Diagnostic challenge: A pediatric patient with severe obesity and complications of imminent death

BACKGROUND: A 15-year-old patient suffering from severe obesity (400 pounds, BMI 71.6 kg/m(2)) with a clinical phenotype suggestive of syndromic obesity was hospitalized for severe heart failure and cardiogenic shock. The hospital admission prompted a palliative care and heart transplant consultation given end-stage-disease and poor prognosis. It further necessitated a pediatric inpatient obesity consult, which was complicated by several significant hurdles including lack of insurance coverage, FDA approvals, availability of medications, and inadequate knowledge among the medical community. METHODS: Innovative treatment, proactive, persistent advocacy, anti-obesity medication combination strategies modeled after diabetes and hypertension treatment algorithms, and latest evidence in obesity management were utilized to effectively and expeditiously overcome major challenges to care and the medical emergency. RESULTS: The patient was stabilized and ultimately discharged home, after −25.2% weight loss over 4 months (weight down to 299 pounds, BMI 49.9 kg/m(2)) through collaborative medical obesity intervention. CONCLUSION: The typical delay in care sought by patients suffering from obesity, often due to stigma and lack of disease awareness, results in missed opportunities to prevent serious obesity-related complications. Skilled specialist expertise, fund of obesity-specific knowledge, and constant advocacy can be crucial in surmounting regulatory barriers to obesity care and in generating successful weight loss outcomes.