Weight loss surgery for children and teens struggling with obesity

In the US, the number of severely obese children and adolescents is alarming: one in 12 currently, and among 12-to-15-year-olds, it jumps to one in 10, and among 16-to-19-year-olds, it is one in seven. The American Academy of Pediatrics (AAP) suggests that for many of these youths, the best hope may be bariatric surgery, a procedure that reduces the stomach's size and modifies the digestive system to promote weight loss.

While the idea of performing irreversible surgery on an adolescent or child is unsettling, the reality is that obesity and its associated risks may be irreversible as well. Obesity in children and teenagers is defined as having a body mass index (BMI) greater than or equal to the 95th percentile for age and sex. Research indicates that individuals who are obese at 12 years old have a 98% chance of being obese as adults. This is particularly concerning considering the complications associated with obesity, including diabetes, high blood pressure, fatty liver disease, obstructive sleep apnea, and heart disease.

While lifestyle changes such as a healthy diet and exercise are effective for mild obesity, once an individual reaches severe obesity, with a BMI of 35 or higher, lifestyle changes are generally insufficient. Severe obesity is a BMI greater than or equal to 120% of the 95th percentile for age and sex. Failing to address severe obesity through interventions like bariatric surgery risks condemning children to obesity and its complications.

What does research on bariatric surgery tell us?

The longest study on the efficacy of bariatric surgery in youths, which tracked patients for an average of eight years, showed that those who underwent surgery experienced a 29% decrease in their BMI. Conversely, those who didn't have surgery experienced an average increase of 3.3 BMI points.

The prospect of surgery may seem daunting, but bariatric surgery is actually safe and effective when performed by experienced surgeons in high-quality facilities, with a robust multidisciplinary team to provide patients and families with ongoing education and support, including psychological support. Surgical complications are rare and generally minor, with the most common being micronutrient deficiencies, such as iron deficiency. Although these can be prevented by regularly taking supplements, adolescents are not always diligent about taking them. That's why it's crucial for the surgery to be conducted at a center that takes a team approach and offers follow-up care for years to come.

Which children might benefit from weight loss surgery?

According to the AAP, bariatric surgery may be considered for a child or teenager if they have a BMI equal to or greater than 35 and have one or more obesity-related complications, or a BMI equal to or greater than 40, regardless of complications. However, not all children in these groups should undergo surgery.

It is not recommended for those with untreated or poorly controlled substance abuse problems, eating disorders, or those who are pregnant or planning to become pregnant. Additionally, those who cannot follow post-operative recommendations, including necessary lifestyle and dietary changes, should not undergo surgery. Patients who have undergone bariatric surgery must be cautious about their diet and take daily supplements.

While bariatric surgery is a serious decision, it should not be avoided if it is the best option for severely obese children and teenagers. Overcoming fear of surgery and biases that view obesity as a matter of personal responsibility is necessary to ensure that our children have the best chance at a healthy life.

Caroline Buckee

Caroline Flannigan is an epidemiologist. She is an Associate Professor of Epidemiology and is the Associate Director of the Center for Communicable Disease Dynamics.

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