Elizabeth Shepard

All Publications

• A Digital Health Behavior Intervention to Prevent Childhood Obesity: The Greenlight Plus Randomized Clinical Trial. JAMA Heerman, W. J., Rothman, R. L., Sanders, L. M., Schildcrout, J. S., Flower, K. B., Delamater, A. M., Kay, M. C., Wood, C. T., Gross, R. S., Bian, A., Adams, L. E., Sommer, E. C., Yin, H. S., Perrin, E. M., de la Barrera, B., Bility, M., Cruz Jimenez Smith, M., Cruzatte, E. F., Guevara, G., Howard, J. B., Lampkin, J., Orr, C. J., Pilotos McBride, J., Quintana Forster, L., Ramirez, K. S., Rodriguez, J., Schilling, S., Shepard, W. E., Soto, A., Velazquez, J. J., Wallace, S. 2024

  Abstract

  Infant growth predicts long-term obesity and cardiovascular disease. Previous interventions designed to prevent obesity in the first 2 years of life have been largely unsuccessful. Obesity prevalence is high among traditional racial and ethnic minority groups.To compare the effectiveness of adding a digital childhood obesity prevention intervention to health behavior counseling delivered by pediatric primary care clinicians.Individually randomized, parallel-group trial conducted at 6 US medical centers and enrolling patients shortly after birth. To be eligible, parents spoke English or Spanish, and children were born after 34 weeks' gestational age. Study enrollment occurred between October 2019 and January 2022, with follow-up through January 2024.In the clinic-based health behavior counseling (clinic-only) group, pediatric clinicians used health literacy-informed booklets at well-child visits to promote healthy behaviors (n = 451). In the clinic + digital intervention group, families also received health literacy-informed, individually tailored, responsive text messages to support health behavior goals and a web-based dashboard (n = 449).The primary outcome was child weight-for-length trajectory over 24 months. Secondary outcomes included weight-for-length z score, body mass index (BMI) z score, and the percentage of children with overweight or obesity.Of 900 randomized children, 86.3% had primary outcome data at the 24-month follow-up time point; 143 (15.9%) were Black, non-Hispanic; 405 (45.0%) were Hispanic; 185 (20.6%) were White, non-Hispanic; and 165 (18.3%) identified as other or multiple races and ethnicities. Children in the clinic + digital intervention group had a lower mean weight-for-length trajectory, with an estimated reduction of 0.33 kg/m (95% CI, 0.09 to 0.57) at 24 months. There was also an adjusted mean difference of -0.19 (95% CI, -0.37 to -0.02) for weight-for-length z score and -0.19 (95% CI, -0.36 to -0.01) for BMI z score. At age 24 months, 23.2% of the clinic + digital intervention group compared with 24.5% of the clinic-only group had overweight or obesity (adjusted risk ratio, 0.91 [95% CI, 0.70 to 1.17]) based on the Centers for Disease Control and Prevention criteria of BMI 85th percentile or greater. At that age, 7.4% of the clinic + digital intervention group compared with 12.7% of the clinic-only group had obesity (adjusted risk ratio, 0.56 [95% CI, 0.36 to 0.88]).A health literacy-informed digital intervention improved child weight-for-length trajectory across the first 24 months of life and reduced childhood obesity at 24 months. The intervention was effective in a racially and ethnically diverse population that included groups at elevated risk for childhood obesity.ClinicalTrials.gov Identifier: NCT04042467.

  View details for DOI 10.1001/jama.2024.22362

  View details for PubMedID 39489149

  View details for PubMedCentralID PMC11533126

• Experience With Vertical Sleeve Gastrectomy in Adolescent and Young Adult Ehlers-Danlos Syndrome Patients: a Case Series and Review of the Literature. Obesity surgery Herdes, R. E., El Haija, M. A., Johnson, K., Shepard, W. E., Zak, Y., Bruzoni, M., Pratt, J. S. 2021

  View details for DOI 10.1007/s11695-021-05453-3

  View details for PubMedID 33948912

• Pilot Evaluation of a Multidisciplinary Strategy for Laparoscopic Sleeve Gastrectomy in Adolescents and Young Adults with Obesity and Intellectual Disabilities. Obesity surgery Jones, R. E., Wood, L. S., Matheson, B. E., Pratt, J. S., Burgart, A. M., Garza, D., Shepard, W. E., Bruzoni, M. 2021

  View details for DOI 10.1007/s11695-021-05393-y

  View details for PubMedID 33797732

• Experience With Vertical Sleeve Gastrectomy in Adolescent and Young Adult Ehlers-Danlos Syndrome Patients: a Case Series and Review of the Literature Obesity Surgery Herdes, R. E., Abu El Haija, M., Johnson, K., Shepard, W., Zak, Y., Bruzoni, M., Pratt, J. S. 2021

  View details for DOI 10.1007/s11695-021-05453-3

• A multidisciplinary approach to laparoscopic sleeve gastrectomy among multiethnic adolescents in the United States. Journal of pediatric surgery Jaramillo, J. D., Snyder, E. n., Farrales, S. n., Stevens, M. n., Wall, J. K., Chao, S. n., Morton, J. n., Pratt, J. S., Hammer, L. n., Shepard, W. E., Bruzoni, M. n. 2017

  Abstract

  Childhood obesity has become a serious public health problem in our country with a prevalence that is disproportionately higher among minority groups. Laparoscopic sleeve gastrectomy (LSG) is gaining attention as a safe bariatric alternative for severely obese adolescents.A retrospective study on morbidly obese adolescents that underwent LSG at our institution from 2009 to 2017. Primary outcomes were weight loss as measured by change in BMI and percent excess weight loss (%EWL) at 1 year after surgery, resolution of comorbidities and occurrence of complications.Thirty-eight patients, of whom 71% were female and 74% were ethnic minorities, underwent LSG between 2009 and 2016. Mean age was 16.8years, mean weight was 132.0kg and mean BMI was 46.7. There were no surgical complications. Mean %EWL was 19.4%, 27.9%, 37.4%, 44.9%, and 47.7% at 1.5, 3, 6, 9, and 12month follow up visits, respectively. Comorbidity resolution rates were 100% for hypertension and nonalcoholic fatty liver disease, 91% for diabetes, 44% for prediabetes, 82% for dyslipidemia and 89% for OSA.LSG is an effective and safe method of treatment of morbid obesity in adolescents as it can significantly decrease excess body weight and resolve comorbid conditions. Further studies are needed to investigate the long-term effects of LSG in adolescents.Descriptive case series with prospective database.IV.

  View details for PubMedID 28697852

• Vitamin D-Deficient Rickets in a Child With Cow's Milk Allergy (vol 25, pg 394, 2010) NUTRITION IN CLINICAL PRACTICE Barreto-Chang, O. L., Pearson, D., Shepard, E., Longhurst, C. A., Greene, A. 2011; 26 (2): 208-208

  View details for DOI 10.1177/0884533611404528

  View details for Web of Science ID 000289630600017

• Clinical resolution of severely symptomatic pseudotumor cerebri after gastric bypass in an adolescent SURGERY FOR OBESITY AND RELATED DISEASES Chandra, V., Dutta, S., Albanese, C. T., Shepard, E., Farrales-Nguyen, S., Morton, J. 2007; 3 (2): 198-200

  Abstract

  Pseudotumor cerebri is a disease characterized by increased intracranial pressure, often manifested by headaches, and occasionally leading to severe visual impairment or even blindness. Most cases in adolescents, as in adults, are associated with obesity. We report a 16-year-old morbidly obese adolescent girl (body mass index 42.3 kg/m(2)) with severely symptomatic pseudotumor cerebri who had progressive visual field deficits and elevated intracranial pressure (opening pressure on lumbar puncture of 50 cm H(2)O) despite intensive medical management and placement of both ventriculoperitoneal and lumboperitoneal shunts. Six months after she underwent gastric bypass surgery, she had lost 43% of her excess body weight and had had near complete regression of her visual field deficits, along with normalization of her intracranial pressures. This case demonstrates the dramatic reversal of symptoms of pseudotumor cerebri with surgically induced weight loss. Gastric bypass should be considered as a treatment option for adolescents with severe and progressive pseudotumor cerebri.

  View details for DOI 10.1016/j.soard.2006.11.015

  View details for PubMedID 17324634

• Methamphetamine use following bariatric surgery in an adolescent OBESITY SURGERY Dutta, S., Morton, J., Shepard, E., Peebles, R., Farrales-Nguyen, S., Hammer, L. D., Albanese, C. T. 2006; 16 (6): 780-782

  Abstract

  Bariatric surgery is increasingly popular as a therapeutic strategy for morbidly obese adolescents. Adolescence represents a sensitive period of psychosocial development, and children with considerable weight loss may experience greater peer acceptance, accompanied by both positive and negative influences. Substance abuse exists as one of these negative influences. We present the case of an adolescent bariatric surgical patient who abused methamphetamines in the postoperative period, with consequent nutritional instability. A concerted effort must be made in the preoperative assessment of adolescent bariatric patients to delineate a history of illicit drug use, including abuse of diet pills and stimulants. Excessive postoperative weight loss or micronutrient supplementation non-compliance should raise a suspicion of stimulant use and appropriate screening tests should be performed. The consequent appetite suppression may manifest with signs of malnutrition such as bradycardia, hypotension, and weakness. Inpatient nutritional rehabilitation and psychiatric assessment should be considered.

  View details for Web of Science ID 000238156200019

  View details for PubMedID 16756743