So I'd like to actually know, what do you think is the root cause of obesity?

Yeah, so that's about as complicated a question as the disease itself.

But what I would say, especially to your listeners who are, you know, in their 20s or early 30s or on the younger side, and a group that... group of people generally actually don't necessarily seek out healthcare as often as older adults do.

So this is a particularly good opportunity for me to sort of talk about this.

So the drivers of obesity, are, or obesity itself is about somewhere between 40 and 70% inherited from your parents.

And how does it get inherited? It gets inherited by at least two, probably at least three different ways.

One is your genetics, which none of us can really do anything about.

now is it possible to lose those weight

Even as a pediatrician and someone who has encountered obesity in children and also in adults, what did you find or what did you encounter as the differences between an obese child and an obese adult or the similarities between them.

Yeah.

Well, first I have to just correct your terminology a little bit because we now say, you know, an adult with obesity or a child with obesity because using obese as an adjective is now sort of falling out of favor because it's got so much negative connotation.

There's so much negative associated with it that we don't basically say that anymore.

But, yeah, no, I mean, no worries, obviously.

And everybody makes mistakes, and I even sometimes make the same mistake.

But I just try to remember.

Yeah,

When people are making care plans and planning... management plans, it's almost like a different take when it comes to how far they go with children with neurodevelopmental

differences.

I'll start with an anecdote that people might find interesting.

And as I'm sure your listeners will come to understand, I'm a little bit of a...

I don't know if I want to say instigator, but I'm a stir the pot a little bit.

I do things that I think are right, whether or not other folks may think they're right.

And so early in my pediatric bariatric surgical practice, there was a patient who came to me with down syndrome and she was actually a young adult, but in the U S the young adults, the adults with down syndrome or autism spectrum disorder, the adult surgeons won't take care of them.

And Dr. Adler, just going back for the purpose of our audience, can you talk a bit more about obesity itself as a disease and why you think it's a disease and what is obesity?

So what do you think the role of processed food, sugar, and the fat, and all of these things that is in food of today has played in this issue of obesity?

Yeah.

So I think the ultra-processed foods certainly play a role.

I think right now they're maybe being given too much credit for that role.

I think that what people need to understand is the way it works.

And yes, the foods are salty, they're sugary, they're what's called hyperpalatable, so they're engineered so that people eat more and more of them.

And often your brain doesn't even process feeling full when you eat these foods.

So before we go through some of the solutions, I want to ask, how is the child obesity fundamentally different from obesity that is developed in adulthood?

Am I wrong? Is this correct?

So it's true in part.

So the brain controls your... sort of what we call the weight set point or the mass, fat mass set point, or otherwise known as the hypothalamic set point, because the hypothalamus is the center piece of your brain function that determines your hunger, your appetite, and there's a slight difference between those two things, and your feeling of satiety or your feeling of fullness.

And you asked me before what sort of keeps pulling me back.

And one of the things, and I talked about individual variation.

So the stories I can tell you, I've seen children who weigh as much as 300 kilos with relatively few metabolic problems.

And then I see children who weigh 100 kilos who have type 2 diabetes.

Yeah, that's how the body regulates weight,

So where are you with that?

Yeah, so it's a great question.

The likelihood of the...

So the medication that's approved to age 12 is semaglutide.

Its precursor, liraglutide, is the one that's been used down to age six in clinical trials and shown to have safety.

But that medication has now gone generic.

So the impetus for getting the approval down to age six probably isn't there, but it has been shown to be safe down to that age group.

So how are you managing that or screening for it or discussing it?