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Key Factors in Weight Gain After Pediatric Tonsillectomy

Key Factors in Weight Gain After Pediatric Tonsillectomy

Studies have indicated that adenotonsillectomy may be associated with significant weight gain after surgery, a problem that can be concerning for both parents and patients. Previous research also suggests that the postoperative weight gain associated with adenotonsillectomy occurs mostly in children who undergo the procedure as treatment for diagnosed obstructive sleep apnea (OSA). “Potentially worrisome weight gains following adenotonsillectomy occurred primarily in children under the age of 6 years who were underweight or normal weight to begin with.” At the 2012 annual meeting of the American Academy of Otolaryngology–Head and Neck Surgeons, my colleagues and I presented data from a study involving a large population of children undergoing adenotonsillectomy and the demographic factors that may contribute to weight gain. We analyzed medical records of children aged 6 months to 18 years who had their tonsils removed between 2008 and 2011. These data were then refined to only include medical records for children who were routinely examined for at least 6 months after their surgery and had recorded height and weight measurements. All patients in the study had a history of OSA or recurrent tonsillitis. Who’s At Risk for Weight Gain? Results of our analysis showed that, on average, patients had a weight gain of 0.5 to 2.0 lbs— equivalent to a 0.4- to 0.6-point increase in BMI scores—after their surgery. Importantly, the gains that were observed were not dependent on whether the children had OSA or recurrent tonsillitis. In a multiple linear regression analysis that controlled for gender and height, only age was significantly and negatively associated with changes in BMI. Potentially worrisome weight gains following adenotonsillectomy occurred primarily...
Overweight Teens Often Missed by Preventive Care

Overweight Teens Often Missed by Preventive Care

Despite the well-documented rise in pediatric obesity, University of California, San Francisco researchers report in Pediatrics that overweight teenagers do not appear to be receiving the preventive care they need. Following a survey from 2003 to 2007 of 9,220 adolescents aged 12 to 17 who were asked if they received screening for nutrition, physical activity, and emotional distress, the researchers found that obese teens received more screening than normal-weight peers, but overweight teens did not. Obese participants in the survey were 40% more likely than normal-weight peers to report undergoing screening of their physical activity and were 60% more likely to be screened for nutrition. Those who were overweight but not obese did not receive more screening than normal-weight teens for physical activity or nutrition in any of the survey years. Screening rates for physical activity were 75.5% for obese participants, 68.8% for overweight participants, and 68.6% for normal-weight participants; corresponding rates for nutrition were 77.6%, 69.7%, and 66.2%, respectively. Over the 4 years of the study, screening appeared to decline overall. In fact, odds for screening dropped by half for both physical activity and nutrition and by 30% for emotional distress, even after adjusting for factors related to screening. Physician’s Weekly wants to know… Do you believe short office visit times, low reimbursement, and/or a lack of local resources for referring patients for pediatric weight management play a role in the level of screenings? How could screening rates for overweight children can be...
Are Parents to Blame for Their Child’s Obesity?

Are Parents to Blame for Their Child’s Obesity?

According to the CDC, childhood obesity has more than tripled in the past 30 years … but who or what is to blame? Over the past several years, the childhood obesity/child protection issue has emerged, attracting both media and professional attention. As a complex and controversial issue, fingers are being pointed in many directions — including at parents. In a recently published paper from the July issue of British Medical Journal, experts argue that the aetiology of obesity is so complex and parental neglect cannot be the root cause of their child’s obesity. However, consistent failure by parents to make efforts to change lifestyle and engage with professionals or weight management initiatives would constitute neglect. This is of particular concern if an obese child is at imminent risk of disorders like obstructive sleep apnea, hypertension, type 2 diabetes, or mobility restrictions. The child health experts wrote, “In all areas of child health, we have a duty to be open to the possibility of child neglect or abuse in any form. Guidelines for professionals are urgently needed, as is further research on the outcomes of child protection actions in obesity and links between early adversity and later obesity.” Physicians can play a key role in fighting childhood obesity. Check out this week’s “In My Opinion” article, Dealing with Childhood Obesity, which explores the strategies physicians can use to positively impact overweight...

Dealing With Childhood Obesity

One-third of the nation’s children are carrying too much weight, and researchers are beginning to uncover that medical professionals are leery of proactively discussing weight issues with their patients. A recent study revealed that, even though 39% believed that treatment of obesity by physicians has the potential to be effective. “Displaying posters on eating habits in patient exam rooms can have a positive impact on patients.”  Given the sensitivity with young patients in particular, medical professionals often respond vaguely with nonspecific health instructions such as, “lose some weight” and/or “get some exercise.” Unfortunately, these vague commands result in gaps in care. Many parents of obese children often walk out of the doctor’s office just as confused as when they came in. As with any other chronic health problem, the challenge of low literacy may also impact how patients understand the information they are presented. Studies indicate that one of three American adults have limited health literacy skills. Although providers can’t cure all physical illnesses their patients face, childhood obesity and the potential of lifelong diabetes are conditions that physicians must try to proactively prevent and treat. Be Visual Community clinics that routinely deal with family obesity issues have found that displaying posters on eating habits in patient exam rooms can have a positive impact on patients. Being visual is an important strategy that can be easily implemented to address this problem. “Seeing is believing” when it comes to height and weight charts. Hanging a colorful height and weight poster of boys and girls ages 2 to 12 in physician offices can be a helpful asset in teaching parents about...
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