Weight Loss Surgery for Children Should Be Reserved for Severe Cases
In the United States, the number of people seeking weight loss surgery has increased rapidly over the last several years. In 2007, about 205,000 people underwent bariatric surgery, up from 171,000 in 2005. There are not specific statistics for adolescents, but due to the increase in childhood obesity, the number of surgeries being performed on teens has also increased.
Although an effective tool for weight loss, a team of experts from the US and the UK say that bariatric (weight loss) surgery should only be performed on severely obese children in the highest five percent of BMI and only after proving unsuccessful weight loss with non-invasive methods.
To date, no controlled trials have addressed the long-term safety of bariatric surgery in adolescents. “The risks of bariatric surgery are substantial, and long-term safety and effectiveness in children remain largely unknown,” write the authors of the study.
Weight loss surgery is associated with malabsorption of nutrients that could be detrimental to growing teens. Calcium, for example, is crucial during this time period of building peak bone mass and interruption of calcium absorption could lead to earlier onset of osteoporosis.
The data review, published in The Lancet and led by Susal J. Woolford MD MPH, medical director of the Pediatric Comprehensive Weight Management Center at the University of Michigan, included statistics from Australia, Brazil, Canada, Chile, Finland, France, Germany, Greece, Japan, Britain, and the United States. She concluded that weight loss surgery should be limited to children who have a body mass index over 50. If there are substantial risk factors involved, such as poorly controlled diabetes or obstructive sleep apnea, a lower BMI of 40 could be considered. Before undergoing surgery, most physicians recommend an extended pre-surgical period of monitored treatment lasting at least 12 months.
Although the laparoscopic adjustable gastric band (LAGB) is less invasive, a major obstacle to its use in adolescents is the dramatic changes that the teen must make to his or her lifestyle in order to be successful. For many doctors, this raises the question of whether or not teens have the maturity to understand this and cope with the regimen restrictions.
The researchers also recommend a “very conservative approach when considering drug therapy” in obese children and adolescents. A comprehensive, multi-disciplinary team effort focusing on diet, exercise, and behavioral management should be used prior to the initiation of pharmacotherapy.
"In keeping with recommendations from the American Academy of Pediatrics for the treatment of obesity in adolescents, after primary care efforts to lose weight have failed to achieve sufficient weight loss, patients should be referred for multidisciplinary care," Dr. Woolford said. "In this setting, bariatric surgery can also be considered if intensive behavioral interventions are not effective."