Obesity

Is Bariatric Surgery Safe and Effective for Adolescents?

Using bariatric surgery, a surgery which alters the stomach and/or intestines to treat severe obesity, as a method for weight loss is recommended by the U.S. National Institutes of Health (NIH) for those adults with a body mass index (BMI) of 40 and above or for those with a BMI of 35 to 39.9 who have obesity related illnesses such as type 2 diabetes, severe sleep apnea and/or high blood pressure.  It is generally advised that these people try an appropriate weight loss and exercise program first and if this fails than bariatric surgery may be considered.   These recommendations are for adults so the question remains is bariatric surgery safe and effective for adolescents under the age of 18 years.

Adolescents or teens that are morbidly obese may benefit from bariatric surgery if all else has failed.  According to a study published in May of 2010 in the Journal of Obesity Surgery, 50 percent of primary care physicians do not recommend bariatric surgery for very young children.  There are many factors to be considered when it comes to teens and whether surgery would be safe and effective for them. The same strict guidelines and criteria set forth for adults needs to be followed for teens as well.  The decision needs to be based on individual cases and the child’s medical team will need to weigh out the risks and benefits for that child.

  • Obesity in adolescents has dramatically increased in the United States in the last 40 years reaching epidemic proportions in recent times.
  • Life for obese adolescents can be difficult socially as well as emotionally because of the stigma attached with the physical state.  Many experience depression, anxiety and low self-esteem.
  • Obese adolescents are at risk of developing type 2 diabetes, hypertension, sleep apnea, high cholesterol, gallbladder stones and even early death upon reaching adulthood.
  • The risk for associated complications can be decreased when experienced doctors who specialize in this age group do the surgery.
  • According to the director of the Pediatric Comprehensive Weight Management Center at the University of Michigan, the long-term effects of this surgery on young people is not known sufficiently by the medical fraternity.
  • Questions that remain unanswered are the duration of the weight loss, risks of regaining the weight and the effects of the surgery on the mental and emotional health of the teen.
  • Doctors can still propose the surgical option to parents of obese teens, as there are considerable numbers of studies supporting it.
  • The American Academy of Pediatrics (AAP) has very strict and specific criteria that need to be followed before a child can even be considered for bariatric surgery.  Among their criteria girls should be older then 13 years and boys should be older then 15 years.
  • The American Society for Bariatric Surgery agrees with most of the AAP’s criteria but does disagree on the age restrictions.  They have also added a few of their own guidelines.

Both primary physicians, including pediatricians, and parents need to be fully aware of both the benefits and risks of bariatric surgery as the number of our obese teens grow.  If a teen is going to have bariatric surgery, they should receive care in a center that specializes in adolescent bariatric surgery with a team of experts that will provide them with the very special care they need both physically and emotionally.  Bariatric surgery should never be the first and only solution for an obese teen.  Proper nutritional support from a registered dietitian specializing in this age population should be the first line of defense and should be given a proper amount of time to help the teen achieve success.  Not only should a dietitian be part of the medical team but a child psychiatrist or psychologist should also be involved.  Bariatric surgery should be weighed carefully and should hardly be thought of as a quick fix.  Even if a teen undergoes this serious surgery they will still need to commit to lifelong lifestyle changes to achieve long-term success.

References

Weight-loss surgery and children:

U.S. Obesity Trends:

Childhood Obesity: What Can Be Done to Help Today’s Youth?: Bariatric Surgery as a Treatment
Option for Children:
http://www.medscape.com/viewarticle/501526_4

Bariatric Surgery for Severely Overweight Adolescents: Concerns and Recommendations:
http://www.pediatricsdigest.mobi/content/114/1/217.full

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