October 30, 2019

Weight-loss surgery could be right for some kids, pediatrician group says

Daily Briefing

    Children and adolescents with severe obesity should be considered candidates for bariatric and metabolic surgery, the American Academy of Pediatrics said in a policy statement on Sunday.

    Bariatric services: Policy direction, service models, and the future horizon

    American Academy of Pediatrics recommends obesity surgery for children

    The guidance is based on a review of multiple studies that found that lifestyle changes are not as effective among children with severe obesity as they are among less obese children. The evidence also revealed that bariatric surgery can lead to long-term weight loss and reduced chronic comorbid conditions among severely obese children. In a lot of cases, health issues related to obesity, such as diabetes and high blood pressure, disappeared after the surgery.

    The majority of the studies involved teen participants, but one study, which included children younger than 12 years old, found the surgeries had no negative effect on growth.

    The American Academy of Pediatrics recommends pediatricians consider patients with severe obesity who meet the criteria for the surgery regardless of age, meaning that children with a body mass index (BMI) of 40 or higher, or a BMI of at least 35 with major health problems related to obesity, would be eligible.

    The guidance also recommends that the health care system reduce barriers to the surgeries for all patients, including cost of the procedure, which can be more than $20,000.

    Is the surgery 'safe and effective'?

    According to the Associated Press, it's rare for children to undergo bariatric or metabolic surgery, in part because the procedure typically is not covered by health plans. Pediatricians also have hesitated to recommend the procedure over concerns that it will be too risky or alter children's growth.

    However, the new guidance says based on the evidence, the new "message" is that bariatric and metabolic surgery is "safe and effective" and that age alone should not rule out patients as candidates for the procedure, according to Sarah Armstrong, a professor of pediatrics at Duke University and lead author of the new guidance. Armstrong added that while prepubescent patients might not be sufficiently mature to understand the surgery's life-altering ramifications, prepubescence alone shouldn't rule out eligibility.

    Rebecca Carter, an assistant professor of pediatrics at the University of Maryland School of Medicine, said the new guidance can give pediatricians a better idea of which children should be considered and evaluated for the procedure and which children are most likely to benefit.

    According to AP/Los Angeles Times, one of the patients who benefited from the surgery is 16-year-old Faith Newsome, who before her procedure weighed 273 pounds at 5 feet 8 inches and had a BMI of almost 42. Newsome also had high blood pressure and prediabetes.

    At 16, she had gastric bypass surgery, and a year later she had lost 100 pounds and her health problems completely disappeared. Now, her BMI is under 30, meaning she is still overweight, but not considered severely obese.

    Now at 21-years-old, Newsome said she has no regrets of getting the surgery. "Teens should be able to discuss every option with their doctors, and surgery should be one of those options," she said (Vaidya, Becker's Clinical Leadership & Infection Control, 10/28; AP/Los Angeles Times, 10/28; AP/Modern Healthcare, 10/28).

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