CF 344: Obesity In Adolescents & Combined Cognitive Behavioral Therapy and Physical Therapy Today we’re going to talk about Obesity In Adolescents & Combined Cognitive Behavioral Therapy and Physical Therapy But first, here’s that sweet sweet bumper music  

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [email protected] If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #344 Now if you missed last week’s episode, we talked about Knee Osteoarthritis Recommendations & Ruptured Breast Implants Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. Still mumbling bumbling tumbling through the process of changing our medical provider. And it is a process. We’re working on a new contract and all that fun crap.  This is a post I made recently on my personal Facebook page – I just had a buddy remind me of this contraption that’s floating around and being shared.  The link to this contraption on Facebook can be found at this point in the show notes for this episode. 

https://heliomd.com/products/heliomd-cervical-traction-device

A brief description for those of you that aren’t going to go check it out but are curious.

It’s distributed by HelioMD and it’s called a manual pump neck brace. It rests on your shoulders and has a carriage under your chin and occiput.

I guess that’s the best way to describe it. It’s also called NeckRevive Neck stretcher.  It says it naturally relieves chronic neck pain in minutes, restore healthy neck posture and avoids further injuries. OK, where do you see the immediate problems? Chronic pain pathways are permanent and you’ll never correct chronic pain in minutes. Even with surgery typically. How can you ever avoid further injuries? That’s just silly right? It goes on to say that it eliminates neck humps. Through traction. Riiiigghhhhttt. As Dr. Evil would say. 

They’re asking $139.00 for this thing. Wow.  So I posted on my Facebook the following because it’s our duty to call out BS when we perceive BS is afoot. 

My plea to my friends is this: PLEASE understand something when you see claims like these. Every patient is different, everyone heals differently, everyone has different levels of fitness or degeneration and daily activity, and there is no ONE SINGLE DEVICE that’s going to solve all of your problems. 

Typically, when a ‘hump’ or other boney deformity develops over time, it is the body’s response to altered posture, altered activity, or altered body dynamics and stressors, etc.  Once those things appear, usually the body has remodeled itself and there is no reversing the issue. The best you can do at that point is simply try to alleviate pain that may result from it.  With that being said, I cannot personally see how this device can do what they claim, which is reversing a ‘hump’ in just two weeks.

My opinion is that something of that nature would be magical and I don’t see how it would be possible on any planet in our known universe. 

Also, posture isn’t as important as we’ve been led to believe all these years. As long as you’re changing positions regularly, sit however you like. You’ll suffer no consequences.  It’s the people who have SUSTAINED poor postures that have a hard time. Those people like professional drivers, dental workers, desk workers, teens on their phones all the time, and those that play video games for hours on end each day. Those people, if not changing positions regularly, will suffer consequences eventually. 

Back to this device…….however, if someone got some relief from pain through the traction this device might perform, well that might be something to talk about and for some, even useful.  But not some sort of ‘correction’. I would add that if traction is what is helpful, they sell $25 over-the-door traction mechanisms on Amazon. I think that would be the more reasonable route financially.  IF that traction didn’t do the job, we can do decompression here at the office that helps LOTS of folks with ongoing neck and back pain all of the time. Especially for those with disc injuries, stenosis, facet arthropathy, etc.  So, now my friends and family will hopefully be more aware, they see me as knowledgeable on the topic, and they’re more aware of their options up to and including coming to see me if they happen to be serious enough.  Is that effective social media marketing? I’m not sure.

The first thing is I don’t want to open myself to some sort of legal complaint so I’m careful to make sure they know that it’s my opinion based my experience and knowledge. Secondly, I’m mostly giving free information and advice without expecting anything in return. I’m offering a free service to my community and if they happen to like what they see and it turns their attention to me in a positive way, then it’s a win/win. Also, I’m not trying to be obnoxious about my disdain for the marketing practices.

I’m not using terms like ‘stupid company’, ‘asnine idiots’, or something like that. I think that looks bad on me and accomplishes the opposite of what I want. 

Anyway, just a tip from your Ol’ Uncle Jeffro. Don’t say I never gave you anything. 

Item #1 The first one today is called, “Obesity in Adolescents A Review” by Kelly et al and published in JAMA Network on August 5, 2024 schiza! Es muy caliente, mi ami! Yes, that was German, Spanish, and French in one exclamation! You are so very welcome.  

Remember, the citations can be found at chiropracticforward.com under this episode. 

Kelly AS, Armstrong SC, Michalsky MP, Fox CK. Obesity in Adolescents: A Review. JAMA. Published online August 05, 2024. doi:10.1001/jama.2024.11809

https://jamanetwork.com/journals/jama/fullarticle/2821829?guestAccessKey=f8345ddd-071d-47c4-b2c9-9cc8eafde342&utm_source=silverchair&utm_medium=email&utm_campaign=jama_network&utm_content=network_highlights&utm_term=081824&adv=000003189471

Why They Did It

Obesity affects approximately 21% of US adolescents and is associated with insulin resistance, hypertension, dyslipidemia, sleep disorders, depression, and musculoskeletal problems.  Obesity during adolescence has also been associated with an increased risk of mortality from cardiovascular disease and type 2 diabetes in adulthood.

What They Found

Obesity in adolescents aged 12 to younger than 18 years is commonly defined as a body mass index (BMI) at the 95th or greater age- and sex-adjusted percentile.  Comprehensive treatment in adolescents includes lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery.  Lifestyle modification therapy, which includes dietary, physical activity, and behavioral counseling, is first-line treatment; as monotherapy, lifestyle modification requires more than 26 contact hours over 1 year to elicit approximately 3% mean BMI reduction.  Newer antiobesity medications, such as liraglutide, semaglutide, and phentermine/topiramate, in combination with lifestyle modification therapy, can reduce mean BMI by approximately 5% to 17% at 1 year of treatment.  Adverse effects vary, but severe adverse events from these newer antiobesity medications are rare.  Surgery like gastric bypass and vertical sleeve gastrectomy for severe adolescent obesity (BMI ≥120% of the 95th percentile) reduces mean BMI by approximately 30% at 1 year.  Minor and major perioperative complications, such as reoperation and hospital readmission for dehydration, are experienced by approximately 15% and 8% of patients, respectively. Determining the long-term durability of all obesity treatments warrants future research.

Wrap It Up

The prevalence of adolescent obesity is approximately 21% in the US. Treatment options for adolescents with obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery.  Intensive lifestyle modification therapy reduces BMI by approximately 3% while pharmacotherapy added to lifestyle modification therapy can attain BMI reductions ranging from 5% to 17%. 

Surgery is the most effective intervention for adolescents with severe obesity and has been shown to achieve BMI reduction of approximately 30%. Item #2 Our second one today is called, “Combined Physiotherapy and Cognitive Behavioral Therapy for Functional Movement Disorders A Randomized Clinical Trial” by Macias-Garcia et al and published in JAMA Neurology on August 5, 2024 and that’s two hot one’s for the price of one, amigo. 

Macías-García D, Méndez-Del Barrio M, Canal-Rivero M, et al. Combined Physiotherapy and Cognitive Behavioral Therapy for Functional Movement Disorders: A Randomized Clinical Trial. JAMA Neurol. Published online August 05, 2024. doi:10.1001/jamaneurol.2024.2393

https://jamanetwork.com/journals/jamaneurology/fullarticle/2822067?guestAccessKey=2f88c764-a3c5-4f46-b321-8c21459326d6&utm_source=silverchair&utm_medium=email&utm_campaign=jama_network&utm_content=network_highlights&utm_term=081824&adv=000003189471

Why They Did It Question 

What is the efficacy of a multidisciplinary treatment (combining specialized physiotherapy and cognitive behavioral therapy) for individuals with functional movement disorders, comparing its effect on patient-reported quality of life with that of a control intervention (psychological support intervention)?

Findings  In this parallel randomized clinical trial that included 40 adults with functional movement disorders, multidisciplinary treatment significantly improved physical aspects of quality of life. There was no significant difference between interventions on mental health–related quality of life, but there was a nonsignificant improvement in general health self-perception; at months 3 and 5 after intervention, 42% and 47% of patients in the multidisciplinary-treatment group reported improved health compared with 26% and 16% in the control group, respectively.

Meaning  Results show that multidisciplinary treatment (physiotherapy plus cognitive behavioral therapy) effectively improves symptoms and physical aspects of the quality of life of patients with functional movement disorders against nondirected psychological support and education; this improvement seems to be driven by changes in mobility and pain domains.   Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger    

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