Welcome to a year in review of Metabolic Health in teens! 

A year in review: Teen Metabolic Health in 2023



I can’t think of a more prolific year for teen metabolic health than 2023. And, I’m not just talking about the FDA’s approval of GLP-1 medications like wegovy. In fact, did you know I created my metabolic telehealth clinic well before I even heard of the STEP teens trial showing the results of using semaglutide in teens?  Medication is one part of the puzzle.

Not the whole treatment puzzle. 



It’s been a frustrating year too. The most frustrating thing about what I do is that no one is focusing on health. Our culture and health systems (lots of doctors) are still attached to the Energy Balance Theory of CICO (calories in calories out). Parents are very stuck in it and then their teens are stuck in it too. Their bodies are metabolically adapted to a low number of poor quality macronutrients. That’s their biggest obstacle to getting results. They often binge on refined carbohydrates at home after restricting their intake during the day.  Some teens don’t feel safe eating in front of other people. It all makes sense to me. The UPF (ultra-processed food) system and its addictive triad of trans fats, salt and refined sugar (HFCS, high fructose corn syrup) along with their digital neuromarketing tactics are powerful drivers of the epidemic of poor nutrition and binge eating in teens. Our weight-biased society creates constant body judging and food shaming in teens.  



The best study findings out in 2023, and there’s absolutely no comparison are the TODAY study findings showing that Youth Type 2 Diabetes is a more aggressive disease than seen in adults. Learn more here: 

https://www.adameetingnews.org/live-updates/session-coverage/today2-study-youth-onset-type-2-diabetes-more-severe-than-adult-onset-disease/



I want my legacy to be that I helped as many children and teens as possible enter young adulthood without the burden of metabolic diseases like type 2 diabetes and non-alcoholic fatty liver disease. Sound easy? It’s not. It’s an epically difficult mission. 2023 has been a year with metabolic ups and downs and some wins. 



As parents learn more about insulin resistance and metabolic health and are willing to let go of the harms of diet culture, then their teens are able to make the changes necessary to get positive health outcomes. 



Medication is only one part of the puzzle. There are so many action steps to take to improve metabolic health. All health habits count. Start by downloading my What’s your health why? Printable and fill it out for 2024. It’s powerful work! 



Start with your health why,

Dr. Karla

Welcome to a year in review of Metabolic Health in teens! 
A year in review: Teen Metabolic Health in 2023
 
I can’t think of a more prolific year for teen metabolic health than 2023. And, I’m not just talking about the FDA’s approval of GLP-1 medications like wegovy. In fact, did you know I created my metabolic telehealth clinic well before I even heard of the STEP teens trial showing the results of using semaglutide in teens?  Medication is one part of the puzzle.
Not the whole treatment puzzle. 
 
It’s been a frustrating year too. The most frustrating thing about what I do is that no one is focusing on health. Our culture and health systems (lots of doctors) are still attached to the Energy Balance Theory of CICO (calories in calories out). Parents are very stuck in it and then their teens are stuck in it too. Their bodies are metabolically adapted to a low number of poor quality macronutrients. That’s their biggest obstacle to getting results. They often binge on refined carbohydrates at home after restricting their intake during the day.  Some teens don’t feel safe eating in front of other people. It all makes sense to me. The UPF (ultra-processed food) system and its addictive triad of trans fats, salt and refined sugar (HFCS, high fructose corn syrup) along with their digital neuromarketing tactics are powerful drivers of the epidemic of poor nutrition and binge eating in teens. Our weight-biased society creates constant body judging and food shaming in teens.  
 
The best study findings out in 2023, and there’s absolutely no comparison are the TODAY study findings showing that Youth Type 2 Diabetes is a more aggressive disease than seen in adults. Learn more here: 
<a href="https://www.adameetingnews.org/live-updates/session-coverage/today2-study-youth-onset-type-2-diabetes-more-severe-than-adult-onset-disease/">https://www.adameetingnews.org/live-updates/session-coverage/today2-study-youth-onset-type-2-diabetes-more-severe-than-adult-onset-disease/</a>
 
I want my legacy to be that I helped as many children and teens as possible enter young adulthood without the burden of metabolic diseases like type 2 diabetes and non-alcoholic fatty liver disease. Sound easy? It’s not. It’s an epically difficult mission. 2023 has been a year with metabolic ups and downs and some wins. 
 
As parents learn more about insulin resistance and metabolic health and are willing to let go of the harms of diet culture, then their teens are able to make the changes necessary to get positive health outcomes. 
 
Medication is only one part of the puzzle. There are so many action steps to take to improve metabolic health. All health habits count. Start by downloading my What’s your health why? Printable and fill it out for 2024. It’s powerful work! 
 
Start with your health why,
Dr. Karla

Welcome to the IME Community podcast for teens, parents and doctors.  IME Community, powered by Dr.Karla, ActivistMD is where self-love is your superpower to achieve your weight and life goals and make your mark in the world!

Welcome to the IME Community podcast for teens, parents and doctors. &nbsp;IME Community, powered by Dr.Karla, ActivistMD is where self-love is your superpower to achieve your weight and life goals and make your mark in the world!

IME Community Podcast

IME Community

Metabolic Health in Teens with Dr. Karla

Parents, Teens, Doctors, listen to a Mom of an adolescent with insulin resistance and obesity talk with Dr. Karla about her journey of how she advocates to get her daughter effective treatment with the new Anti-Obesity Medications. It's been a long road for Mom, Kailey, and her family as she has advocated since her daughter started to gain unhealthy weight in early childhood. Though she was shut down by her pediatrician and told to restrict her daughter's intake and was referred to a dietitian and a psychologist, Kailey's intuition told her there was something more going on. Kailey shares her journey navigating our weight-biased healthcare system which often blames and shames children, adolescents and their parents and tells parents to place their children on restrictive diets. She finally found a pediatric endocrinologist who would listen and did a full assessment to rule-out causes and contributing factors, diagnosed her with Insulin Resistance and started treatment. Kailey has also taken a GLP-1 medication and shares her journey on TikTok and IG @thegeriatricmillennial. Recently, she started sharing their f struggles with finding a doctor who would listen and actually help. Go to drkarlamd.com to learn more about Metabolic Telehealth for children & adolescents. 

Self-love superpower,

Dr. Karla #teenhealthandwellness #childobesity #pediatricians #obesitytreatment #childhealthcare #wegovy #semaglutide #saxenda #insulinresistance #pcos #type2diabetes

Parents, Teens, Doctors, listen to a Mom of an adolescent with insulin resistance and obesity talk with Dr. Karla about her journey of how she advocates to get her daughter effective treatment with the new Anti-Obesity Medications. It's been a long road for Mom, Kailey, and her family as she has advocated since her daughter started to gain unhealthy weight in early childhood. Though she was shut down by her pediatrician and told to restrict her daughter's intake and was referred to a dietitian and a psychologist, Kailey's intuition told her there was something more going on. Kailey shares her journey navigating our weight-biased healthcare system which often blames and shames children, adolescents and their parents and tells parents to place their children on restrictive diets. She finally found a pediatric endocrinologist who would listen and did a full assessment to rule-out causes and contributing factors, diagnosed her with Insulin Resistance and started treatment. Kailey has also taken a GLP-1 medication and shares her journey on TikTok and IG @thegeriatricmillennial. Recently, she started sharing their f struggles with finding a doctor who would listen and actually help. Go to drkarlamd.com to learn more about Metabolic Telehealth for children &amp; adolescents. 
Self-love superpower,
Dr. Karla #teenhealthandwellness #childobesity #pediatricians #obesitytreatment #childhealthcare #wegovy #semaglutide #saxenda #insulinresistance #pcos #type2diabetes

A Mom's Journey of Advocacy to finally find effective treatment for her daughter with obesity

A Doctor’s Take on Weight Loss Medications & Teens Go to drkarlamd.com to learn more. The results of the STEP TEENS phase 3 trial of once-weekly subcutaneous semaglutide 2.4mg (Wegovy) in adolescents aged 12 up to 18 years old with obesity are very promising. Published in November of this year in the NEJM, the study showed that patients who received semaglutide vs. placebo had greater reductions in body weight, improvements in waist circumference, A1C, lipids (except HDL cholesterol) and alanine aminotransferase. Quality of Life measures were better in the semaglutide group. Adverse gastrointestinal events were greater with semaglutide compared with placebo. Many pediatricians and childhood obesity experts, like me, who have been working for decades, taking care of hundreds of adolescent patients while watching the rates of severe obesity rise, especially during the pandemic, have hope that medical treatment will finally have effective tools to help our teen patients. Up until now, the weight loss medications approved for adolescents have been Qysmia, a combination of phentermine and topiramate which curbs appetite and once-daily injectable GLP-1 agonist. There have, of course, been other medications used for weight loss in adolescents, but with minimal effect and more side effects. Teen patients have told me they don’t like how they feel taking phentermine, especially if they have anxiety disorder. A daily injection is, well, a daily injection. I’m grateful these medications are coming out now instead of four years ago when I was the medical director of a pediatric weight management program at a Children’s Hospital and before I went through my own weight loss journey. The program was stuck in CICO thinking. The old Calories In Calories Out Energy Imbalance Model of Obesity and ignoring the epidemic of Insulin Resistance and that obesity is hormonal and not simply caloric. I was stuck in it too. Now, after becoming a certified life and weight coach and Diplomate of the ABOM, as I add a virtual health component to my digital coaching platform for teens, the timing to add in GLP-1 agonists to my physician toolbox is spot on. Mostly, I’m grateful for the countless hours I have been able to spend coaching teens and parents and as a TikTokdoc learning what it’s actually like for patients who share their journey using GLP-1 agonists on the app. The biggest benefit of GLP-1 agonists is the “quiet mind” patients experience. For the first time, their mind is not constantly food seeking and craving. Patients also feel fuller faster which makes sense because GLP-1 delays gastric emptying. Weight loss medications that effectively treat the root cause is what’s exciting: Insulin Resistance and sugar cravings from ultra-processed foods. Weight gain is a byproduct of Insulin Resistance and weight loss is a byproduct of reversing insulin resistance. Of course, as appetite is suppressed, it is important to make sure patients are getting adequate intake and don’t get into a restrictive eating pattern that will rebound as binging if and when they stop their medication. If you are someone like me who has successfully and sustainably lost weight, you know a major part of the journey is making changes to transition to eating real food. You understand what it’s like to believe that sugar and ultra-processed food is addictive. The instant gratification of dopamine from ultra-processed foods is powerful. Helping teen patients create a dopamine balance so their daily life is full of true reward and gratification is imperative even with the use of GLP-1 agonists. There is so much stigma around weight in the clinic setting and the patient-doctor interaction. Attrition rates are high and attendance rates are low for teens going to weight management programs. As a doctor in a clinic, patients didn’t share with me what they share with me when I’m coaching them. Now, I get to meet them where they are. Motivational Interviewing is powerful but isn’t the same as offering access to parents and teen patients coaching through obstacles as they come up in real time. What is your plan for patients to have access to you? Obviously, there’s the issue of accessibility, insurance coverage, supply chain issues, side effects and whether the patient is interested and willing to take an injection. There’s also a belief that teens I coach often express, I'm broken or there’s something wrong with me so I need this singular fix. Stay away from perpetuating that. Frame up the use of medications as just one part of a whole approach to health. The new GLP-1 agonists potentially reduce disease risk and chronic disease burden in teens with a once-weekly injection. Let’s focus on what the GLP-1 agonists are really treating and be excited about that instead of celebrating weight loss. I want to caution all of us to stay out of singular solution quick fix thinking while treating a chronic complex disease in teens.

A Doctor’s Take on Weight Loss Medications &amp; Teens Go to drkarlamd.com to learn more. The results of the STEP TEENS phase 3 trial of once-weekly subcutaneous semaglutide 2.4mg (Wegovy) in adolescents aged 12 up to 18 years old with obesity are very promising. Published in November of this year in the NEJM, the study showed that patients who received semaglutide vs. placebo had greater reductions in body weight, improvements in waist circumference, A1C, lipids (except HDL cholesterol) and alanine aminotransferase. Quality of Life measures were better in the semaglutide group. Adverse gastrointestinal events were greater with semaglutide compared with placebo. Many pediatricians and childhood obesity experts, like me, who have been working for decades, taking care of hundreds of adolescent patients while watching the rates of severe obesity rise, especially during the pandemic, have hope that medical treatment will finally have effective tools to help our teen patients. Up until now, the weight loss medications approved for adolescents have been Qysmia, a combination of phentermine and topiramate which curbs appetite and once-daily injectable GLP-1 agonist. There have, of course, been other medications used for weight loss in adolescents, but with minimal effect and more side effects. Teen patients have told me they don’t like how they feel taking phentermine, especially if they have anxiety disorder. A daily injection is, well, a daily injection. I’m grateful these medications are coming out now instead of four years ago when I was the medical director of a pediatric weight management program at a Children’s Hospital and before I went through my own weight loss journey. The program was stuck in CICO thinking. The old Calories In Calories Out Energy Imbalance Model of Obesity and ignoring the epidemic of Insulin Resistance and that obesity is hormonal and not simply caloric. I was stuck in it too. Now, after becoming a certified life and weight coach and Diplomate of the ABOM, as I add a virtual health component to my digital coaching platform for teens, the timing to add in GLP-1 agonists to my physician toolbox is spot on. Mostly, I’m grateful for the countless hours I have been able to spend coaching teens and parents and as a TikTokdoc learning what it’s actually like for patients who share their journey using GLP-1 agonists on the app. The biggest benefit of GLP-1 agonists is the “quiet mind” patients experience. For the first time, their mind is not constantly food seeking and craving. Patients also feel fuller faster which makes sense because GLP-1 delays gastric emptying. Weight loss medications that effectively treat the root cause is what’s exciting: Insulin Resistance and sugar cravings from ultra-processed foods. Weight gain is a byproduct of Insulin Resistance and weight loss is a byproduct of reversing insulin resistance. Of course, as appetite is suppressed, it is important to make sure patients are getting adequate intake and don’t get into a restrictive eating pattern that will rebound as binging if and when they stop their medication. If you are someone like me who has successfully and sustainably lost weight, you know a major part of the journey is making changes to transition to eating real food. You understand what it’s like to believe that sugar and ultra-processed food is addictive. The instant gratification of dopamine from ultra-processed foods is powerful. Helping teen patients create a dopamine balance so their daily life is full of true reward and gratification is imperative even with the use of GLP-1 agonists. There is so much stigma around weight in the clinic setting and the patient-doctor interaction. Attrition rates are high and attendance rates are low for teens going to weight management programs. As a doctor in a clinic, patients didn’t share with me what they share with me when I’m coaching them. Now, I get to meet them where they are. Motivational Interviewing is powerful but isn’t the same as offering access to parents and teen patients coaching through obstacles as they come up in real time. What is your plan for patients to have access to you? Obviously, there’s the issue of accessibility, insurance coverage, supply chain issues, side effects and whether the patient is interested and willing to take an injection. There’s also a belief that teens I coach often express, I'm broken or there’s something wrong with me so I need this singular fix. Stay away from perpetuating that. Frame up the use of medications as just one part of a whole approach to health. The new GLP-1 agonists potentially reduce disease risk and chronic disease burden in teens with a once-weekly injection. Let’s focus on what the GLP-1 agonists are really treating and be excited about that instead of celebrating weight loss. I want to caution all of us to stay out of singular solution quick fix thinking while treating a chronic complex disease in teens.

Weight Loss Medications like Wegovy in Teens with Dr. Karla

I'm struggling with wanting to help my daughter who is overweight.  I want her to be healthy and feel good about her body. I also know there is so much stigma about size in our society. I feel stuck. How can I help her?



This is what I call dualistic thinking, black and white, two sides of a coin, where on one side Mom is stuck in wanting her daughter to be body positive and fully love and accept herself and feel healthy, but also is stuck in diet culture beliefs perpetuated by our society and in all the promises of thinness. You’re pinging back and forth and that’s creating a lot of confusion and self-doubt and fear and keeping you stuck and not taking action. What if they are not mutually exclusive? What if you could meet in the middle and believe your daughter can be both body positive and have healthy habits that help her reach her healthy weight range? Research shows that positive body image and family mealtimes are protective factors to prevent weight gain and eating disorders. Helping her create healthy habits takes action steps like more family mealtime planning. Get yourself in the middle lane taking action. 



How can I help my daughter when she feels frustrated and gets upset about her body and uses food and sugary drinks to feel better? I know that external fixes are just a quick fix band-aid and seem to make the problem worse.  



You have great awareness. Sounds like she is buffering her emotions with food. It’s like numbing out. Instead of allowing an urge that comes up, which is a feeling, she is avoiding the feeling by getting the false reward sugary dopamine zing. It’s a conditioned overdesire pathway in the brain. It’s a habit path in the brain.  Habits are based on environmental cues. Good news is the brain is malleable and adaptable and so is the environment. Don’t get in her lane. Stay in yours. Start by creating more openness about feelings so that she is able to respond and process instead of avoiding and going to food. How are you feeling? Talk about your feelings and get a bit descriptive by using a metaphor. Model healthy coping skills. Also, don’t assume you know what’s going on in her mind.  Don’t bring up body image issues unless she does. This can bite you in the butt. If she has urges and cravings at certain times of the day, then have some snacks readily available that have a balance and aren’t processed foods.  Ask her what she wants and plan a day ahead. You are helping her create mindfulness eating habits and awareness before choice. 



I know my daughter is unhappy about her body and I desperately want to help her, but I am also terrified that if I bring it up she will feel judged or I will destroy her confidence.  



You get to decide ahead of time how you want to show up in situations. That’s what you can control.  You can’t control how your daughter feels or how she responds. If she feels judged, it’s coming from her thoughts.  That being said, what you want is to be a responsive parent, to be intentional about how you will respond when SHE brings it up or there are situations that activate her negative body image thoughts.  You want to be a soft place to land.  

Self-love superpower,

Dr. Karla

<ul>
<li aria-level="1">I'm struggling with wanting to help my daughter who is overweight.  I want her to be healthy and feel good about her body. I also know there is so much stigma about size in our society. I feel stuck. How can I help her?</li>
</ul>
 
This is what I call dualistic thinking, black and white, two sides of a coin, where on one side Mom is stuck in wanting her daughter to be body positive and fully love and accept herself and feel healthy, but also is stuck in diet culture beliefs perpetuated by our society and in all the promises of thinness. You’re pinging back and forth and that’s creating a lot of confusion and self-doubt and fear and keeping you stuck and not taking action. What if they are not mutually exclusive? What if you could meet in the middle and believe your daughter can be both body positive and have healthy habits that help her reach her healthy weight range? Research shows that positive body image and family mealtimes are protective factors to prevent weight gain and eating disorders. Helping her create healthy habits takes action steps like more family mealtime planning. Get yourself in the middle lane taking action. 
 
<ul>
<li aria-level="1">How can I help my daughter when she feels frustrated and gets upset about her body and uses food and sugary drinks to feel better? I know that external fixes are just a quick fix band-aid and seem to make the problem worse.  </li>
</ul>
 
You have great awareness. Sounds like she is buffering her emotions with food. It’s like numbing out. Instead of allowing an urge that comes up, which is a feeling, she is avoiding the feeling by getting the false reward sugary dopamine zing. It’s a conditioned overdesire pathway in the brain. It’s a habit path in the brain.  Habits are based on environmental cues. Good news is the brain is malleable and adaptable and so is the environment. Don’t get in her lane. Stay in yours. Start by creating more openness about feelings so that she is able to respond and process instead of avoiding and going to food. How are you feeling? Talk about your feelings and get a bit descriptive by using a metaphor. Model healthy coping skills. Also, don’t assume you know what’s going on in her mind.  Don’t bring up body image issues unless she does. This can bite you in the butt. If she has urges and cravings at certain times of the day, then have some snacks readily available that have a balance and aren’t processed foods.  Ask her what she wants and plan a day ahead. You are helping her create mindfulness eating habits and awareness before choice. 
 
<ul>
<li aria-level="1">I know my daughter is unhappy about her body and I desperately want to help her, but I am also terrified that if I bring it up she will feel judged or I will destroy her confidence.  </li>
</ul>
 
You get to decide ahead of time how you want to show up in situations. That’s what you can control.  You can’t control how your daughter feels or how she responds. If she feels judged, it’s coming from her thoughts.  That being said, what you want is to be a responsive parent, to be intentional about how you will respond when SHE brings it up or there are situations that activate her negative body image thoughts.  You want to be a soft place to land.  
Self-love superpower,
Dr. Karla

Metabolic Health in Teens with Dr. Karla

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