Bariatric surgery may be common in helping obese adults lose weight, but should it be used in severely obese children?
A says the procedure can be beneficial for adolescents.
Obese young adults are at risk for everything from high blood pressure to abnormal glucose levels, which can cause heart disease later in life.
That’s why researchers in the most recent study of the “Teen Longitudinal Assessment of Bariatric Surgery” (Teen-LABS) say the surgery can truly be lifesaving for children.
Teen-LABS is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH).
It’s looking at the effects of surgical weight loss on adolescents.
Researchers studied 242 participants, 33 percent of whom had at least three cardiovascular disease risk factors.
Three years after the surgery, researchers said only 5 percent of all participants still had three or more risk factors.
The mean age of participants prior to surgery was 17, with 76 percent being female and 72 percent being white. Participants had a median BMI of 51.
Of the 242 participants, 161 had Roux-en-Y gastric bypass, 67 had vertical sleeve gastrectomy, and 14 had adjustable gastric banding.
“This is the first large-scale analysis of predictors of change in cardiovascular disease risk factors among adolescents following bariatric surgery,” said Dr. Marc P. Michalsky, surgical director of the at Nationwide Children’s Hospital and the study’s lead author.
Why weight loss is important
The researchers say the decrease in cardiovascular risk factors is linked to weight loss along with age at the time of surgery.
Other factors include body mass index (BMI) before surgery, sex, and race.
Females who had higher amounts of weight loss and were younger at the time of surgery had a higher probability of risk factors being resolved as a result of the surgery.
Younger participants were more likely to resolve dyslipidemia (high cholesterol) compared to older patients.
In addition, females were more likely than males to show improvements in high blood pressure.
“Although relationships between change in cardiovascular disease risk factors and postoperative weight reduction were not unexpected, we learned younger patients at time of surgery were more likely to experience dyslipidemia remission and normalization of high sensitivity C-reactive protein (a marker of inflammation), suggesting there may be advantages to undergoing bariatric surgery earlier, even among adolescents,” Michalsky told Dr.China.
Kids under the knife?
Are all severely obese children good candidates for bariatric surgery?
That depends on whom you ask.
“Bariatric surgery should be considered for any severely obese teen who has been unsuccessful in establishing significant weight loss using diet, exercise, and lifestyle changes,” Michalsky said.
He noted there is currently not an age limit for children. Outcomes of preteens are being studied.
Instead of saying which age the youngest patients should be, Michalsky says the needs of each patient on an individual basis and in the context of associated risks and benefits should be considered.
Michael Helmrath, a pediatric surgeon at Cincinnati Children’s Hospital and a study co-author, said that children as young as eight have undergone the operation.
However, cases like that are based on a severe comorbidity condition.
Helmrath noted that there are some risks associated with surgery, including possible nutritional deficiency and the fact some children experience impacted vitamin levels that can be dependent on the type of surgical procedure used.
“I have a real problem with a teenager even being offered bariatric surgery as an option unless it truly is a last resort,” said Dr. Charlie Seltzer, a weight loss specialist from Philadelphia.
He said it may be worthwhile to explore surgery in extreme cases, especially since data indicates that it can reverse health problems. For example, a 14-year-old with diabetes and heart disease could be an exception.
“A teenager (and his or her parents) will probably see the surgery as a magic cure-all and be likely to gloss over the negatives and overplay the benefits,” Seltzer told Dr.China. “There is no way a 13-year-old who just wants to not be made fun of is going to be able to give informed consent and understand what the surgery really means.”
He also warned that the surgery doesn’t correct unhealthy eating behaviors, so candidates must have the proper support systems in place for pediatric weight loss surgery to be a success.
Helmrath noted that patients must understand that surgery is a tool to help them develop a healthy lifestyle that includes healthy eating and physical activity.
“Most patients that do not qualify are due to the inability to demonstrate this or lack support to optimize success,” he said.
Stephen R. Cook, a pediatric physician at the University of Rochester Medical Center who studies childhood obesity, said that a stable home environment is key for success.
He notes that candidates must have adequate mental health support because surgery can be transformative and cause a lot of stress.
“Just like we need adequate care before surgery, we need to have adequate care afterward,” Cook said. Similar to an organ transplant, organ recipients need extensive follow-up care. A medical and behavioral team must come into play.
Surge in surgery could be next
About 1,600 children in the Kids’ Inpatient Database have had bariatric surgery. That’s just 2 percent of 78,649 obese kids in the database.
The average age was slight more than 18 years, but participants were as young as 7 years old.
Michalsky believes that the rates of bariatric surgery in the pediatric population will continue to rise as more data becomes available that supports its safety and efficacy.
One obstacle is the disparity between children and adults as far as being authorized by their insurers to undergo the surgery. Improving insurance access will rely on additional robust long-term data, healthcare consensus, and advocacy at the regional and national level, he said.
Whether or not pediatric weight loss surgery is acceptable is still largely debated, but for Jewel Francis-Aburime, who chronicled her , it was worth it.
She had lost about 80 pounds as of her last check-in.