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A Clinician’s Perspective on Obesity: Syndromic and Non-Syndromic Causes, Treatment and Challenges

Date of Release: July 19, 2021

Expiration Date: July 1, 2023

Revised Expiration Date: August 31, 2025 

Credits offered: CME, P.A.C.E.®

Estimate time of completion: 4. 5 hours

Course must be completed by the expiration date.

www.acmgeducation.net

Course Description

Obesity is highly prevalent in the USA and frequently associated with increased healthcare costs. Increased weight can be an isolated health condition or part of a syndrome, with implications for evaluation, testing, management and treatment strategies. This course will provide an overview of current knowledge of syndromic and non-syndromic obesity from a clinical and molecular perspective. We will provide updates on the management and treatment of common syndromes with obesity, including Prader-Willi syndrome, Bardet-Biedl syndrome, Alström syndrome, Albright Hereditary Osteodystrophy, and Smith-Magenis syndrome. These conditions will be contrasted to those arising from disturbance to the pathways involved in non-syndromic obesity, including the leptin and MC4R pathway. Testing strategies for the diagnosis of monogenic obesity and a selection of the signaling pathways involved in fat metabolism will also be presented. These three talks will be followed by a panel presentation of cases that illustrate an approach to typical referral indications, such as tall stature and increased weight gain in childhood. The cases will include a prenatal patient and the prenatal determinants of postnatal obesity will be discussed. Lastly, the course will conclude with a talk on treatment of syndromic and non-syndromic obesity, including a summary of therapeutic trials for obesity and studies examining the efficacy of gene therapy in mice.

Learning Objectives

At the conclusion of this session, participants should be able to:

1. Formulate an approach for a genetics consultation for a syndromic cause of obesity
2. Recognize the clinical findings in common syndromes that include obesity
3. Distinguish between syndromic and non-syndromic obesity
4. Interpret the leptin pathway involved in appetite and growth
5. Recognize the common features associated with pathogenic MC4R variants
6. Explain the testing strategies for monogenic obesity
7. Discuss prenatal determinants of postnatal obesity
8. List treatments and management strategies for obesity and overgrowth conditions
9. Recognize optimal partnerships for multidisciplinary obesity clinic

Moderators:

Anne Slavotinek, MD, PhD, FACMG

University of California San Francisco

David Stevenson, MD, FACMG

Professor of Pediatrics in the Division of Medical Genetics at Stanford University

Presenter(s):

Julian Martinez-Agosto, MD, PhD, FACMG

Associate Professor Departments of Human Genetics, Pediatrics and Psychiatry David Geffen School of Medicine at UCLA

Kim Keppler-Noreuil, MD, FACMG

Division Chief of Pediatric Genetics & Metabolism, Director of Genetics & Metabolism

University of Wisconsin Hospital and Clinics/ Waisman Center

Sadaf Farooqi, PhD, FRCP, FMedSci

Wellcome Trust Principal Research Fellow and Professor of Metabolism and Medicine

University of Cambridge

Claudia Soler-Alfonso, MD, FACMG

Associate Professor, Departments of Human Genetics, Pediatrics and Psychiatry

Texas Children's Hospital

Margaret Dow, MD

Consultant, Division of Obstetrics, Assistant Professor of OBGYN

Mayo Clinic Alix School of Medicine

Jennifer Miller, MD

Pediatric Endocrinology

University of Florida

CME, P.A.C.E^® Educational Credits

Accreditation
The American College of Medical Genetics is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
The American College of Medical Genetics and Genomics designates this enduring activity for a maximum of 4.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

P.A.C.E.® CEUs- Laboratory Directors and Laboratory Personnel

ACMG is approved as a provider of continuing education programs in the clinical laboratory sciences by the American Society for Clinical Laboratory Science (ASCLS) Professional Acknowledgment for Continuing Education (P.A.C.E.®) Program.

The American College of Medical Genetics and Genomics designates this OnDemand course for a maximum of 4.5 contact hours. ACMG is approved by the Florida Board of Clinical Laboratory Personnel as CE Provider #50-11878. This course is registered # 20-865016 with CEBroker.  ACMG is approved by the California Department of Health Services through the ASCLS P.A.C.E.®

Claiming your Educational Credits

Complete the activity, score 80% or better on the post-test, and carefully complete the evaluation form.

Financial Disclosures

Disclosure Statement

It is the policy of the American College of Medical Genetics and Genomics to plan and implement all of its educational activities in accordance with the ACCME Essentials and Areas and ACCME® Policies to ensure balance, independence, objectivity and scientific rigor. In accordance with the ACCME® Standards for Commercial Support, everyone (speakers, moderators, committee members and staff) who is in a position to control the content of an educational activity certified for AMA PRA Category 1 Credit™ is required to disclose all financial relationships with any commercial interests within the past 12 months that creates a real or apparent conflict of interest. Individuals who do not disclose will be disqualified from participating in a CME activity.

This disclosure pertains to relationships with ACCME-defined commercial interests whose products or services may be related to the subject matter of the presentation topic. Any real or apparent conflicts of interest related to the content of the presentations must be managed prior to the educational activity. ACMG will identify, review and resolve all conflicts of interests prior to an educational activity being delivered to learners.

NOTE:

• ACMG will follow the ACCME’s expectation that no employees or owners of commercial interests will be involved as planners/faculty/presenters of a CME accredited activity.
• The ACCME definition of a commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
• The ACCME does not consider providers of clinical service directly to patients to be commercial interests – unless the provider of clinical service is owned, or controlled by, an ACCME-defined commercial interest.
• Diagnostic laboratories are not considered commercial interests unless they are owned by or have a sister organization which is a commercial interest.

Content Validation and Fair Balance

1. ACMG follows the ACCME policy on Content Validation for CME activities, which requires:
2. a) All recommendations involving clinical medicine must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients.
3. b) All scientific research referred to, reported or used in CME in support or justification of patient care recommendations must conform to the generally accepted standards of experimental design, data collection and analysis.
4. Activities that fall outside the definition of CME/CE; “Educational activities that serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession” (source: ACCME and AMA) will not be certified for credit. CME activities that promote recommendations, treatment, or manners of practicing medicine or pharmacy that are not within the definition of CME/CE or, are known to have risks or dangers that outweigh the benefits or, are known to be ineffective in the treatment of patients.
5. Presentations and CME/CE activity materials must give a balanced view of therapeutic options; use of generic names will contribute to this impartiality. If the CME/CE educational materials or content includes trade names, where available, trade names from several companies must be used.

Off-Label Uses of Products

When an off-label use of a product, or an investigational use not yet approved for any purpose, is discussed during an educational activity, the accredited sponsor shall require the speaker to disclose that the product is not labeled for the use under discussion, or that the product is still investigational. Discussions of such uses shall focus on those uses that have been subject of objective investigation.

HIPAA Compliance by Faculty

The ACMG supports medical information privacy. While the ACMG is not a “covered entity” under HIPAA 1996 and therefore is not required to meet these standards, ACMG wishes to take reasonable steps to ensure that the presentation of individually identifiable health information at ACMG-sponsored events has been properly authorized. All presenters have completed a form indicating whether they intend to present any form of individually identifiable healthcare information. If so, they were asked either to at that a HIPAA-compliant consent form is on file at their institution, or to send ACMG a copy of the HIPAA compliance form. This information is on record at the ACMG Administrative Office and will be made available upon request.

Disclaimer

ACMG educational programs are designed primarily as an educational tool for health care providers who wish to increase their understanding of the application of genomic technologies to patient care. The ACMG does not endorse or recommend the use of this educational program to make patient diagnoses, particular by individuals not trained in medical genetics. Adherence to the information provided in these programs does not necessarily ensure a successful diagnostic outcome. The program should not be considered inclusive of all proper procedures and s or exclusive of other procedures and s that are reasonably directed at obtaining the same results. In determining the propriety of any specific procedure or, a healthcare provider should apply his or her own professional judgment to the specific clinical circumstances presented by the individual patient or specimen.

Questions regarding CE credit should be directed toeducation@acmg.net

Financial Disclosures

The following reported disclosures and none are relevant to the content of this course. All of the relevant financial relationships listed for these individuals have been mitigated.