Clinical Research
Bariatric
Do bariatric surgery patients have obese children/grandchildren? (Bao, Desai, Christoffel, Smith-Ray, Nagle; supported by funding from the Society for Pediatric Research student research program). This study was designed to 1) describe the prevalence of obese preteen children in families of adult bariatric surgery patients; and 2) understand the implications of this information for future clinical care and research.
Adult bariatric surgery patients were enrolled in the primary study titled “Long-term Outcomes of Bariatric Surgery Patients” were recruited over the phone and in the bariatric surgery follow-up clinic. Patient information (e.g., BMI at surgery) was obtained from the parent study database. Each enrolled patient was presented with a survey that included their children/grandchildren’s weight and height. Child obesity was defined as BMI percentile ≥95th percentile. Analyses identified associations between patient/child /grandchild characteristics
and child/grandchild obesity, and explored discrepancies between reported and perceived child overweight.
Metabolic Syndrome in Polycystic Ovary Syndrome (PCOS): Precursors and Interventions (Brickman with PI Dunaif at FSM, funded by NIH): The overarching hypothesis of this proposal is that 1) hyper-androgenemia plays an independent role in the pathogenesis of the metabolic abnormalities in PCOS, 2) hyperandrogenemia results from A8 PCOS susceptibility variant and 3) hyperandrogenemia begins early in life producing metabolic abnormalities prior to puberty. First degree relatives will be studied to determine whether there is a premenarchal phenotype and whether A8 identifies at risk girls. We will determine whether the androgen receptor antagonist flutamide, the insulin sensitizing agent metformin or a combination of these medications reduces visceral adiposity, improves insulin sensitivity, or ameliorates dyslipidemia in women with PCOS. Further, we will determine whether A8 genotype predicts response to these interventions.
Characteristics of 1906 overweight children seen at pediatric specialty clinics over one year (Christoffel, funded by internal funds): To obtain an overview of the characteristics of overweight children seen at our hospital, data were collected in 8 clinics that treat overweight and/or its co-morbidities. The data describe these patients, and demonstrate variability in overweight severity and in workup across clinics.
WHY THIS PAPER IS POSTED HERE
This paper is the result of one of the first COMP projects. The idea for the paper was based on the observations of Children’s Memorial Hospital (CMH) physician-scientists in many disciplines and the questions raised by those observations.
The key observations were:
Many overweight/obese children are seen at CMH (and other referral centers), so this is a potentially good source for the study of young obese patients with co-morbidities;
Different specialties see patients with different obesity co-morbidities, and we are not clear why a patient develops one and not another; interventions are often aimed at the presenting co-morbidity, and we have no information on how, if at all, other outcomes (BMI, other co-morbidities) may be affected;
Workups for obesity co-morbidities differ across specialty clinics.
The group wanted to do a multi-disciplinary study to understand why different children have different co-morbidities. But first, we needed to better understand if/how obese patients seen in different specialty settings differed; the literature contained (and to this day still contains) no information on this. To answer this question, specialty clinics that see children with obesity-related conditions were approached, and those interested (almost all) joined together to design a study to describe obese patients across specialties. The year of data collection (slowly) resulted in this paper.
The study was undertaken when COMP had the question, which, by chance, was right around the time that CMH was switching to electronic medical records. When we (finally) were ready to publish results, it became clear that studies based on paper records are not competitive in today’s tight publishing environment. Yet the authors believe that the study provides novel information, still highly relevant in the EMR era, which is of use to obesity investigators who draw patients from specialty settings. We are therefore posting the paper on the COMP website, where it can be found by web searches. Investigators at COMP and beyond will use the study findings in planning future studies.
The main study findings are:
a) The medical record did not readily identify overweight/obese patients (as the diagnosis was often not recorded) and did not provide comprehensive information on markers of co-morbidities (as workups were inconsistent and outside lab reports were often missing);
b) Patterns of recognized co-morbidity varied greatly across specialty settings, so overweight/obese patients seen in a single specialty are unrepresentative of all overweight/obese medical center patients;
c) Very few patients were seen in more than one specialty setting, so study of varied patients requires systems to recruit patients across specialties.
The main implications of these findings for future childhood obesity co-morbidity research are:
a) More detailed understanding is needed of the varying characteristics of patients seen within specialties;
b) Improved linkage is needed between specialty evaluation/treatment of obesity co-morbidities and weight management and other care in primary and secondary care settings;
c) Medical records must be modified or complemented with other data, in order to capture comprehensive information on patients relevant to their overweight/obesity;
d) Novel means are needed to capture and characterize representative samples of overweight/obese children seen for co-morbidities, which reach across care settings.
Testing the reliability of a survey on the use of over-the-counter products for weight loss by overweight and obese Chicago children (Christoffel, funded by the American Pediatric Society and Society for Pediatric Research student training program). This study investigates the reliability of a new tool to assess the medicine that families of overweight children take.
Delineation of phenotypes and genetic markers in young overweight children using a family based association study (Christoffel, Wang, and Binns, funded by internal funds and the FSM GCRC): Study aims are: To conduct a pilot study (1) to define clinical features and age at adiposity rebound (i.e., first postnatal BMI nadir, based on growth records) among pre-pubertal very overweight children (>97th percentile BMI); (2) to examine environmental and genetic features associated with the children’s severe obesity and time of adiposity rebound.
Practice-Based Research Group (PPRG) - www.childrensmrc/pprg/