This is Jack, a teenager who struggled with obesity after taking medications to treat autism and cerebral palsy that charged up his appetite.
After subsequent mobility challenges left Jack largely unable to bike, swim or even build his favorite Lego sets, his mom, Natalie, knew they needed to do something different.
“We tried so many things prior to going to the clinic to help Jack be healthier that didn’t work,” Natalie remembered. “You kind of think, ‘well, we’ll try it,’ but not thinking the outcome would be helpful. But as a parent, you do anything to help your child.”
Jack’s primary care physician referred him and his family to Claudia Fox, MD, MPH, a University of Minnesota Physicians (M Physicians) pediatrician and co-director of the University of Minnesota Medical School’s Center for Pediatric Obesity Medicine (CPOM).
“CPOM is an interdisciplinary research center that focuses on improving outcomes for youth afflicted with obesity and related conditions,” Dr. Fox explains. “We ground our work in research that we bring to the clinic to help care for families struggling with obesity.”
Dr. Fox and CPOM use an individualized approach to help each patient, which may include enrolling patients in clinical trials to study medicines that may help treat obesity as well as lifestyle modification therapy and counseling. “It’s kind of like Jack’s Legos,” Dr. Fox said. “There are a lot of unique building blocks that need to fit together, so we help patients find and use the right ones to build a treatment and lifestyle pattern that’s healthy for them.”
Understanding obesity
Dr. Fox, and her CPOM co-director, Aaron Kelly, PhD, say that it is important to recognize that obesity is a complex disease with multiple biologic and environmental pieces at play, not a failure of willpower. “There are so many factors that lead to extra weight, especially in children. For some patients, it’s genetic, and their parents have been struggling with it and its stigma for a long time,” Dr. Kelly said, adding, “So we need to first address that stigma and help our patients and families better understand what obesity is, and because it’s a disease, how we can treat it for each individual patient.”
Part of how obesity works is that people’s brains react to food differently, says Dr. Fox. For some, the brain does not detect signals from the body that are supposed to tell them they are full after eating. For others, foods rich in fat and sugar trigger the reward system and override the brain’s ability to detect hunger or fullness. Some medications can help to dampen hunger or the reward response and “level the playing field” for some people who struggle to manage their weight.
Treating each patient in a way that works for them
Dr. Fox and Dr. Kelly aim to discover and study different types of therapies and medications for obesity so they can continue to help patients find the right treatment building blocks for them. One of the treatments they studied to help curb appetite, Dr. Fox said, worked for Jack.
After prescribing the medicine, Dr. Fox helped Jack work in another important piece of his treatment: a dietician who helped him become an avid fan of fruits, vegetables and lean meats. Jack’s parents also pitched in with their own piece to help Jack get moving, a $5 per workout incentive that helped him save for his growing Lego collection.
“Obesity is complex, and it is very different for each patient, so we need to treat it uniquely for each patient,” Dr. Fox noted. “That’s why we study different medicines and different kinds of treatments, so we find out what will work best for each patient to help them live a healthier, fuller life.”
Dr. Fox also noted that CPOM is always enrolling patients in a variety of studies. Some of the studies are investigating treatments that may work for different patients. Other studies aim to understand what causes a person to carry extra weight or how to help with weight-related health problems like diabetes. “Being able to bring these therapies to patients in the clinic is what keeps us going,” she said.
As for Jack, losing 50 pounds has made a world of difference. He moves both regularly and independently, and he is back to building his beloved Legos.
Patients and families who want to learn more about ongoing CPOM studies and clinical trials can visit the CPOM website.
