Episode 127: Obesity Update and Uterine Cancer

Episode 127: Obesity Update and Uterine CancerSaakshi presents some updates on the treatment of obesity in pediatric patients. Wendy explains a recent study connecting hair iron to uterine cancer. Updates on obesity management in pediatric patients.Written by Saakshi Dulani, MS3, Western University College of Osteopathic Medicine of the Pacific. Edited by Hector Arreaza, MD.Background information:The American Academy of Pediatrics has released new guidelines on obesity management in pediatric patients. This is the first update regarding childhood obesity in 15 years. According to the CDC, the rates of childhood obesity have tripled since the 1980s, and as of now, 1 in every 5 children suffers from obesity in the United States. It is important to recognize obesity is a chronic, multifaceted disease that comes with its own set of complications, such as type 2 diabetes mellitus, high blood pressure, asthma, sleep apnea, heart disease, and various mental and psychosocial health issues. The first-line treatment used to be comprised of behavioral health and lifestyle counseling, however, now, 1st line treatment for pediatric patients includes medications and surgery in addition to the previously suggested counseling. This is because research has shown that diet and level of physical activity are not the only factors that determine weight but also include genes, hormones, and metabolism. Similar to many other chronic diseases, the sooner the treatment is started, the better. There has been no benefit shown in waiting for adulthood to treat obesity. Who qualifies for which treatments?As a reminder, in the pediatric population, we use the BMI percentiles instead of the absolute number for BMI. Overweight is defined as BMI between 85-95th for patients of the same gender and age. Obesity is defined as being above the 95th percentile.Four drugs are now approved for obesity treatment in adolescents starting at age 12, which are Saxenda® (liraglutide), Qsymia® (phentermine-topiramate), Wegovy® (semaglutide), and Xenical® or Alli® (orlistat). Phentermine as monotherapy has been approved for teens aged 16 and older. Another drug called Imcivree® has been approved for children 6 and older affected by Bardet-Biedl syndrome. The problem with medications is that they are not available to everyone due to the cost, and there are many shortages occurring due to the high demand for these drugs. Surgical options:This is a MAJOR change in the recommendations for obesity treatment in children.  The new guidelines recommend discussing SURGERY with patients that are 13 years old and have severe obesity. It has been shown that bariatric surgery provides lasting results but also that it can reverse health issues such as type 2 diabetes mellitus and hypertension. It is exciting that more research is being done to provide us with more evidence regarding the treatment of obesity in children. Obesity treatment is challenging, even more so in children. So, we encourage all listeners to review the new guidelines about the use of medications and surgery to treat obesity in children and put them to practice if appropriate for your patients.____________________________You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.____________________________Hair products and uterine cancer.Written by Wendy Collins, MS3, Ross University School of Medicine. Edited by Hector Arreaza, MD.What is the sister study? The Sister Study is a nationwide effort in the US conducted by the National Institute of Environmental Health Sciences, which includes over 50,000 sisters of women who have had breast cancer. This study aims to find environmental and genetic causes of breast cancer. The women in this study were breast cancer free and lived in the United States, including Puerto Rico. They were enrolled from 2003-2009 and were followed up until September 2019. If the sister study is made up of 50,000 women, why does this study only use about 30,000 of those women? Excluded women include those who withdrew from the study (n = 3), who self-reported a diagnosis of uterine cancer before enrollment (n = 380), had an uncertain uterine cancer history (n = 10), had an unclear timing of diagnosis relative to enrollment (n = 59), had a hysterectomy before enrollment (n = 15,585), who did not answer any hair product use questions (n = 736), and who did not contribute any follow-up time (n = 164), resulting in 33,947 eligible women. How was it done?The authors reviewed medical records and questionnaires about hair care within the past 12 months and compared women who developed uterine cancer with those who did not for about 10 years between 2003-2009. Of this sample, only 378 women developed uterine cancer. Further investigation needs to be done to make worthwhile associations between hair straighter use and the incidence of uterine cancer. This study drew 2 primary conclusions:Hair products are not associated with uterine cancer: No associations were found between hair product usage and the incidence of uterine cancer. This was investigated because it's thought that synthetic estrogenic compounds, such as endocrine-disrupting chemicals, could contribute to uterine cancer risk because of their ability to alter hormonal actions. This is something that has been linked to breast and ovarian cancers in the past, so it made sense to consider the same for uterine cancers.Using a straightening iron is positively associated with uterine cancer: Ever vs. never use of a straightening iron in the previous 12 months was associated with a hazard ratio of 1.80 with 95% confidence interval 1.12 to 2.88. The association was stronger when comparing frequent use (>4 times in the past 12 months) vs never use was associated with a hazard ratio of 2.55, 95% confidence interval 1.146 to 4.45.This was investigated because it is thought that heating processes such as flat ironing or blow drying could release or thermally decompose chemicals from the products. This can lead to potential higher exposures to hazardous chemicals through inhalation or percutaneous absorption of chemicals, which is higher in the scalp compared to other areas. While this hypothesis makes sense and supports the results, there are many confounding variables, including physical activity. Women with higher physical activity tend to have decreased sex steroid hormones and less chronic inflammation, reducing their risk of uterine cancer.Hair products are not associated with uterine cancer, and straightening iron is positively associated with uterine cancer, but further research is needed.The incidence of uterine cancer in the past 20 years has significantly increased. Investigating reasons for why this might be could lead to the discovery of potential targets for intervention. However, I am personally unconvinced by this study, and I fully intend to continue to use hair products, my blow dryer, my curling iron, my crimper, and yes even my straightener for the foreseeable future until further research is done.__________________________Conclusion: Now we conclude episode 127 “Obesity Update and Uterine Cancer.” We learned from Saakshi that the American Academy of Pediatrics now recommends discussion of pharmacologic and surgical treatments for pediatric obesity; then Wendy explained that some association between hair iron and uterine cancer was found but further research is needed. This week we thank Hector Arreaza, Saakshi Dulani, and Wendy Collins. Audio edition by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at [email protected], or visit our website riobravofmrp.org/qweek. See you next week! _____________________Links:Chang CJ, O'Brien KM, Keil AP, Gaston SA, Jackson CL, Sandler DP, White AJ. Use of Straighteners and Other Hair Products and Incident Uterine Cancer. J Natl Cancer Inst. 2022 Oct 17:djac165. doi: 10.1093/jnci/djac165. Epub ahead of print. PMID: 36245087. https://pubmed.ncbi.nlm.nih.gov/36245087/American Academy of Pediatrics Issues Its First Comprehensive Guideline on Evaluating, Treating Children and Adolescents With Obesity, American Academy of Pediatrics, AAP.org, published on January, 9, 2023, available at: https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-issues-its-first-comprehensive-guideline-on-evaluating-treating-children-and-adolescents-with-obesity/Gumbrecht, Jamie and Jacqueline Howard, Updated childhood obesity treatment guidelines include medications, surgery for some young people, January 11, 2023. CNN.com, available at: https://www.cnn.com/2023/01/09/health/childhood-obesity-treatment-guidelines-wellness/index.htmlSullivan, Kaitlin, New guidelines for treating childhood obesity include medications and surgery for first time, January 9, 2023. NBCnews.com, available at: https://www.nbcnews.com/health/kids-health/new-guidelines-treating-childhood-obesity-include-medications-surgery-rcna64651Royalty-free music used for this episode: “Gushito - Burn Flow." Downloaded on October 13, 2022, from https://www.videvo.net/ Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at [email protected], or visit our website riobravofmrp.org/qweek. See you next week!