Justin Ryder, PhD
Today, one in six children and adolescents in the United States has obesity, and the numbers increase linearly each year. The many facets of obesity as a chronic medical condition mean a potential lifetime of increased risk for developing complications such as type 2 diabetes, heart and liver diseases, joint pain, hypertension, and psychosocial issues. Fifty percent of school-age children with obesity will become adults with obesity. Even worse, for adolescents with obesity, 70–80 percent will develop adult obesity, making the treatment of childhood and youth obesity a national priority. At Stanley Manne Children’s Research Institute, a talented team of research professionals and clinical trial experts is addressing childhood obesity treatment, led by Justin Ryder, PhD, a clinical translational pediatric obesity researcher and Vice Chair of Research for the Department of Surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago. By focusing on treatment options, this collaborative, National Institutes of Health-funded research provides new insights into opportunities to improve health outcomes for youth with obesity.
Recent investigations at the Manne Research Institute aim to identify predictors of therapeutic responses from genetic, epigenetic, social-cultural, and behavioral factors and personalized treatment options, such as bariatric surgery, lifestyle modifications, and medications. Justin’s decade-long partnership with Thomas Inge, MD, PhD, Surgeon-in-Chief, Chair of the Department of Surgery, and Director of the Adolescent Bariatric Surgery Program at Lurie Children’s, has produced important findings on the effectiveness of bariatric surgery for adolescents with severe obesity. A study led by Drs. Ryder and Inge, published in The New England Journal of Medicine, analyzed the outcomes of 260 patients 10 years after undergoing bariatric surgery as teens and found that 55 percent had sustained weight loss and remission of type 2 diabetes, high cholesterol, and high blood pressure. When it comes to lifestyle and behavioral modification therapies, Justin explains these do not address the biological (metabolism and brain–gut interactions) and genetic factors that are associated with obesity and are therefore modestly effective as standalone treatment options for most children. They are, however, important cornerstones to be used in conjunction with bariatric surgery or medications, and Justin often draws on the expertise of Caren Mangarelli, MD, Medical Director of Lurie Children’s Wellness and Weight Management Program, as a resource for research in this area. Currently, Justin has funding from the NIH to study the mechanisms responsible for weight regain in adolescents, with the goal of identifying new treatment approaches.
Finally, Justin and his team have focused on the safety and effectiveness of medications to treat pediatric obesity, including glucagon-like peptide-1 (GLP-1) receptor agonists, through work on clinical trials and partnerships with industry. U.S Food and Drug Administration oversight for pediatric drug trials is more challenging than for many adult drug trials. For a medication with potential to treat a disease that occurs in both adults and children, such as obesity, the FDA requires that the medication be tested in adults first, and once sufficient data is available, it can then be tested in children. Currently, five medications are FDA-approved to treat obesity in adolescents aged 12 and older: two stimulants, a lipase inhibitor, and two GLP-1 receptor agonists. First used to treat type 2 diabetes in adults, the GLP-1 receptor agonists have garnered significant public attention for their role in promoting substantial weight loss. Interestingly, children tend to respond better to GLP-1 drugs than adults; one of the two GLP-1 medications approved for use in adolescent patients results in an average 15 percent weight loss, an impressive number that outperforms the adult data, Justin remarks. The exact reason for this result is unknown; however, this research aims to uncover insights into this phenomenon and further study the safety and efficacy of obesity medications and other treatments for obesity and metabolic diseases in pediatric patients. He credits collaborations with Lurie Children’s physician-scientists Laura Torchen, MD, Jami Josefson, MD, and Mark Fishbein, MD—who serve as medical safety officers for these drug trials—as an essential part of bringing these medication trials to fruition at Lurie Children’s.
Supporting Justin’s investigations is a dynamic pediatric obesity research team, which is essential for recruitment, study management, regulatory compliance, and care of the youth we are privileged to serve. Christine Stake, DHA, Associate Director of Surgical Research Operations, oversees and supports the full pediatric obesity research team. Angie Figueroa, MS, Clinical Research Coordinator Lead, leads the SHIELD project, an NIH-funded study of a novel medication for adolescents with obesity and metabolic dysfunction-associated fatty liver disease (steatotic). Darian Dorantes, BS, Clinical Research Coordinator III, leads the ADMIRE study, an NIH-funded study of adolescents with obesity focused on understanding mechanisms of weight regain; Mia De Tella, BS, Clinical Research Coordinator III, coordinates several investigator and industry-sponsored clinical trials, with both adult and pediatric populations; and Farah Salim, MS, Clinical Research Coordinator II, coordinates an industry-sponsored trial with adults for patients with hypoglycemia after bariatric surgery and provides recruitment support and development of patient engagement surveys. With more than 25 years of experience, Sally Schwartz, RD, LDN, Clinical Research Dietitian, offers expertise, educational development, and lifestyle support during participant visits as part of several studies.
Research conducted by our impressive network of childhood obesity experts continues to generate new scientific knowledge about obesity and the therapies and interventions that can treat it. Justin predicts that with continued funding and investment, more medications will be approved to treat children with obesity within the next several years. These medications, along with lifestyle options and bariatric surgery, will provide health practitioners with tools for integrated obesity management and treatment strategies.
