Obesity by the Numbers
Obesity by the...
Managing Pain in Obese ED Patients
Weight-based dosing of opioids is a commonly used approach for managing patients who present to the ED with more severe pain. “Many patients who present to the ED with pain are obese or morbidly obese,” says Asad E. Patanwala, PharmD. “Heavier patients often receive larger total doses of opioids when compared with normal weight individuals. This can potentially increase the risk of serious adverse events.” He adds that morphine is one of the most commonly used opioids in EDs, but data on morphine dosing are limited among obese individuals. Studies are needed to evaluate the analgesic response to morphine, especially in patients with very high BMIs. Comparing Analgesic Responses In a study published in the Emergency Medicine Journal, Dr. Patanwala and colleagues retrospectively reviewed 300 consecutive patients who received intravenous morphine (4 mg) for pain. Patients were categorized into three groups based on their BMI: non-obese, obese, and morbidly obese. The authors then compared analgesic responses to morphine in the three groups. “Our primary goal was to see if patient weight really matters with regard to analgesic response to morphine,” Dr. Patanwala says. Using a scale of 0 being no pain and 10 being worst possible pain, the median baseline pain scores were 8.5, 8.0, and 8.5 in the non-obese, obese, and morbidly obese groups, respectively. The median analgesic response after morphine administration was 2.0, 3.0, and 2.0 in the non-obese, obese, and morbidly obese groups, respectively. In a linear regression analysis, BMI was not predictive of analgesic response. The analgesic response to a fixed dose of morphine did not appear to change as a function of BMI, says...
Battling Severe Obesity in Children & Adolescents
Recent data suggest that overall rates of obesity among children and adolescents have slowed, but worrisome trends have emerged in the form of severe pediatric obesity. “Severe obesity is the fastest-growing subcategory of obesity in children and adolescents, affecting 4% to 6% of all youths in the United States,” says Aaron S. Kelly, PhD. Severe obesity in childhood has both immediate and long-term health consequences, including a greater risk for adverse cardiometabolic risk factors and earlier signs of vascular dysfunction and subclinical atherosclerosis. High BMI and adiposity levels in childhood have been associated with a higher risk of cardiovascular disease (CVD), diabetes, and premature death. “Unfortunately,” says Dr. Kelly, “many of the treatment approaches commonly used in overweight and obese youths are less effective for cases in which severe obesity is present. Treatment options for children with severe obesity are limited, and most standard approaches to weight loss are insufficient for them. Novel treatment strategies must be tailored for severe obesity in order to alter the health trajectory of children and adolescents afflicted with this disease.” Defining Severe Obesity To begin addressing the challenges of managing this patient population, the American Heart Association (AHA) published a scientific statement in Circulation. “A key component of the statement was to develop a standardized definition of severe obesity in children and adolescents,” says Dr. Kelly, who co-chaired the AHA writing group’s scientific statement. The statement defines children older than 2 (and adolescents) as severely obese if they either have a BMI that is at least 20% higher than the 95th percentile for their gender and age, or a BMI of 35 kg/m2...