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Clinician-to-Clinician Update
To schedule a consultation, referral or appointment:
Weight management referrals:
952-892-2920 (Burnsville), 763-898-1220 (Maple Grove), 612-365-6777 (Minneapolis), 888-543-7866 (Woodbury)
Birth to Three Program
Pediatric Specialty Care Discovery Clinic 
2512 S 7th St., Floor 1, Minneapolis, MN 55454 

Healthy You Weight Management Programs:

Specialty Clinic for Children - Burnsville
Ridgeview Medical Building
303 E. Nicollet Blvd., Suite 372
Burnsville, MN 55337

University of Minnesota Health Maple Grove Clinics
14500 99th Ave. N., Floor 1, Desk 1
Maple Grove, MN 55369

Pediatric Specialty Care Discovery Clinic
2512 S. 7th St., Floor 3
Minneapolis, MN 55454

Pediatric Specialty Clinic - Woodbury
9680 Tamarack Road, Suite 130
Woodbury, MN 55125

Family Weight Management Program
Pediatric Specialty Care Discovery Clinic
2512 S 7th St., Floor 3, Minneapolis, MN 55454

Food Insecurity and Pediatric Obesity

The lack of consistent access to adequate food presents serious medical, economic, and social consequences, particularly for children. Food insecurity occurs in 9.4% of U.S. households with children.1 In Minnesota, the occurrence is 7.1%,1 although its prevalence varies by county, race, and household characteristics. 

Children in food-insecure households face numerous health risks, including impaired cognitive development, higher hospitalization rates, behavioral problems, higher rates of anxiety and depression, and lower academic achievement, among other outcomes.1 These children are three times more likely than food-secure children to be hospitalized since birth and twice as likely to have fair or poor health.2 A high incidence of environmental stresses, including serious or chronic illnesses accompanied by weak supports, has also been associated with toxic stress and its damaging effect on neurodevelopment. (See Case Study.)

Food insecurity and weight status in children and youth has been the subject of several studies, although findings have been inconclusive. In a study of 559 adolescents, greater food insecurity at age 15 among females was associated with faster increases in body mass index over the following 16 years.3 A review of 42 studies tracking food insecurity and weight status also noted that for women, food insecurity did co-occur with a tendency to be overweight or obese. However, food insecurity was not found to have a causal relationship with weight gain over time.4

University of Minnesota Health endocrinologist Megan Oberle, MD, investigates the long-term effects of eating behaviors on appetite regulation and fat metabolism. She is currently collecting data on adolescents in the University of Minnesota Masonic Children’s Hospital’s weight management program to learn more about the association between food insecurity, eating patterns, obesity, and participation in the Supplemental Nutrition Assistance Program. Poor diet and erratic eating behavior in children, Oberle finds, is correlated with pediatric obesity. 

Maternal obesity during pregnancy is also associated with excess weight in children. Obesity in pregnant women increases the risk of later obesity in their children twofold5 as well as increases their risk of diabetes and adverse neurodevelopment.6 The breast milk of obese women has also drawn researchers’ attention for its possible role in affecting offspring adiposity.5

In the management of pediatric obesity, behavioral therapy alone has shown less-than-optimal results. Lifestyle management (diet and exercise) alone has also shown less than optimal results for children with severe obesity (BMI >120th percentile of the 95th percentile). New efforts have focused on medication therapy, and pediatric clinical trials of approved-for-adults and “off-label” obesity medications have shown promise. 7 Exenatide and empagliflozin are being trialed at the University of Minnesota. (See Program Updates.) Adolescents with severe obesity can be enrolled through March 2019 in the exenatide trial. Beginning in the summer of 2019, the empagliflozin trial will enroll adolescent participants with moderate to severe obesity.

References

  1. U.S. Department of Agriculture, Economic Research Service, Economic Information Bulletin Number 113 (May 2013), “Food Insecurity in Households With Children: Prevalence, Severity, and Household Characteristics, 2010-11”.
  2. Cook JT, Frank DA, Berkowitz C, et al. Food insecurity is associated with adverse health outcomes among human infants and toddlers. J Nutr. 2004 Jun;134(6):1432-1438.
  3. Lohman BJ, Neppl TK, Lee Y, et al. The association between household food insecurity and body mass index: A prospective growth curve analysis. J Pediatr. 2018 Jul 30. [e-pub ahead of print] doi: 10.1016/j.jpeds.2018.05.052.
  4. Larson NI, Story MT. Food insecurity and weight status among U.S. children and families. Am Jrl of Prev Med. 2011;40(2),166-173.
  5. Demerath, EW, Fields, DA. Maternal obesity, breast milk composition, and infant growth. National Institutes of Health. http://grantome.com/grant/NIH/R01-HD080444-04
  6. Schwarzenberg JS, Georgieff MK. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatr. 2018;141(2).
  7. Kelly, AS, Fox, CK. Pharmacotherapy in the management of pediatric obesity. Curr Diab Rep. 2017;Aug;17(8):55.

When to refer

Pediatric Obesity

Combatting pediatric obesity is a significant challenge for parents, physicians, and, of course, the children and adolescents themselves. University of Minnesota Health pediatric specialists offer the expertise and program-based resources and support needed for patients to successfully manage the condition. 

The Weight Management Program for children and adolescents (“Healthy You”) helps patients overcome the medical, nutritional, and emotional issues that relate to their weight. Our care team includes pediatric obesity specialists, endocrinologists, dietitians, physical therapists, psychologists, and nurses. Through the program, we offer a full continuum of care, including behavioral lifestyle modification therapy, obesity pharmacotherapy, and teen weight-loss surgery. We also treat common obesity-related conditions, including anxiety, binge eating disorders, depression, fatty liver disease, high blood pressure, high cholesterol, irregular periods, pre-diabetes, and sleep apnea. We see patients at Burnsville, Woodbury, Minneapolis, and Maple Grove.

A comprehensive approach for the entire family, the Family Weight Management Program is designed for children and their caregivers who are working on weight management goals together. Our team provides a tailored treatment plan for each participant and addresses physical and emotional health conditions, including high blood pressure, high cholesterol, prediabetes, and type 2 diabetes, malnutrition, binge eating disorders, and sleep disorders, among others. Based in the Pediatric Specialty Care Discovery Clinic in Minneapolis, our team includes an adult specialist and pediatric specialists in weight management, a dietitian, and a psychologist.

Behavioral Health

The University of Minnesota Health Birth to Three Program and Early Childhood Mental Health Program at the Pediatric Specialty Care Discovery Clinic provides mental health services for our youngest patients and is one of the first in the nation to translate research findings on toxic stress into early childhood behavioral health interventions. Interventions focus on building positive, stress-buffering family relationships for young patients. For behavioral health or Discovery Clinic weight management referrals, call 612-365-6777.


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If you have feedback about our service, please contact Levi Downs, MD, Chief Medical Officer: downs008@umn.edu