4.19.2023 Board Book

majority of studies showing only a 1-3% improvement in BMI percentile even when participating in programs with the recommended level of face-to-face contact hours (>26 hours). Patients and families should be informed of the likely change in weight status to expect when pursuing IHBLT. Managing the disease of obesity in children and adolescents includes addressing weight stigma and bias. All providers should work to reduce stigma and bias and the medical home should not be threatening to the patient. Of note, evidence-based studies show that patients with obesity complicated by restrictive eating disorders have beneficial effects from obesity management with improvement in loss of control eating and binging behaviors when treated in weight management programs. Over the past 3-4 years, several advanced therapies have become available for the management of children and adolescents with obesity. These advanced therapies are discussed in detail in the OMA Pediatric CPS 5 2 . Use of these advanced therapies is yielding improvements in weight status far above that seen with IHBLT. Improvement in weight status and associated complications in children and adolescents is similar to that noted in adults with the use of advanced therapies. FDA approval of the combined AOM containing Phentermine and Topiramate is associated with an 8.5-11% decrease in BMI. Use of glucagon like peptide 1 (GLP-1) receptor agonists also show greater decreases in BMI with 43.3% of patients on daily liraglutide showing a >5% reduction in BMI and 26.1% with >10% reduction in BMI. With once-weekly Semaglutide, the mean change in BMI was 16.1%, with 62% of the participants achieving at least 10% loss of body weight at and 37% of subjects achieving weight loss of at least 20% from baseline to 68 weeks. Other AOMs such as Tirzepatide, a novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, are currently in trials for adolescents. Metabolic bariatric surgery (MBS) has been associated with a mean percent weight loss of 26% at 5 years after surgery. Any of these advanced therapies result in significant improvement in weight status. Side effect profiles must be discussed with patients and families and well as the expected course of not intervening so that the patient and family can make an informed decision on treatment. The sooner the disease is treated, the sooner the progression of disease is addressed. The disease of obesity in children and adolescents is pervasive and is resulting in significant morbidity in our youth. This disease deserves management by providers trained specifically for this purpose and who are financially reimbursed to the point where caring for these patients is financially sustainable. Training begins in medical school with a robust nutrition education and specific teaching about the disease of obesity. Residency programs should increase time spent by trainees in Obesity Medicine clinics and trainees should achieve a level of academic competence showing they have grasped the concepts of management. Finally, children and adolescents should be included in trials of all interventions. Although pharmaceutical companies have performed clinical trials down to the age of 12 years, usually years after they have finished trials in adults, we know that many children have the disease of obesity well before the age of 12 years. Off label use of AOM is done but subject to out-of-pocket expense from the family. Treatment is often stigmatized in the younger patient and even pharmacists may be resistant to dispensing AOM in a child less than 12 years due to lack of FDA approval. These are very real obstacles to providing care to our patients. In conclusion, we are happy to see that the AAP has produced the new clinical practice guideline for evaluation and treatment of children and adolescents with obesity. However, we are concerned that management of this chronic and complicated disease is challenging for the general pediatrician and encourage Obesity Medicine specialists to take responsibility for this care. We realize that the availability of Obesity Medicine specialists is limited and that we must take concrete steps to change this. Our goal is

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