What is the position of Dr. Pretlow, originator of the W8Loss2Go smartphone app?
I’m not an advocate of bariatric surgery, particularly in the pediatric population, except for life-threatening cases. I feel strongly that overeating/obesity is an addictive process and should be treated with addiction medicine methods. Our research results support this position.
In our previous post, Childhood Obesity News began discussing a report published two years ago, titled “What Is the Evidence for Paediatric/Adolescent Bariatric Surgery?” Surgeries intended to accomplish weight loss are performed in many countries, and the researchers examined current guidelines from major medical centers. They found that agreement about an appropriate age range is not unanimous. There is also uncertainty about the severity of obesity the patient must be up against, in order to qualify.
There is said to be agreement everywhere, however, over a principle that may not always be possible to follow in each individual case, but which is honored as a Best Practice. The multidisciplinary team, or MDT, is universally acclaimed and recommended, despite the lack of an element that science usually insists on, namely, hard evidence.
The authors say,
There is no specific evidence for the use of a multidisciplinary team either for adults or adolescents undergoing bariatric surgery. Considering the complex nature of intervention, however, particularly at the vulnerable age of these patients, the MDT has become well established as the gold standard of care necessary to provide a safe and efficient service.
One reason for lack of satisfactory evidence is the paucity of information about long-term results, because this kind of intervention, especially on children, has not been underway long enough to generate a large body of data. The authors speak of two consortiums that are interested in “the sustainability of weight loss, long-term effects on co-morbidities and the safety of bariatric surgery in childhood.”
They are AMOS, named for adolescent morbid obesity surgery, and Teen-LABS, also known as Teen-Longitudinal Assessment of Bariatric Surgery. When the report was written, both had only recently published their first sets of prospective long-term outcomes; and long-term in this instance means less than four years.
The multi-disciplinary team
As defined by the American Society of Metabolic and Obesity Surgeons, the MDT ideally includes:
1. An experienced bariatric surgeon
2. A paediatric specialist; either a paediatrician with a specialty in endocrinology, gastroenterology, nutrition, and/or adolescence, or an internist, or family practitioner with training in adolescent medicine.
3. A registered dietician with experience in treating obesity and working with children and families.
4. A mental health specialist; a psychiatrist or psychologist with specialty training in paediatrics +/− adolescents and particular experience in treating eating disorders and obesity.
The fourth item on that list is strongly approved by Dr. Pretlow, who would like to see mental health professionals more involved in every aspect of the struggle against obesity. Even a child who comes to surgery psychologically unimpaired (unlikely as that might be) will need help afterward. The challenge of reinventing oneself to conform to the needs of the post-op protocol (not to mention the subsequent 60 or 80 years of life) is, as they say, “a lot.”
Dr. Pretlow writes,
Psychologists in the obesity field seem to be treating only the psychological effects of being obese, rather than the psychological causes of obesity.
Having surgery is both a physical and psychological effect of obesity — neither of which might be needed if professionals spent more time beforehand on the psychological causes.
Your responses and feedback are welcome!
Source: “What Is the Evidence for Paediatric/Adolescent Bariatric Surgery?,” NIH.gov, 08/16/17
Image by Matthias Ripp via Flickr