Is disease prevention a sufficient justification for performing surgery? Opponents of neonatal circumcision would say no; on the other hand, women with the genetic predisposition to breast cancer want the choice of bilateral mastectomy just in case. It is a thorny problem. More specifically, is it a good idea to operate on an overweight child or teenager as a precaution?
In 2012, of all bariatric surgeries, between one and two percent were performed on patients under 21 years of age. There would be a lot more if people could afford it, but apparently insurers are reluctant to spring for it until a person is at least 18. For the New York Times, Anemona Hartocollis wrote,
The push toward surgery on the young has brought some resistance from doctors who say it is too drastic to operate on patients whose bodies might still be developing and who have not been given much time to lose pounds on their own.
Some worry that surgery, which is a pretty big deal and certainly an expensive one, would be undertaken purely for reasons of vanity. Some feel that surgery should be a last resort that would not even be suggested except in an immediately life-threatening situation.
But surgery proponents see the youth of these patients as the big selling point, because earlier intervention can prevent the obesity from spawning a host of related health problems. If someone could avoid developing high blood pressure or type 2 diabetes, that would be much preferable to treating it later. Opinion seems to be swinging from the “last resort” school to a more permissive effort to change the future by curbing the metabolic syndrome before it has a chance to take hold.
The New England Journal of Medicine published news of a study that concerned itself with 242 adolescents from 5 different American locations. Going in, the kids were between 13 and 19, and their average weight was 328 pounds. They all underwent one of two popular procedures. On three-year followup, the Roux-en-Y gastric bypass group had a mean weight loss of 28% and the sleeve gastrectomy group had declined by 26%. Not bad, but it gets better. Blood pressure had normalized in 74% of the participants, and a whopping 95% experienced remission of type 2 diabetes.
Adults with the same surgeries top out at a 60% remission rate. That is a persuasive, but not yet definitive, argument for endorsing weight-loss procedures at increasingly earlier ages. The great thing about this study is that it will also publish the follow-up results at 5, 7, and 10 years post-up.
A hard-nosed, heart-felt plea
According to a brand-new study,
Intense research efforts in humans and rodent models are underway to identify the critical mechanisms underlying the beneficial effects with a view towards non-surgical treatment options.
Although a number of changes in food choice, taste functions, hedonic evaluation, motivation and self-control have been documented in both humans and rodents after surgery, their importance and relative contribution to diminished appetite has not yet been demonstrated.
The mechanisms responsible for suppression of appetite, particularly in the face of the large weight loss, are not well understood.
In other words, a lot of observation has been going on, but no one is yet able to pull it all together in a comprehensible manner. It is apparent that surgery does promote weight loss and weight loss is followed by improvements in glycemic control, but the reason is not clear. The research emphasis tends toward pinpointing the origins of appetite and manipulating them. However,
None of the major candidate mechanisms postulated in mediating surgery-induced changes from the gut and other organs to the brain, such as gut hormones and sensory neuronal pathways, have been confirmed yet.
That was an ornate way of saying, we don’t know how to get the good stuff without taking a trip to the OR. The report also suggests that future research should concentrate on “interventional rather than descriptive approaches,” which is a politically correct way of saying “Stop telling us about the problem and tell us what to do.”
Your responses and feedback are welcome!
Source: “Young, Obese and in Surgery,” NYTimes.com, 01/07/12
Source: “Bariatric surgery in teens shows promise in study,” Triblive.com, 11/21/15
Source: “Appetite and body weight regulation after bariatric surgery,” Wiley.com, 01/22/15
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