Transitioning from Pediatric to Adult Care for Obesity
Cleveland Clinic endocrinologist Lina Alkhaled, MD, takes care with transitioning young patients from pediatric to adult care for obesity.
In his mid-teens, a patient with severe obesity joined Cleveland Clinic’s Be Well Kids Clinic, a comprehensive, family-based program for the treatment of obesity in children age 2 and older. Be Well patients receive medical and psychological care as well as nutritional counseling, physical therapy, pharmacological therapy and, if appropriate, access to a metabolic surgery program for adolescents.
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This patient was treated for obesity and related conditions for over a year before undergoing bariatric surgery. Afterward, the patient lost 200 pounds, and his care was transferred to Lina Alkhaled, MD. She specializes in both pediatric and adult obesity medicine, and has a keen interest in building programs that help young patients transition from pediatric to adult care.
Dr. Alkhaled continues today as the patient’s obesity medicine physician. Her attention to the transition has helped him to stay better connected as he assumes more control over his chronic health condition.
“The patient knows that now he needs to make sure his appointments are scheduled for days when he can attend. He requests his refill medications. It’s kind of on him to follow through in terms of getting his annual labs done,” says Dr. Alkhaled. “But at the same time, we make sure he gets a bit of extra care by facilitating this process for him.”
When young people with chronic health conditions age out of pediatric care, the shift can be daunting. They move from a system created to accommodate children and family systems to one in which they are responsible for navigating appointments, medications, insurance, lab tests and more. Those sudden complexities not only can be frustrating, but they can stall or reverse health-related progress the patient has already made.
Dr. Alkhaled advocates for stepping up to help patients navigate the changes.
From her vantage point caring for both children and adults, Dr. Alkhaled sees important differences in the care models for each group.
“We use a handholding process in pediatrics, where we are dealing with not just the patient, but the family,” she says. “We try to accommodate them as much as possible. The visits are longer, and we spend more time talking with patients and their families. We can consider every concern at greater length. And as pediatric providers, we feel an obligation to reach out to parents to ensure that any follow-ups are done, because children aren’t doing that for themselves.”
In the case of the patient who recently has transitioned to adult care, Dr. Alkhaled stays in frequent contact and talks through important issues, such as making sure he schedules lab tests (and attends the appointment) and alerting him if he needs to refill a prescription.
“I remind him that we have to do it, because this is very important,” she says. “So he is an adult, and responsible for his own care, but I give some of that pediatric attention, and that’s OK.”
Dr. Alkhaled’s advice for physicians helping young patients enter the world of adult healthcare is to be patient.
“It’s important to remember that these patients may be coming from a different world. They may be accustomed to visiting a hospital with bright colors, and where child life specialists are around to help. In some cases, they may be going to college, or moving out of their house, or to a different city or state. It’s hard to keep up with all the changes taking place at this time of their lives. So if we can make things easier for them, we should do that.”
Dr. Alkhaled tries to see patients more during these transition periods to help reduce the risk of backsliding on measures that have improved their health.
“If they move to a different city, I can offer virtual visits to help keep them on track,” she says. “There is just a little bit of extra work during this transition, and then you pace it out so that you’re not seeing them as often.”
Dr. Alkhaled and her colleagues now are finalizing a transition program for young patients with diabetes who are moving to adult care.
“We hope to have a quarterly shared medical appointment, where three or four families can sit down with a pediatric provider to discuss the next steps,” she says. “We want to ensure that these kids are actually aware of their insulin doses, and that they know the basics of diabetes control. If they’re going to college, we want them to be thinking about whether there is someone in their dorm who can help them if they need it. And it’s important they understand what alcohol use means for them, as well as to have access to sexual health information.”