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Case Reports
. 2023 Feb 13:11:1095144.
doi: 10.3389/fped.2023.1095144. eCollection 2023.

Inpatient medical management of severe pediatric obesity: Literature review and case reports

Victoria E Goldman  1   2 , Juan C Espinoza  1   2 , Alaina P Vidmar  1   2   3
Affiliations
Case Reports

Inpatient medical management of severe pediatric obesity: Literature review and case reports

Victoria E Goldman et al. Front Pediatr. .

Abstract

Pediatric obesity rates continue to rise steeply with significant adverse effects on health outcomes across the lifespan. Significant obesity can affect the efficacy, side effects, and ability to use certain treatment, medication, or imaging modalities needed in the evaluation and management of acute pediatric conditions. Inpatient settings are rarely used as an opportunity for weight counseling and thus there is a paucity of clinical guidelines on how to manage severe obesity in the inpatient setting. We present a literature review and three patient cases with single-center protocol for non-surgical management of severe obesity in children admitted for other acute medical reasons. We performed a PubMed review from January 2002 to February 2022 utilizing keywords: "inpatient," "obesity," and "intervention." For our cases, we identified three patients with severe obesity acutely impacting their health while admitted for medical treatment who concurrently underwent acute, inpatient, weight loss regimens at a single children's hospital. The literature search yielded 33 articles describing inpatient weight loss treatments. Three patients met case criteria, all three of which demonstrated a decrease in their weight in excess percent of the 95th percentile after inpatient weight-management protocol implementation (% reduction BMIp95: 16%-30%). This highlights obesity acutely limits or impacts specific medical care required during inpatient admissions in pediatric patients. It also suggests that implementation of an inpatient weight-management protocol during admission may provide an opportune setting to support acute weight loss and overall improved health outcomes in this high-risk cohort.

Keywords: case report; inpatient hospitalization; obesity; weight loss; weight management.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Modified PRISMA flow diagram for our literature search results on inpatient, non-surgical, weight loss interventions for adult and pediatric patients.
Figure 2
Figure 2
Model of inpatient obesity treatment roadmap with collaboration of obesity medicine specialists (MD/NP), nutritionists, nurses, and physical therapists to create individualized nutrition, activity, and medical plans for pediatric patients. BMI, body mass index; CMP, comprehensive metabolic panel; MAOI, monoamine oxidase inhibitors; XR, extended release; AKI, acute kidney injury; MTC, medullary thyroid carcinoma; GI, gastrointestinal.
Figure 3
Figure 3
Change in BMI percent of the 95th percentile over time for three pediatric cases of inpatient obesity medical management. T2D, type 2 diabetes; OSA, Obstructive Sleep Apnea; PWS, Prader-Willi Syndrome; BMI, body mass index; Kg/m2, kilograms per meter squared; % BMIp95, BMI percentage of the 95th percentile; pp, percentage points; ΔBMIp95, change in BMI percentage of the 95th percentile; ΔBMI, change in absolute BMI.
See this image and copyright information in PMC

References

    1. Kyler KE, Wagner J, Hosey-Cojocari C, Watt K, Shakhnovich V. Drug dose selection in pediatric obesity: available information for the most commonly prescribed drugs to children. Paediatr Drugs. (2019) 21(5):357–69. 10.1007/s40272-019-00352-8 - DOI - PMC - PubMed
    1. Lv N, Azar KMJ, Rosas LG, Wulfovich S, Xiao L, Ma J. Behavioral lifestyle interventions for moderate and severe obesity: a systematic review. Prev Med. (2017) 100:180–93. 10.1016/j.ypmed.2017.04.022 - DOI - PMC - PubMed
    1. Okubo Y, Handa A. The impact of obesity on pediatric inpatients with urinary tract infections in the United States. J Pediatr Urol. (2017) 13(5):455.e1–e5. 10.1016/j.jpurol.2017.03.038 - DOI - PubMed
    1. Okubo Y, Nochioka K, Testa MA. The impact of pediatric obesity on hospitalized children with lower respiratory tract infections in the United States. Clin Respir J. (2018) 12(4):1479–84. 10.1111/crj.12694 - DOI - PubMed
    1. Bechard LJ, Rothpletz-Puglia P, Touger-Decker R, Duggan C, Mehta NM. Influence of obesity on clinical outcomes in hospitalized children: a systematic review. JAMA Pediatr. (2013) 167(5):476–82. 10.1001/jamapediatrics.2013.13 - DOI - PMC - PubMed

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