May 2025
May 2025Ozempic-like Drugs for Childhood Obesity?
From 2011-2020, obesity in the US increased to almost 20% of kids ages 2-19 years. Multiple studies have demonstrated that obese kids are likely to become obese adults, increasing their risk of type 2 diabetes (T2D), heart disease, and many cancers. For more on childhood obesity, read this, this, this, and this. There are many co-factors of childhood obesity from culture to socioeconomics to genetics. However, initiation of and adherence to regular and consistent intense exercise and healthy, lower-calorie diets as part of an overall weight management effort have not been found to be effective for many.
GLP-1 (glucagon-like peptide-1) hormones secreted by endocrine glands help regulate appetite and satiety. These have been synthesized into now-popular medications such as Mounjaro, Ozempic, and other semaglutides for adults. The question is, are they effective and safe for kids?
A randomized, placebo-controlled study (the gold standard of medical studies) found that a once-daily subcutaneous injection of one type of GLP-1 – liraglutide – in 134 kids (ages 10-17) with obesity and T2D was “effective improving glucose control but not in lowering BMI” scores at week 26 of treatment. Another similar study found liraglutide effective at reducing body weight, compared to a placebo, at the end of 1 year in kids 12 and older. But how about younger kids?
The SCALE-Kids trial gave liraglutide or a placebo to kids 6-12 with an exercise prescription of 1 hour/day and healthy diet recommendations.
BMI decreased in the treatment group but, once treatment stopped, their BMI crept back up, suggesting this therapy may have to continue into adulthood or for life. No adverse effects were noted but they’re still young.
NEJM Sept. 2024
Three Outcome Studies After Knee Replacement
Which is the preferred rehab program after a knee replacement: unilateral (only the affected knee) vs standard bilateral training? The study measured isometric strength, knee flexibility (Goals: full extension and 120 degrees of flexion), thigh circumference, ability to rise from a chair without hands, walking ability, perceived exertion, and pain. The results demonstrated “that unilateral strength training was feasible and improved strength and flexibility better than bilateral training”.
Another study tried to determine which pre-surgical predictors of “instrumental activity of daily living (ADL) disability” prevailed among older adults who were in line for a knee replacement. Instrumental ADL status was evaluated 1 month before and 6 months after surgery. Of the six activities tested – such as ability to dress oneself, make one’s meals, bathe, etc. – if someone needed help or was unable to do more than 1, they were defined as ‘disabled’. At 6 months post-replacement, 50% were deemed disabled with gait speed being “the only significant independent predictor” of ongoing disability.
The final study “revealed that discharge to a skilled nursing facility was independently associated with 90-day readmission but not with 30-day readmission” after controlling for such factors as mobility status, caregiver support, and home area deprivation measures”.
This was a retrospective study examining 30- and 90-day readmission rates. For those at high risk for readmission, the location of post-surgical therapy needs to be considered.
JBJS Dec. 2024
Tid Bits
Do humans absorb milk calcium? Despite some theories that we don’t, most studies of calcium intake suggest otherwise. A study of more than 540,000 – that’s over half-million! – women found that those who had a daily intake of 300 mg from dairy products had a 17% lower risk of colorectal cancer. Other foods that reduced the risk of colorectal cancer were yogurt, whole grains, and fiber; alcohol intake of 20 g/day increased bowel cancer risk by 15%. Nature Communica Jan. 2025
Got low back pain? You’re not alone: approximately 25% of Americans do at any point in time. A recent study (Brit Med J, Mar. 2025) reviewed 301 randomized trials and compared 56 non-invasive (i.e. non-surgical) treatments for LBP. For acute pain, NSAIDs were found to be efficacious while exercise therapy, spinal manipulation, taping, antidepressants, and transient receptor therapy were found to be most efficacious for chronic pain. Antibiotics and anaesthetics were deemed useless for chronic pain; exercise, injections, and acetaminophen were deemed of nominal value for acute LBP. NYT Mar. 2025
azza
Got foot pain during and after pregnancy? A study found that “around half of the body mass acquired during pregnancy is in the woman’s abdominal region… which leads to changes in the center of gravity and more significant oscillations in the center of pressure.” (Duh) These alter the centers of gravity and of pressure that, combined with changes of foot size (ligament laxity and fluid retention), increase step width and other “kinetic parameters” of the hip and ankle during gait that demand more hip abductor, hip extensor, and ankle plantar flexor use. “Overuse of these muscle groups during pregnancy can be a contributing factor to lower back pain, foot pain, and painful muscle cramps in” the calf muscles. LER Sept. 2024
CORRECTION
In the March REAL News, we reported on a study that analyzed contributing factors to plantar fasciitis. According to the pre-print conclusion, the authors noted:
“Regular running with a moderate weekly volume and more toeing out of the foot relative to the shank may reduce the risk against PF in runners…”
Upon further evaluation of their results, they found that they had “discovered a mismatch in the database involving two discrete variables” (Personal communication). They sent a correction to the journal, Medicine and Science in Sports and Medicine, that confirmed, as they told me, “our corrected findings indicate that greater eversion appears to be a risk factor for plantar fasciitis “. This is more in line with what the bulk of research has demonstrated. In other words, beware over-pronation!
