Nearly all epidemiologic studies have found an association between increasing body mass index (BMI) and symptoms of gastroesophageal reflux disease (GERD). Changes in gastroesophageal anatomy and physiology caused by obesity may explain the association. These include an increased prevalence of esophageal motor disorders, diminished lower esophageal sphincter (LES) pressure, the development of a hiatal hernia, and increased intragastric pressure. Central adiposity may be the most important risk for the development of reflux and related complications such as Barrett's esophagus and esophageal adenocarcinoma. Weight loss, through caloric restriction and behavioral modification, has been studied infrequently as a means of improving reflux. Bariatric surgery and its effects on a number of obesity-related disorders have been studied more extensively. Roux-en-Y gastric bypass (RYGB) has been consistently associated with improvement in the symptoms and findings of GERD. The mechanism of action through which this surgery is successful at improving GERD may be independent of weight loss and needs further examination. Current evidence suggests that laparoscopic adjusted gastric banding should be avoided in these patients as the impact on gastroesophageal reflux disease appears unfavorable.

Use of meal replacements (MRs) in lifestyle modification programs (LMPs) for obese adults significantly increases weight loss, compared with prescription of an isocaloric conventional diet (CD). This 12‐month randomized trial examined 113 obese adolescents (mean ± s.d. age of 15.0 ± 1.3 years and BMI of 37.1 ± 5.1 kg/m2) who were assigned to a LMP, combined with meal plans of 1,300–1,500 kcal/day of CD (self‐selected foods) or MR (three SlimFast shakes, one prepackaged meal, five vegetable/fruit servings). After month 4 (phase 1), participants originally treated with MR were unmasked to their phase 2 (months 5–12) random assignment: continued use of MR (i.e., MR+MR) or transitioned to CD (i.e., MR+CD). Participants initially treated with CD in phase 1, continued with CD (i.e., CD). All three groups were treated for an additional 8 months (phase 2). Regression models were used to evaluate percentage change in BMI from baseline to month 4 (phase 1), months 5–12 (phase 2), and baseline to month 12. At month 4, participants assigned to MR (N = 65) achieved a mean (±s.e.) 6.3 ± 0.6% reduction in BMI, compared to a significantly (P = 0.01) smaller 3.8 ± 0.8% for CD participants (N = 37). In phase 2, BMI increased significantly (P < 0.001) in all three conditions, resulting in no significant (P = 0.39) differences between groups in percentage change in BMI at month 12. Across groups, mean reduction in BMI from baseline to month 12 was 3.4 ± 0.7% (P < 0.01). Use of MR significantly improved short‐term weight loss, compared with CD, but its continued use did not improve maintenance of lost weight.

adolescents and their caregivers. To our knowledge, this is the fi rst study focused on the adolescent age group.The purpose of the study was to identify and explore factors that infl uenced adolescent CPAP use, using a modifi ed grounded theory approach.16 Grounded theory is a qualitative method that seeks to generate theories from the data, to offer explanations for the phenomenon being explored. METHODSThis exploratory study consisted of qualitative semi-structured interviews and a download of the adolescent's adherence data from his or her CPAP machine during the previous month.Study Objectives: Adolescents with obstructive sleep apnea syndrome (OSAS) represent an important but understudied subgroup of long-term continuous positive airway pressure (CPAP) users. The purpose of this qualitative study was to identify factors related to adherence from the perspective of adolescents and their caregivers.Methods: Individual open-ended, semi-structured interviews were conducted with adolescents (n = 21) and caregivers (n = 20). Objective adherence data from the adolescents' CPAP machines during the previous month was obtained. Adolescents with different adherence levels and their caregivers were asked their views on CPAP. Using a modifi ed grounded theory approach, we identifi ed themes and developed theories that explained the adolescents' adherence patterns. Results: Adolescent participants (n = 21) were aged 12-18 years, predominantly male (n = 15), African American (n = 16), users of CPAP for at least one month. Caregivers were mainly mothers (n = 17). Seven adolescents had high use (mean use 381 ± 80 min per night), 7 had low use (mean use 30 ± 24 min per night), and 7 had no use during the month prior to being interviewed. Degree of structure in the home, social reactions, mode of communication among family members, and perception of benefi ts were issues that played a role in CPAP adherence. Conclusions: Understanding the adolescent and family experience of using CPAP may be key to increasing adolescent CPAP adherence. As a result of our fi ndings, we speculate that health education, peer support groups, and developmentally appropriate individualized support strategies may be important in promoting adherence. Future studies should examine these theories of CPAP adherence. S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea syndrome (OSAS) affects approximately 2% of children and adolescents.1 OSAS in children may result in severe complications if left untreated, such as growth failure, pulmonary hypertension, neurocognitive defi cits, behavioral problems, and attention defi cit hyperactivity disorder. [2][3][4][5][6] In young children, OSAS can often be treated with adenotonsillectomy. However, in adolescents, adenotonsillectomy may not be effective, as adenoids and tonsils involute with age 7,8 and obesity is more likely to be present. While weight loss may be an effective treatment for OSAS in this age group, it is difficult to achieve and maintain, particularly for those with severe o...

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This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interventions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.

Objectives To describe caregiver-reported QOL in youth with DS and to examine the role of obesity on QOL. Study design Caregivers of youth with and without DS aged 10 through 20 years completed questionnaires examining QOL (PedsQL) and weight-related QOL (Impact of Weight on Quality of Life-Kids: IWQOL-Kids). Age- and sex-specific Z-scores were generated for body mass index (BMI). Obesity was defined as a BMI≥95th percentile for age and sex. Results Caregiver-reported Total QOL, Physical Health, and Psychosocial Health summary scores were all lower in the DS group compared with the non-DS controls (p<0.001). Social and School Functioning were also lower (p<0.001), but Emotional Functioning did not differ between DS and non-DS groups (p=0.31). Physical Functioning (p=0.003) and Total scores (p=0.03) differed between obese and non-obese non-DS youth, but no differences were reported between obese and non-obese youth with DS. On the IWQOL-Kids, caregivers of youth with DS reported higher Body Esteem (p=0.020) and Social Life scores (p=0.03) than caregivers of non-DS youth. Caregivers of youth with obesity, regardless of DS status, reported significantly lower weight-specific QOL scores than caregivers for non-obese youth. Conclusion Caregivers reported lower QOL in youth with DS compared with youth without DS with the exception of emotional functioning. Obesity influences most domains of weight-related QOL in youth with and without DS; therefore, providers should address weight concerns in youth with obesity even in the presence of DS.