The association of psoriasis and elevated blood lipids in overweight and obese children.

OBJECTIVE: To investigate whether obesity and cardiovascular risk factors are associated with psoriasis in children and adolescents. STUDY DESIGN: For this population-based, cross-sectional study, measured weight and height, laboratory data, and psoriasis diagnoses were extracted from electronic medical records of 710,949 patients age 2 to 19 years enrolled in an integrated health plan. Weight class was assigned on the basis of body mass index-for-age. RESULTS: The OR for psoriasis was 0.68, 1.00, 1.31, 1.39, and 1.78 (95% CI, 1.49 to 2.14) for underweight, normal-weight, overweight, moderately obese, and extremely obese children, respectively (P for trend < .001). The OR for psoriasis treated with systemic therapy or phototherapy as an indicator of severe or widespread psoriasis was 0.00, 1.00, 2.78, 2.93, and 4.19 (95% CI, 1.81 to 9.68) for underweight, normal-weight, overweight, moderately obese, and extremely obese children, respectively (P for trend < .003). In adolescents, mean total cholesterol, low-density lipoprotein cholesterol, triglycerides, and alanine aminotransferase were significantly higher in children with psoriasis compared with children without psoriasis after adjustment for body mass index. CONCLUSION: Overweight and obesity are associated with higher odds of psoriasis in youths. Independent of body weight, adolescent patients with psoriasis have higher blood lipids. These data suggest that pediatricians and dermatologists should screen youths with psoriasis for cardiovascular disease risk factors.

Extreme childhood obesity is associated with increased risk for gastroesophageal reflux disease in a large population-based study.

OBJECTIVE: Gastroesophageal reflux disease (GERD) may link the obesity epidemic to an array of adverse health outcomes including chronic esophageal inflammation and, consequentially, to pathophysiological changes of the esophagus. Although obesity and GERD are associated in adults, data in children are scarce and inconclusive. The aim of this study is to investigate whether, similar to adults, obesity is associated with GERD in youth. METHODS: For this population-based, cross-sectional study, measured weight and height and diagnosis of GERD were extracted from electronic medical records of 690 321 patients, aged 2-19 years, who were enrolled in an integrated prepaid health plan between 2007 and 2008. Weight class (normal weight, overweight, moderate and extreme obesity) was assigned based on body mass index-for-age. RESULTS: Overall, GERD was diagnosed in 1.5% of boys and 1.8% of girls (P<0.001). Moderately and extremely obese children, aged 6-11 years, were more likely to have a diagnosis of GERD compared with normal weight (OR 1.16, 95% CI: 1.02-1.32 and 1.32, 95% CI: 1.13-1.56, respectively). Children aged 12-19 years showed similar associations (OR 1.16, 95% CI: 1.07-1.25 and 1.40, 95% CI: 1.28-1.52, respectively). These associations remained with adjustment for sex and race/ethnicity. By contrast, obesity was not related to increased odds for GERD in children aged 2-5 years of age. CONCLUSIONS: The association between childhood obesity and GERD may have important implications for their future risk of GERD-associated diseases, such as esophageal adenocarcinoma.

Prevalence of extreme obesity in a multiethnic cohort of children and adolescents.

OBJECTIVE: To estimate the prevalence of extreme obesity in a large, multiethnic contemporary cohort of children and adolescents. STUDY DESIGN: In a cross-sectional study, measured weight and height were extracted from electronic medical records of 710,949 patients aged 2 to 19 years (87.8% of eligible patients) who were enrolled in an integrated prepaid health plan in 2007 and 2008. Prevalence of extreme obesity was defined as body mass index (BMI)-for-age>or=1.2 times 95th percentile or BMI>or=35 kg/m2. RESULTS: Extreme obesity was observed in 7.3% of boys and 5.5% of girls. The prevalence peaked at 10 years of age in boys and at 12 years of age with a bimodal distribution in girls (second peak at 18 years; P value for sex x age interaction=.036). The prevalence of extreme obesity varied in ethnic/racial and age groups, with the highest prevalence in Hispanic boys (as high as 11.2%) and African-American girls (as high as 11.9%). CONCLUSION: Extreme obesity in Southern California youth is frequently observed at relatively young ages. The shift toward extreme body weights is likely to cause an enormous burden of adverse health outcomes once these children and adolescents grow older.

What do I do with my morbidly obese patient? A detailed case study of bariatric surgery in kaiser permanente southern california.

Unfortunately, many of the traditional methods for weight loss, such as dietary restriction, exercise, meal replacement, psychosocial and behavioral interventions, and medications, have limited effectiveness in long-term weight maintenance and regulation of chronic diseases such as type 2 diabetes. This has led to the development of surgical approaches to weight loss, generally referred to as bariatric surgery. Most bariatric surgery studies have shown excellent weight-loss rates for up to two years after surgery, with patients losing an average of 61 % of their excess weight (losing 100% of excess weight would return patients to their ideal weight). There is also some evidence that most patients maintain some level of weight loss for up to ten years after surgery. The purpose of this article is to provide primary care physicians and other clinicians with some background regarding bariatric surgical procedures and their risks and benefits. We also summarize the bariatric surgery process at Kaiser Permanente Southern California (KPSC), and then provide a detailed case study as an example of how KPSC screens patients referred for surgery, prepares them for the surgery, and cares for them once they have undergone surgery.