nordisk requested that Wegovy be included in the Netherlands’ basic health insurance program. However, a government advisory panel expressed concerns in July about the drug’s long-term effects and the potential €1.3 billion annual cost, deeming it “socially irresponsible.”

These financial concerns might shift in the future, as Novo Nordisk has indicated that it could offer flexible pricing to encourage broader adoption of the drug. Additionally, new medications entering the market in the coming years could help reduce prices.

A Novo Nordisk spokesperson told Euronews Health that the company is continuously exploring ways to collaborate with healthcare systems to make its products more accessible, particularly for patients with significant unmet needs.

The U.S.: cost vs. benefits

Also in recent news, according to the U.S. Congressional Budget Office (CBO), the cost of paying for obesity drugs would be greater than the economic benefits. The CBO estimates that Medicare would spend $35 billion more on obesity drugs from 2026 to 2034, but the savings from improved health would be small.

Here are some details from the CBO’s analysis:

  • The CBO estimates that the federal government would pay an average of $5,600 per user in 2026, and $4,300 per user by 2034.
  • The CBO estimates that the savings from improved health would be less than $50 million in 2026, and increase to $1 billion in 2034.
  • The CBO projects that expanded use of obesity drugs would improve beneficiaries’ health, mainly by reducing the incidence of obesity-related chronic diseases.
  • The CBO continues to monitor trends in the use of obesity drugs, including their prices, effects on health, and coverage by insurance plans.

Your responses and feedback are welcome!

Source: “France won’t pay for weight loss drug Wegovy. What about other European countries?,” EuroNews Health, 11/10/24
Source: “Iceland Sees Sharp Rise in Use of Weight-Management Medications,” Iceland Review, 10/9/24
Source: “How Would Authorizing Medicare to Cover Anti-Obesity Medications Affect the Federal Budget?,” CBO.gov, October 2024
Image by Jakub Żerdzicki on Unsplash

Best Practices in Childhood Obesity Weight Management

Three publications recently discussed the challenges of pediatric obesity treatment and agreed that biological and environmental factors play a big role. Behavioral interventions, while certainly helpful when used a standalone, aren’t as effective as when also involving GLP-1 medications in weight management of children and teens. Let’s take a quick look.

In an interview with Morgan Ebert, Managing Editor at Contemporary Pediatrics, Kay Rhee, M.D., medical director of the Medical Behavioral Unit and research director in the Division of Pediatric Hospital Medicine at the University of California San Diego School of Medicine, highlighted the biological and environmental factors that make fighting childhood obesity management difficult. These include genetic predisposition, food cravings, and limited access to healthy resources in some communities.

Dr. Rhee emphasizes the role of behavioral interventions in helping children and teens adopt healthy eating and activity habits, often involving the whole family. Combining these interventions with medications like GLP-1 agonists can enhance weight loss by reducing appetite and cravings, making it easier for children to learn and stick to healthier behaviors.

She said:

Behavioral weight programs can really help teens/children learn to develop new healthy eating and activity habits. These programs usually involve the parent or caregivers too, so they help the whole family develop new routines and patterns with the hope that these behaviors become second nature to them.

Learning these new skills alongside the use of medications like GLP-1 agonists can be helpful because the medicines can decrease the cravings or decrease appetite to the point where children and youth can focus on learning the new behaviors. Then if they start to be successful in their weight loss efforts, they feel proud and energized because they have successfully learned a new skill that can be linked to these positive outcomes. This sense of pride and accomplishment can really reinforce the new behaviors, and it becomes a great positive feedback loop.

Dr. Rhee suggested practical strategies like removing unhealthy foods from the home to promote better choices. When addressing weight with patients, Dr. Rhee advises providers to focus on the link between obesity and metabolic risks rather than cosmetic concerns, and consider family history to guide conversations about potential health risks.

At the 2024 American Academy of Pediatrics (AAP) National Conference & Exhibition, Tanya Altmann, M.D., a UCLA-trained pediatrician and AAP spokesperson, discussed the growing problem of pediatric obesity in the United States. Her opinions were also published in Contemporary Pediatrics. According to Dr. Altmann, the availability of weight management medications, such as semaglutide, has provided a critical new tool for fighting childhood obesity.

She said:

It really helps those kids no longer be completely focused on what their next meal and snack is, and they’re not constantly hungry… They are able to focus more on eating a balanced meal with the rest of the family, exercising, they’re more self-confident, they can focus more in school and do better.

The article also emphasized that, according to a research letter published in JAMA in May of 2024, “the amount of adolescents and young adults receiving GLP-1 receptor agonists including semaglutide (Ozempic) and tirzepatide increased approximately 6-fold from 2020 to 2023.” Pretty impressive, isn’t it?

Finally, Caissa Troutman M.D., DABOM, CCMS, the Physician Founder of WEIGHT reMDy, a Direct Care Wellness practice in Pennsylvania, discussed the guidelines for evaluating and treating children aged 2-12 with obesity, provided by the Obesity Medicine Association in a new Clinical Practice Statement. She addressed the complex factors behind childhood obesity, including societal and genetic influences, with lifestyle interventions being the cornerstone of weight management.

At the same time, Dr. Troutman noted that intensive health behavior and lifestyle treatment often results in only modest weight changes (1-3%), making early identification of non-responders crucial for timely referrals.

According to Dr. Troutman, the Clinical Practice Statement outlines pharmacotherapy options, including FDA-approved anti-obesity medications and those approved for other uses that affect weight. In other words, multidisciplinary care may be required in “early, intensive treatment to prevent the progression of obesity and improve long-term health outcomes.”

Your responses and feedback are welcome!

Source: “Overcoming pediatric obesity: Behavioral strategies and GLP-1 support,” Contemporary Pediatrics, 10/4/24
“Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024,” ScienceDirect, September 2024
“Highlights of OMA’s Clinical Practice Statement on Obesity in Children,” MedPageToday.com, 10/1/24
“Tanya Altmann, MD, discusses childhood obesity, lifestyle changes, and medications,” Contemporary Pediatrics, 10/2/24
Image by Kelly Sikkema on Unsplash

As Obesity Booms, Doctors Seek Additional Treatment Options

A recent article on Medscape highlights the work and the opinions of Dr. Gitanjali Srivastava, a professor of medicine, pediatrics, and surgery, and the medical director of Obesity Medicine at Vanderbilt University, who had been practicing pediatric medicine for nearly a decade before completing an obesity medicine fellowship at Massachusetts General Hospital in 2013. Reflecting on that time, she recalls that there were no established guidelines or curricula for the specialty.

At that point, obesity was already a widespread issue, but there was still significant stigma both in the medical field and among the general public. After completing her fellowship, Dr. Srivastava spent months traveling and meeting with hospital executives across the country, explaining the importance and value of obesity medicine, covering details about its budget, business model, space needs, and revenue potential.

Specialized obesity treatment gains traction

Today, the field of obesity medicine is growing rapidly. More patients are seeking obesity treatment, and healthcare systems are actively recruiting specialists and building metabolic health centers. Since 2020, the number of doctors certified by the American Board of Obesity Medicine (ABOM) has nearly doubled, and fellowships have more than doubled as well. This year, over 2,100 doctors from various specialties will take the board exam, marking obesity medicine’s increasing integration with other medical fields.

The growing demand for obesity treatment has coincided with the U.S. Food and Drug Administration’s approval of GLP-1 injections, which have shown remarkable weight loss effects. Dr. Marcio Griebeler, head of the obesity medicine fellowship at Cleveland Clinic, explains that the recognition of obesity as a chronic disease, rather than a lifestyle issue, has been long overdue. Obesity treatment has shifted away from advice about diet and exercise to a more scientific understanding of the disease.

Dr. Kimberly Gudzune, chief medical officer for the ABOM Foundation, and others highlight that the brain functions differently in people with obesity, making it more challenging for them to lose weight through willpower alone. New treatments like GLP-1 have shown that obesity can be managed with medication, much like conditions such as high blood pressure or diabetes, but the disease often returns if treatment stops.

More obesity management and treatment training is needed

As more patients seek obesity care, doctors from various specialties are being asked about obesity treatment options, yet many feel unprepared due to a lack of education in this area. Medical training has historically neglected obesity and metabolic health, according to Dr. Nina Paddu, an obesity medicine specialist, who notes that her own training barely addressed these topics.

Dr. Srivastava explains that while the medical community has long sought to establish guidelines for obesity treatment, only recently has enough evidence emerged to create standards. Over the past five years, understanding of obesity’s underlying causes has advanced, with research highlighting the brain’s role and its connections to other diseases. This progress is transforming the way multiple specialties, including endocrinology and surgery, approach obesity.

In response to the growing need, more doctors are pursuing additional training in obesity management. The ABOM offers two certification pathways: completing 60 hours of continuing medical education (CME) credits or undertaking a 12-month fellowship. Dr. Srivastava points out that while the fellowship is more intensive, many physicians are choosing to immerse themselves in it to further their careers. Some return to their previous specialties, but many take on roles specifically focused on obesity medicine.

Despite the field’s growth, there are still not enough obesity specialists to meet the rising demand. With only a small percentage of U.S. physicians certified by the ABOM, many patients may not have access to comprehensive care. Dr. Gudzune emphasizes that while the field is expanding, it remains small relative to the number of patients in need.

Liraglutide is safe for kids as young as six, study finds

Speaking of weight loss medications, a new study shows that liraglutide, a drug already approved for treating obesity in adults and teens, is safe and effective for children as young as six when combined with diet and exercise. The results of the study were published in The New England Journal of Medicine. The drug was found to reduce body mass and slow weight gain in kids aged 6 to 11. Based on these results, the manufacturer, Novo Nordisk, has asked U.S. regulators to expand its use for this younger age group. If approved, it would be the first drug authorized for treating the most common form of obesity affecting over 20% of U.S. children in this age range.

The study involved 82 children, with those receiving liraglutide showing a 5.8% reduction in body mass index (BMI) after over a year of treatment, compared to a BMI increase of 1.6% in the placebo group. Nearly half of the children taking the drug saw significant health improvements. However, side effects, particularly gastrointestinal issues like nausea and vomiting, were common. While experts welcome the potential benefits of the drug, they urge caution in its widespread use due to the risks and lack of long-term data.

The study highlights liraglutide’s potential to treat the underlying causes of obesity in young children, potentially preventing serious health issues like diabetes and heart disease later in life. The trial will continue, with further results expected in 2027.

Your responses and feedback are welcome!

Source: “Doctors Seek Additional Obesity Training in Wake of Obesity Patient Boom,” Medscape.com, 10/1/24
Source: “Weight-loss drug Saxenda effective for kids as young as 6, study shows,” MSN.com, 9/29/24
Source: “Liraglutide for Children 6 to <12 Years of Age with Obesity — A Randomized Trial,” NEJM.org, 9/10/24
Image by Accuray on Unsplash

The Role of Digital Technology in Improving Pediatric Care

In the rapidly evolving world of healthcare, digital technology has emerged as a powerful tool, especially for pediatric populations. The September 2024 issue of Contemporary Pediatrics highlights how digital interventions are reshaping pediatric care across a range of conditions, including mental health and obesity management. With new research and technologies making it easier for both children and their families to manage health challenges, the future of pediatric care looks promising.

Enhancing Mental Health Through Digital Therapeutics

One of the standout articles in this issue presents groundbreaking research conducted by J. Khan, Ph.D., co-founder of Mightier digital therapeutics. This innovative platform uses video game interactions to help children and adolescents learn how to manage their emotions. By receiving real-time feedback during gameplay, young users are taught how to regulate their emotional responses and cope with symptoms like aggression, anxiety, and frustration.

Mightier’s effectiveness has been backed by a randomized controlled trial, which found that children who used the platform showed significant improvement in managing aggression. The potential for this technology is vast, especially for children who are waiting for mental health referrals or are already receiving care. As digital therapeutics continue to evolve, there is great hope for more personalized and accessible mental health care for young populations.

Addressing Childhood Obesity Through Digital Health Programs

Childhood obesity remains a pressing issue in pediatric healthcare, with behavioral factors playing a significant role in its development and management. Another key article in the tech issue of Contemporary Pediatrics highlights how digital tools — such as health apps, text-based interventions, and telemedicine — can support weight management in children and adolescents.

These digital programs focus on behavior change by encouraging healthier eating and physical activity, aiming to help children develop habits that support growth within the expected growth curve. The article emphasizes the need for future research to assess the effectiveness of these technologies, especially among underrepresented pediatric populations. Additionally, the development of apps targeting parental feeding habits during the first three years of life could play a crucial role in preventing childhood obesity before it starts.

The Future of Pediatric Healthcare in a Digital World

As these articles demonstrate, the integration of digital technology into pediatric healthcare offers exciting opportunities to improve outcomes for children. Whether it’s helping children manage mental health challenges, addressing obesity through behavior-focused digital tools, or supporting parents of medically complex children, technology is reshaping the future of care.

However, as healthcare moves deeper into the digital age, the rise of artificial intelligence (AI) poses both challenges and opportunities. AI has the potential to revolutionize healthcare by offering predictive analytics, personalized treatments, and enhanced decision-making. Yet, the rapid pace of AI advancement demands thoughtful reflection on its integration into healthcare systems.

For nurse practitioners and other healthcare professionals, adapting to this technological evolution will require ongoing education and a commitment to high standards of patient care. It will be essential to develop educational programs that incorporate AI and train healthcare providers on how to use these tools effectively, while ensuring that critical thinking remains at the core of all clinical decision-making.

Preparing for the Future

The future of pediatric healthcare is undeniably intertwined with digital technology and AI. As these innovations continue to develop, healthcare professionals must stay informed, agile, and committed to the highest standards of care. By embracing these changes thoughtfully, healthcare providers can help ensure that children and their families receive the best care possible in an increasingly digital world.

Your responses and feedback are welcome!

Source: “Technology: How far we have come and how far can we go?,” Contemporary Pediatrics, 9/23/24
Source: “Digital therapeutics and what they can do for mental health,” Contemporary Pediatrics, 8/8/24
Image by Photo by National Cancer Institute on Unsplash

New Findings on Liraglutide for Younger Children

September is National Childhood Obesity Month, and we don’t need to tell you that obesity is a growing health crisis in the United States, affecting people of all ages. For children, the situation is particularly alarming: nearly 20% of all children in the U.S. have obesity, a number that has tripled since the 1970s.

This troubling rise has serious implications, not only for their immediate health but also for their future well-being. Children with obesity often become adults with obesity, facing a higher risk of developing long-term health problems like diabetes, heart disease, and even cancer. Despite these risks, weight loss for children — especially younger ones — has proven to be a significant challenge.

Doctors have long recognized how difficult it is for individuals with obesity to lose weight, regardless of age. While medications like GLP-1 receptor agonists, including the well-known drug liraglutide, offer promising results for adults and teens, younger children have been left with fewer options.

Until recently, children under the age of 12 could only rely on lifestyle changes like diet, exercise, and counseling to manage their weight. However, groundbreaking research on liraglutide is showing that this may be about to change.

Study details

A new study published in the New England Journal of Medicine explains how GLP-1 drugs could play a critical role in treating obesity in younger children. Dr. Claudia Fox, a pediatrician from the University of Minnesota, presented the findings at the European Association for the Study of Diabetes conference. The study focused on children between the ages of 6 and 12 who had high BMIs. Over the course of a year, 82 children participated, with 56 receiving daily injections of liraglutide while the rest received a placebo. Both groups were also provided with counseling to promote healthy diet and exercise habits.

Study findings

The results were impressive. Children who received liraglutide saw their BMI drop by 5.8%, compared to a 1.6% increase in the placebo group. This difference — 7.4 percentage points — was even more significant than the results seen in studies with teenagers. According to Dr. Fox, these outcomes suggest that early intervention with medications like liraglutide may yield better results, possibly even preventing the progression of obesity as children grow older.

Safety and Side Effects

One of the key concerns about using weight-loss medications in younger children is safety. Fortunately, liraglutide proved to be safe for the participants in the study. While some children experienced side effects like nausea, diarrhea, and vomiting, these issues were generally mild and tended to subside as the trial progressed. Very few participants dropped out due to adverse reactions.

However, one major question remains unanswered: How long would children need to stay on these medications to maintain the benefits? Once the trial ended and children stopped taking liraglutide, their BMI started to increase again, though not as sharply as seen in older children. This suggests that while the drug may be effective, it might require ongoing use to sustain weight loss, similar to how other chronic conditions like diabetes or hypertension require long-term management.

Dr. Sarah Armstrong, a professor of pediatrics at Duke University and a co-author of the American Academy of Pediatrics guidelines, said that medication will probably be necessary for children with severe obesity; that is, a BMI of at least 35. She said:

It is pretty clear that without effective treatment, this does tend to get worse, not better, over time… If a child has severe obesity and maybe has developed some early life comorbidities, it’s probably the right thing to do.

Dr. Armstrong does have some concerns about the use of medications in young kids because of the long-term nature of treatment:

What happens to kids if you put them on medication that makes them less hungry while they’re still growing? Are they going to have delayed puberty? Are they going to have delayed growth? Will it somehow affect their bone density? Will it create disordered eating patterns that are going to cause other problems later in life?

A New Era of Treatment for Childhood Obesity?

The potential for GLP-1 drugs like liraglutide to revolutionize treatment for childhood obesity cannot be overstated. While lifestyle changes are crucial, they often aren’t enough on their own. Dr. Fox and other experts emphasize that obesity is a biological disease, not simply a matter of poor lifestyle choices. As such, more aggressive interventions — including medications and, in some cases, surgical procedures — may be necessary to provide meaningful results.

The implications of these findings could be enormous. Children with obesity face not only physical health challenges but also significant social stigma and emotional stress. Successfully treating obesity in childhood could lead to long-lasting health benefits, reducing the risk of complications like type 2 diabetes, heart disease, and even early puberty. This could also help ease the burden on healthcare systems in the long term.

However, more research is needed, and questions about long-term use, the cost, insurance coverage, potential effects on growth and puberty, and the best time to start treatment are still open.

Your responses and feedback are welcome!

Source: “Weight loss drug liraglutide shows promise for younger children with obesity, study finds,” CNN.com, 9/10/24
Source: “A Novo Nordisk weight loss drug lowers BMI in kids as young as 6,” NBC News, 9/10/24
Image by Lidya Nada on Unsplash

Researching the Differences in Weight Loss Drugs

A new generation of weight loss drugs has revolutionized obesity treatment and expanded therapeutic options for weight management. In her recent article for Nature.com, reporter Mariana Lenharo lays out how emerging research now highlights that these medications, despite their similar mechanisms, can vary in effectiveness.

Drugs like semaglutide and tirzepatide, designed to treat obesity and metabolic disorders, work by mimicking a natural hormone called glucagon-like peptide-1 (GLP-1). Yet, studies have revealed notable differences in their impact. Some are better at preventing type 2 diabetes, and certain drugs promote greater weight loss than others. Research also indicates that older GLP-1 drugs may be more effective in treating neurodegenerative conditions such as Parkinson’s disease than newer alternatives.

Understanding these differences can help physicians better tailor treatments, says Dr. Beverly Tchang, an endocrinologist at Weill Cornell Medicine:

If a patient with obesity has cardiovascular disease, I tend to prescribe semaglutide over tirzepatide, because we have data.

Dr. Tchang cited a study that shows semaglutide reduces the risk of severe cardiovascular events in patients with cardiovascular conditions. For a patient with sleep apnea, the choice might be different, Dr. Tchang notes, referring to research indicating that tirzepatide helps reduce sleep apnea symptoms in obese individuals.

Comparing effectiveness

Among the most popular weight loss drugs are semaglutide, marketed as Ozempic and Wegovy; and tirzepatide, sold as Mounjaro and Zepbound. A recent study found that tirzepatide is more effective than semaglutide in preventing type 2 diabetes in obese patients. Another analysis showed that tirzepatide leads to greater weight loss than semaglutide in people with overweight and obesity. Researchers are now anticipating results from a randomized controlled trial comparing the two drugs for weight loss, which could provide a more definitive answer than earlier retrospective studies.

Both semaglutide and tirzepatide mimic GLP-1, which regulates blood sugar and suppresses appetite. This allows these drugs to activate receptors that GLP-1 normally targets. However, tirzepatide also mimics another hormone called gastric inhibitory polypeptide (GIP), involved in fat metabolism. As a result, tirzepatide activates both GLP-1 and GIP receptors.

But attributing tirzepatide’s greater potency solely to its dual hormone targeting oversimplifies its function, says Dr. Tchang. Tirzepatide does not equally activate GLP-1 and GIP receptors; it binds more effectively with GIP receptors. One theory suggests that its GIP activity enhances GLP-1-driven weight loss, despite weaker activation of the GLP-1 receptor.

Amgen, a biotechnology company, is developing an experimental drug that also targets GLP-1 and GIP receptors. Unlike tirzepatide, this drug blocks GIP receptors while activating GLP-1 receptors, and it has shown promising weight loss results in early clinical trials.

Researchers are now grappling with why significant weight loss can occur both by activating GIP and GLP-1 receptors and by activating GLP-1 while blocking GIP receptors. “There are theories, but we still have much to learn,” says Daniel Drucker, an endocrinologist at the University of Toronto.

Protecting the brain

GLP-1 drugs not only promote weight loss but also reduce inflammation, which may explain their potential to slow neurodegenerative diseases like Parkinson’s and Alzheimer’s, both of which involve brain inflammation.

In one small trial, the GLP-1 drug exenatide improved symptoms in people with moderate Parkinson’s disease. Exenatide, which was approved by the U.S. Food and Drug Administration in 2005, was the first GLP-1 drug on the market. A small trial of another GLP-1 drug, liraglutide, slowed cognitive decline in people with mild Alzheimer’s disease by up to 18% over one year.

Some researchers believe that the better a GLP-1 drug can penetrate the brain, the more effective it might be in treating neurodegenerative diseases. While it remains unclear how far these drugs can reach into the brain, animal studies suggest differences between GLP-1 medications in this regard.

Exenatide, for instance, appears to cross the blood-brain barrier, a protective shield that regulates which substances can enter the brain from the bloodstream. Christian Hölscher, a neuroscientist at the Henan Academy of Innovations in Medical Science in China, credits exenatide’s initial success in treating Parkinson’s to this ability.

Hölscher points out that a longer-lasting version of exenatide was less effective in treating Parkinson’s because it is a larger molecule that cannot penetrate the brain. He says:

This shows how crucial it is for the drug to reach the damaged areas of the brain to improve and protect neurons.

He also notes that semaglutide may not cross the blood-brain barrier, making it unlikely to be as effective against Alzheimer’s or Parkinson’s. However, not all researchers agree. “We don’t have solid data linking brain penetration with effectiveness in neurodegenerative diseases,” says Drucker.

Your responses and feedback are welcome!

Source: “How rival weight-loss drugs fare at treating obesity, diabetes and more,” Nature.com, 09/03/24
Source: “The Weight Loss Drug That Can Prevent Diabetes,” TIME, 09/04/24
Image by EpicTop10.com/Attribution 2.0 Generic

Recent Evaluations of Pediatric Obesity Treatments

As we know, obesity now affects over 20% of children in the United States, and while there are proven interventions to address it, many children still lack access to these treatments. Yale researchers recently explored the cost-effectiveness of one such intervention and examined the challenges and successes in implementing another. Their goal was to identify ways to increase access to effective pediatric obesity treatments. The studies were published in the journal Obesity.

Why do we need these studies?

These studies come at a crucial time. Experts from Yale, in collaboration with national medical organizations, are backing a proposal being considered by the Centers for Medicare and Medicaid Services. This proposal suggests a new billing code that could allow health insurance to cover intensive behavioral and lifestyle treatments for childhood obesity. Such a change would encourage the adoption of these programs and improve access, according to the researchers.

Previous research has shown that interventions providing comprehensive, family-focused nutrition and behavioral education with at least 26 contact hours over a three- to 12-month period are effective in treating childhood obesity. These programs have been recommended by the U.S. Preventative Service Task Force and the American Academy of Pediatrics.

Dr. Mona Sharifi, one of the study authors and an associate professor of pediatrics at Yale School of Medicine, said:

We have effective treatment options… But there are systemic barriers that limit access, and we need to address them urgently.

The first study findings

Cost is a recurring issue in healthcare programs, including obesity treatments. In the first study, Sharifi and her colleagues evaluated the costs associated with implementing the Healthy Weight Clinic intervention in federally qualified health centers from both healthcare and societal perspectives.

The Healthy Weight Clinic offers intensive behavioral and lifestyle treatment for children and adolescents with obesity or overweight. The program involves a team of pediatricians, dieticians and community health workers delivering care within primary care settings, where families are already engaged. The researchers focused on federally qualified health centers because they serve underserved communities disproportionately affected by obesity.

“This choice was intentional to reach communities that face higher obesity disparities,” Dr. Sharifi explained.

The researchers broke down the costs of the intervention, including personnel, materials, and family expenses like time, transportation, and childcare. They then used a model to simulate the impact on a sample of patients over 10 years, comparing those who participated in the Healthy Weight Clinic with those who did not.

The findings showed that if Healthy Weight Clinics were available in all federally qualified health centers over 10 years, they could reach 888,000 children with obesity or overweight and prevent 12,100 cases of obesity and 7,080 cases of severe obesity. The cost per child was estimated at $667, with $456 covered by the healthcare sector and $211 incurred by families. The reduction in obesity cases could save an estimated $14.6 million in healthcare costs over the same period.

Dr. Sharifi said:

It’s a relatively low-cost intervention that our team previously found to be effective… And scaling it up in federally qualified health centers could help reduce health disparities in underserved populations.

The second study findings

In the second study, the researchers examined another intervention by looking at the spread of a program called Smart Moves, which is based on Yale’s Bright Bodies program. Earlier research by Drs. Sharifi, Mary Savoye (the creator of Smart Moves), and others found Bright Bodies to be effective in improving health outcomes in children with obesity and overweight and more cost-effective than standard clinical care.

Between 2003 and 2018, the Smart Moves curriculum was introduced in over 30 sites across the U.S. The new study collected feedback from staff at those sites to identify what helped or hindered the program’s success.

Addressing funding instability

Local partnerships with schools and exercise facilities were key to successfully implementing Smart Moves by providing resources and creating demand for the program. However, funding instability was a major barrier, often preventing programs from being implemented or sustained.

According to Dr. Sharifi,

When a child breaks their arm, their family seeks care, and the clinic bills the insurance company. But this funding model doesn’t work as well for behavioral and lifestyle treatment programs. For example, Bright Bodies involves group visits with families and is led by a dietician, an exercise physiologist, and a social worker.

But insurance companies typically don’t reimburse these programs, even though Bright Bodies has proven to be more effective and cost-saving than usual care. Programs often rely on grants, which eventually run out, leaving communities without access to standard care.

To address this, several organizations, including the American Academy of Pediatrics, the American Academy of Family Physicians, and the CDC, have submitted a proposal for a new billing code. The Centers for Medicare and Medicaid Services will review this proposal in the coming months.

“If approved, it would open the door to more efficient funding for these treatments and give families better access to interventions,” Sharifi said. “In other areas like surgery, not reimbursing for standard care would be unheard of, but in pediatrics, children often get overlooked in health policy, and pediatricians are underpaid.”

Policy changes are needed to ensure that first-line treatments are available to families across the country, Sharifi emphasized.

“Expanding access to these treatments is a pressing need,” she said. “Denying equitable access to effective, low-cost treatment for children is simply unethical.”

What else could be done?

According to the World Economic Forum (and proven by research and statistics), policymakers are working to address harmful food marketing, particularly by restricting marketing to children, imposing taxes on sugary drinks, mandating clear nutrition labels, and limiting portion sizes.

Additionally, research indicates that digital health interventions, such as text messaging programs and digital therapeutics, show promise in supporting weight management and promoting healthy behaviors among children and adolescents.

Your responses and feedback are welcome!

Source: “Evaluating the benefits of and barriers to pediatric obesity programs,” Medical Xpress, 8/28/24
Source: “Childhood obesity — how do we tackle this worsening health issue?,” World Economic Forum, 8/30/24
Image by Vitolda Klein on Unsplash

Is the Natural Compound Berberine a Safer Alternative to Weight Loss Medications?

As we’ve been seeing over and over, a new class of medications, GLP-1 agonists — including Ozempic, Wegovy and Mounjaro — has gained immense popularity since their release. These medications work by mimicking hormones that influence the body’s control over appetite and food intake, as well as slowing digestion to promote a sense of fullness. Common side effects include gastrointestinal issues and injection site reactions.

These drugs have been a breakthrough for those dealing with weight-related conditions such as diabetes, high blood pressure, and heart disease. However, as with any new medication hailed as a “miracle” solution, some people use them to shed a few pounds for aesthetic reasons.

Susan B. Trachman, M.D., in her article in Psychology Today, writes that she is particularly concerned about how these “miracle” drugs might impact mental health. She reminds us that previously, weight-loss drugs like Zimulti were pulled from the European market due to increased reports of suicidal thoughts and behaviors. In the U.S., Qnexa (Vivus), containing phentermine and topiramate, was rejected by the FDA due to concerns over potential risks, including suicidal ideation, despite demonstrating significant weight loss.

Alarming side effects of GLP-1 drugs

While the research on the subject remains limited and conflicting, suicidal ideation has been linked to other weight-loss drugs in the past. For example, Sanofi’s Acomplia, which was never approved in the U.S., was withdrawn from the European market in 2008 due to similar concerns. Contrave, another weight-loss drug, carries a “black box warning” for suicidal thinking, and Qsymia includes a warning advising users to stop taking it if they experience such thoughts.

A recent study, published in the journal JAMA Network Open, examined reports of suicidal thoughts among individuals using semaglutide, whether for diabetes management or weight loss. The researchers analyzed data from a World Health Organization database that tracks adverse drug reactions in over 140 countries.

Out of more than 30,500 people taking semaglutide, 107 reported experiencing suicidal thoughts. Similarly, 162 cases of suicidal ideation were found among over 52,000 patients using liraglutide, another injectable diabetes medication from the same drug class as semaglutide. Since liraglutide has been on the market longer, it has been used by more people.

The study highlighted a disproportionate risk of suicidal thoughts in individuals taking semaglutide, which was not observed in those on liraglutide. Comparing the frequency of suicidal thoughts in semaglutide users with those on other medications in the database, the researchers noted an approximately 45% higher risk associated with semaglutide use.

Enter berberine, nature’s potentially safer alternative

Given that even a slight risk of suicidal ideation should be carefully monitored and mitigated, nature offers a potentially safer alternative for weight loss: berberine. This compound is found in various plants, including goldenseal, barberry, and Oregon grape, and has been used for centuries in Ayurvedic and Chinese medicine. Traditionally, berberine has been utilized to treat infections, skin diseases, and digestive issues. More recently, it has gained attention for its potential positive effects on diabetes and heart disease, as well as its growing popularity as a weight-loss aid.

When taken as a pill or powder, berberine enters the bloodstream and interacts with cells, influencing various biological processes. Instead of targeting a single pathway, berberine acts on multiple fronts, impacting several conditions simultaneously.

In a review published in Biomedicine and Pharmacotherapy, researchers highlighted berberine’s effectiveness in lowering fasting blood sugar levels in hundreds of patients. Additionally, the compound was found to reduce body mass index in a small group of subjects over three months. Other studies have shown that berberine supplements can reduce cardiovascular risk in postmenopausal women by lowering total cholesterol, and when combined with blood pressure medication, it has enhanced the effects of the treatment in hypertensive patients.

Berberine seems to decrease insulin resistance, which can lead to obesity and type 2 diabetes. It may also modulate gut hormones that regulate food intake and energy balance. However, scientific studies focused specifically on berberine’s weight-loss effects are limited due to small sample sizes. One such study involving individuals with fatty liver disease found that those who took berberine daily for three months experienced significant weight loss.

Berberine improves cellular responses to insulin and affects how blood sugar is utilized, helping reduce hunger signals. Additionally, it benefits gut health by promoting a balanced gut microbiome, suppressing harmful bacteria, and encouraging the growth of beneficial ones.

Thinking about trying berberine?

If you consider adding berberine to your regimen, Dr. Trachman advises:

The FDA does not regulate it. Try to source a higher-quality product to avoid side effects from additives in some less expensive forms.

Berberine does interact with some drugs because it can inhibit the clearance of these drugs from the liver, causing an elevated blood level. Check with your healthcare provider before starting this if you take prescription medication.

Berberine’s half-life is only a few hours. That means your blood level will decrease to about 50 percent within a few hours. To maintain a more constant level, many providers recommend multiple daily dosing — two or three times per day at a total of 1500mg.

On a final note, side effects, primarily gastrointestinal, include constipation, nausea, and diarrhea — similar to the side effects reported with newer weight-loss drugs. However, unlike those drugs, berberine has not been associated with mental health issues.

Your responses and feedback are welcome!

Source: “Is Berberine Nature’s Weight Loss Drug?, Psychology Today, 8/23/24
Source: “A study linking popular weight loss drug to suicide risk again raises long-standing safety questions,” CNN.com, 8/20/24
Image by Chris Abney on Unsplash

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources