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A Compassionate Approach to Adolescent Weight and Health · Meaningful Medicine with Novant Health

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  Melanie Cole, MS (Host): Welcome to Meaningful Medicine, a Novant
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  Health podcast, bringing you access to leading doctors who answer
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  questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm Melanie Cole.
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  And today, we're exploring a compassionate approach to adolescent weight and health.
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  Joining me is Dr.
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  David Voellinger.
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  He's a bariatric surgeon and board-certified in Obesity Medicine.
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  Dr.
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  Voellinger, welcome.
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  Thank you so much for being with us today as we get into this topic.
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  You and I both know that obesity is an epidemic.
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  And among our children, we are seeing things we never did see
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  before, comorbidities, high blood pressure, diabetes in kids, type 2
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  diabetes that we did not see before.
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  Tell us what you've seen.
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  What's kind of happening in the trends of obesity today?
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  Dr. David Voellinger:
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  Melanie, thanks for having me today and excited to talk about this subject.
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  What we have seen in the adult world is absolutely happening to our kids.
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  And your point is well made.
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  We used to call it adult-onset diabetes and juvenile-onset diabetes.
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  We can't do that anymore, because our kids are getting diabetes at
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  earlier ages as type 1 and type 2 now.
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  They're seeing sleep apnea.
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  They're seeing hypertension.
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  And in this particular group, what happens in our adolescents, it's a different type
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  of disease because of the social-emotional effects, the peer group effects.
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  It can really affect their lives forever starting at this early age.
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  Melanie Cole, MS: Well, it absolutely can.
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  So, Dr.
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  Voellinger—and I've been in the field a long time, and we talked
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  about that a little bit—when I talk to parents when you talk to parents,
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  this is a very sensitive subject.
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  It's one thing if, you know, you're talking to adults about their weight
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  and things to change and ways to change their lifestyle and such.
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  But when you are talking to parents about adolescent weight and health, please
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  tell us how you approach this sensitive topic in a way that feels supportive.
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  Because these kids, as you just pointed out, it's already hard enough for them.
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  I mean, other kids, it's already hard socio and psychosocial ways.
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  How do you talk to them about this?
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  Dr. David Voellinger:
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  Great point, and we don't address it as obesity.
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  We address it as a chronic disease like any other disease you would
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  have, high blood pressure, diabetes.
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  That's kind of from, one, framing this as a chronic, relapsing, lifelong disease.
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  It's not a matter of willpower.
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  It's not the kid's fault that they have the disease.
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  It's also not the parents'.
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  It's not lack of parental supervision.
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  It's not a parent issue.
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  It's not a child issue.
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  It is a disease like any other.
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  And framing it that way helps them better understand it and not have
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  that guilt complex at recognizing, "Look, this is a disease I need
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  help with like any other disease."
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  That's really the key there, is that messaging.
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  Staying away from the biased terms.
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  We never use, words like fat or large or anything that's detrimental
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  to the way they think about it.
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  It is an adolescent with obesity, right?
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  it's important.
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  The way we talk about it is as important as the treatment itself.
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  Melanie Cole, MS: Wow.
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  That was so well said.
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  I love that that's how you approach it.
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  We all know the teenage brain is a little bit different, so they process
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  things just a little bit differently.
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  Now, Doctor, what makes the Novant Health Adolescent Bariatrics
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  Clinic different from traditional weight management approaches?
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  Because now you have more tools in your toolbox, and it's a pretty
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  exciting time in your field.
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  Dr. David Voellinger:
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  It really is.
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  And I think that the key is we are big believers in the comprehensive
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  obesity care model, meaning we want lifestyle, integrative, medical, and
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  surgical to all live under one roof.
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  And that's what we've duplicated with our adolescents.
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  We have adolescent specialty providers, physicians, APPs.
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  We have behavioral health specialists that are adolescent specialized
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  adolescent, registered dieticians, and a nurse navigator, who is an
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  adolescent specialist who coordinates and helps us develop a program.
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  So, we're very adolescent-specific and very comprehensive in our approach,
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  and that's what really sets us apart.
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  Melanie Cole, MS: That multidisciplinary approach is just so important.
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  So at what point should families consider seeking specialized care?
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  What signs would you like to tell them indicate that their adolescent may
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  benefit from these kinds of treatments?
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  Dr. David Voellinger:
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  It first starts with signs and symptoms.
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  You know, joint pain, fatigue, medical issues, diabetes, hypertension,
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  sleep apnea, snoring, for example.
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  Also, psychosocial issues, are they withdrawing?
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  Are they getting bullied?
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  Those types of issues.
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  And then, from a numerical standpoint, is their weight in the 95th percentile,
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  or has their BMI reached 30?
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  And that's when we really think they need to be thinking about
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  treatment for the disease of obesity.
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  Melanie Cole, MS: So once they come to you, how do you involve both the teen and
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  the families in creating that care plan that feels realistic and sustainable?
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  Because, I mean, the families do have to be involved, including siblings.
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  And if there's going to be lifestyle and cooking and nutrition, how do you
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  involve that whole family in this journey?
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  Dr. David Voellinger:
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  That's very key, Melanie.
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  As we know, the adolescent is very rarely the meal planner and the cook.
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  They're not always preparing their own meals, buying their own groceries.
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  So, that family buy-in is crucial.
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  And again, it's about getting not just the adolescent healthy,
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  but the entire family healthy.
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  So, what we do is we bring in the caregivers, with the adolescent.
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  We have a conversation about what's going on in their home, how we can
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  make improvements, to their lifestyle.
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  It's not only about eating healthier food, lean protein, fruits and
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  vegetables, staying away from the processed sugary drinks.
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  It's also eating together as a family without screens, making those kind of
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  changes, going for walks as a family.
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  Trying to get the entire family healthy.
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  By working with the adolescent, we can elevate the entire family.
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  And as you probably know, with an obese adolescent, there's probably
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  a 70% chance that at least one parent has the disease as well.
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  So, it's something that we really work at as certainly an individual
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  approach, but also as a team approach as well with the entire family.
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  Melanie Cole, MS: Such an important point.
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  You do typically maybe see that one of the parents does suffer from obesity as well.
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  So, it does tend to run in the family and culturally as well.
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  So, tell us a little bit about bariatric surgery, especially
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  when you're considering it for adolescents and young adults.
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  How does this conversation begin and how do you help families understand
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  what the right option may be?
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  Because again, you have a few different options available to you now.
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  So, tell us how you speak to them about this, when this conversation
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  happens, and how you address some of the common fears and myths.
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  Dr. David Voellinger:
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  As we mentioned before, you know, we are definitely believers in a
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  comprehensive multidisciplinary approach.
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  And if we think about obesity, it is a multifactorial disease, meaning there's
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  a lot of different things that cause it.
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  Well, that means that there needs to be a multimodal treatment, and we
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  need to have multiple treatment plans.
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  There's not a one-size-fits-all silver bullet approach.
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  So, lifestyle management, nutrition, exercise and activity, behavior
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  change, habit change, sleep.
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  Then, maybe an integrative approach.
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  Are there any supplements, pharmaceutical, non-pharmaceutical
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  approaches that we can do?
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  More exercise physiology, again, kind of non-medicine treatments.
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  Then, next would be medications.
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  What are some weight loss medications we can use?
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  And finally, when a BMI is 35 and they've developed medical problems
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  such as hypertension, sleep apnea, high cholesterol, those types of
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  things, or if their BMI is already over 40, then that's when we're going
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  to really consider surgery as a tool.
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  Now, what does that tool do?
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  Surgery currently is our most durable and effective method for treating obesity.
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  Our medicines have gotten very, very good, GLP-1s in particular.
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  But still from a durability and long-term effectiveness standpoint, surgery is
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  still the best thing that we have.
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  So when that patient gets to that point that I just mentioned, we want
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  to offer one of those tools to help them, put that disease in remission,
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  help them with those comorbidities.
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  So, the sleeve gastrectomy, and the gastric bypass are the most common.
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  In our adolescent population, we really prefer the sleeve gastrectomy.
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  Basically, what we do is we take the stomach from a bag into a tube.
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  We're not rearranging their intestines, rearranging their anatomy, really just
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  changing the size of the reservoir, limiting the major changes to an
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  adolescent's body at a young age.
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  But this will allow us to, A, help control their portions and, B,
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  it takes out a lot of the hunger factor production, so they're not as
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  hungry with smaller amounts of food.
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  That's really where the magic is with surgery.
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  But the foundation of everything is still that lifestyle management.
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  They have to eat right.
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  They have to move more.
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  They have to change behaviors.
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  They have to get enough sleep.
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  Plus, the surgical tool that we will offer.
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  The scary part about surgery is certainly the surgical risk, right?
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  That is why particularly adolescents stay away from surgery.
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  But fortunately today, with our minimally invasive approaches and our vast
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  experience in bariatric surgery today, the risks are very low, less than 1%.
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  It's even less risky than, say, getting your gallbladder out.
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  So, the risk of them having a major complication is very low.
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  Obviously, this is particularly important in adolescents, but it can
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  be a life-changing procedure at a young age so that they're not having
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  to develop and go through the issues they would have to with that obesity.
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  It's that balance, right?
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  Let's balance the risk of the surgery versus the risk of doing nothing and
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  the potential benefits of surgery.
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  Melanie Cole, MS: Well, as you said, and I want to emphasize that you said
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  it's a tool, because that really is one of the biggest misconceptions.
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  "Oh, that's the easy way out."
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  Well, it's not.
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  But it certainly is, as you say, so beneficial.
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  It's the gold standard.
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  And it really is so, so approachable.
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  Now, one of the things that goes along with this tool is that
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  mental and emotional aspect.
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  Dr.
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  Voellinger, speak a little bit about how your team helps the teens, the
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  adolescents, and their families deal with the emotional bit that goes
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  with surgical decisions and with the lifestyle changes that go along with it
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  Dr. David Voellinger:
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  A huge component, right?
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  It is way more than just changing your diet.
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  It goes for a couple of ways.
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  One is what is the obesity doing to them from a psychosocial level already?
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  You know, again, withdrawing, not having as many friends, staying online
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  too much, withdrawing from life, not being active in school activities.
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  You know, that's one component, what the obesity has done.
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  Then, the next is going through the stress of surgery and how
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  they adapt to those changes.
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  So, on one hand, it's, okay, with our behavioral health therapist meeting
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  them where they are, working through stress management, coping skills.
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  If there's any signs of depressions or anxieties, working with those.
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  Certainly, we got to rule out eating disorders.
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  You know, obviously these are common in the adolescent group.
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  So, we want to rule out any eating disorders that may need more
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  formal therapy before we even approach a medicine or a surgery.
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  So, a lot of different levels go into this.
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  And then, it's that follow-up and support where they have a safe,
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  comfortable environment, a non-bias where they can come in, feel like
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  they're getting the help they need without the outside peer pressure, other
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  things that adolescents experience.
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  Melanie Cole, MS: That was so well said.
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  So, this is just such important information.
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  As we get ready to wrap up, Dr.
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  Voellinger, what would you like teens, adolescents, young adults, and their
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  families to hear directly about their health, their options, their future,
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  and the work that you're doing at the Adolescent Clinic at Novant Health?
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  Dr. David Voellinger:
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  This is not your fault, and we are here for you.
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  Obesity is a disease.
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  It is not something you were doing.
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  It is something that is, genetically, unfortunately given to you.
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  We want you to have a place where you can get the disease taken care of,
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  treated, so that we can be there to help.
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  Our goal for you, whether it's lifestyle management, medical management, surgical
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  management, whatever you need, we want to be able to provide that for you.
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  At Novant Health Adolescent Weight Management, our goal is for you to live
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  longer, live better, live healthier.
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  That's what we want to be able to provide for you.
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  Melanie Cole, MS: I can hear the compassion and the
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  passion in your voice, Dr.
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  Voellinger, for what you do.
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  Thank you so much for joining us today and sharing really your
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  incredible expertise and your passion.
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  Thank you again.
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• 14:20
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• 14:24
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  That concludes this episode of Meaningful Medicine, a podcast from
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  the specialists at Novant Health.