Disparities in Access and Quality of Obesity Care.

Obesity is a chronic disease and a significant public health threat predicated on complex genetic, psychological, and environmental factors. Individuals with higher body mass index are more likely to avoid health care due to weight stigma. Disparities in obesity care disproportionately impact racial and ethnic minorities. In addition to this unequal disease burden, access to obesity treatment varies significantly. Even if treatment options are theoretically productive, they may be more difficult for low-income families, and racial and ethnic minorities to implement in practice secondary to socioeconomic factors. Lastly, the outcomes of undertreatment are significant. Disparities in obesity foreshadow integral inequality in health outcomes, including disability, and premature mortality.

A Women's health perspective on managing obesity.

While the prevalence of obesity in US men and women is nearly equivalent, obesity management in women requires a different approach that considers age and life stage in development including sexual maturation/reproduction, menopause and post-menopause. In this review, the diagnosis and treatment of obesity using lifestyle modification, pharmacotherapy and metabolic and bariatric surgery are discussed from a women's health perspective, with emphasis on management during pregnancy and post-partum.

Food as Medicine for Obesity Treatment and Management.

PURPOSE: Nutrition is an important lifestyle modification used in the treatment of obesity. The purpose of this review is to highlight different dietary interventions used to promote weight loss in both adults and children. METHODS: A search using PubMed was performed for articles on topics related to nutrition and management and/or treatment of obesity in adults adolescents and children. The literature was reviewed and pertinent sources were used for this narrative review. DISCUSSION: There are many effective nutrition interventions used to treat obesity, including altering macronutrient composition, implementing different dietary patterns, and changing meal timing. Although these interventions can induce weight loss in adults, management of obesity in children is more difficult given their varied nutrition needs in growth and development. The use of food as medicine in obesity treatment is individualized based on patient's age, food preference, and concurrent medical conditions. IMPLICATIONS: Given the multifactorial etiology of obesity, treatment requires multidisciplinary care beyond nutrition intervention.

Hearing Their Voices: Exploring the Patient Narratives of Adolescent and Young Adults Who Have Undergone Metabolic and Bariatric Surgery-A Case Series.

BACKGROUND: Severe obesity in adolescence and young adulthood is undertreated which leads to obesity-related chronic diseases that progress into adulthood. Many organizations including the American Academy of Pediatrics (AAP) support early consideration of metabolic and bariatric surgery (MBS) in the pediatric population to reduce morbidity and mortality. METHODS: Five diverse patients who underwent metabolic and bariatric surgery (MBS) in the form of a Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) contributed patient narratives that captured their life, with a focus on health related quality of life, before and after MBS. RESULTS: MBS leads to significant improvement in health status via decreased mortality and improved health related quality of life. CONCLUSION: The perspectives of those patients who have undergone surgery in adolescence and young adulthood are not adequately captured in the medical literature. While the featured voices are not representative of all, their narratives may increase awareness and utilization of MBS in the treatment of severe obesity in the pediatric population.

Racial Disparities in Obesity Treatment Among Children and Adolescents.

PURPOSE OF REVIEW: With the growing obesity epidemic among children and adolescents, the evaluation of disease origin to slow disease progression is necessary. Racial disparities which are evident amid prevalence and treatment must be studied to counteract disease propagation. RECENT FINDINGS: Disparities are pronounced among Black and Hispanic pediatric patients prior to conception and birth due to genetic composition and fetal environment. Postnatal environment and psychosocial influences can further increase a child/adolescent's propensity to increased weight. Current treatment options including nutrition, physical activity, behavior modification, pharmacotherapy, and surgery are underutilized in communities of color due to limited access to care and cost. Data is limited to demonstrate disparities among treatment of obesity in children and adolescents. The reviewed studies show the role of race on disease treatment. Increased research efforts, especially in pharmacotherapy and metabolic and bariatric surgery (MBS), will help combat obesity in pediatric communities of color.

Strategies in the Management of Adolescent Obesity.

PURPOSE OF REVIEW: We review the current options to manage adolescent obesity which include nutrition, physical activity, behavior modification, sleep management, pharmacotherapy and surgery. Since lifestyle interventions alone are often not effective in adolescents, a multi-disciplinary treatment approach is necessary in management. RECENT FINDINGS: Medications (often used off-label) and metabolic/bariatric surgery are effective treatment strategies to treat adolescents with severe obesity. SUMMARY: The use of pharmacotherapy and surgery is limited due to lack of pediatric obesity tertiary care centers. With more centers, the treatment of adolescent obesity will improve and aid to decrease the prevalence of adult obesity.

Geographic Availability of Physicians Certified by the American Board of Obesity Medicine Relative to Obesity Prevalence.

OBJECTIVE: The objective of this study is to determine the distribution of adult and pediatric American Board of Obesity Medicine (ABOM) diplomates relative to the prevalence of obesity by US state. METHODS: Data from the ABOM physician directory were used to determine original specialty and US state. Physicians were labeled as "adult medicine" physicians (i.e., internal medicine, family medicine, or internal medicine and pediatrics), "pediatric medicine" physicians (i.e., pediatrics, family medicine, or internal medicine and pediatrics), and "other physicians" (i.e., surgical specialty, other specialty, or unknown). Prevalence of obesity by state, according to the Centers for Disease Control and Prevention, was used for adults and adolescents in 2017 and for children in 2014. Counts of ABOM-certified adult medicine physicians and pediatric medicine physicians were conducted relative to obesity prevalence by state. RESULTS: A total of 2,577 US-based ABOM-certified physicians were included (79% from adult medicine, 38% from pediatric medicine, and 15% from other fields). All US states had more than one ABOM-certified adult medicine physician, although geographic disparities existed in physician availability relative to obesity prevalence. Fewer pediatric medicine ABOM diplomates were available in all states. CONCLUSIONS: Promotion of ABOM training and certification in certain geographic locations and among pediatric physicians may help address disparities in ABOM diplomate availability relative to obesity burden.