Bariatric Surgery in a Less Than Ideal World

There are, as it turns out, four important registries of adolescent bariatric surgery: AMOS, Teen-LABS, Saudi Arabia, and the Germany Obesity Registry. Their studies about bariatric surgery were described by Natalie Durkin and Ashish P. Desai.

Childhood Obesity News noted that there is universal agreement over the importance of the multi-disciplinary team. Another thing that strikes everybody as an urgent need, for the benefit of both patients and Science, is diligent and conscientious long-term followup. What other insights did the study from King’s Hospital, London, publish?

It had a lot to say about psychosocial well-being, and the effects of obesity on that state in children and teenagers. They get depressed, perform badly in school, and are prone to leaving without credentials. However,

The AMOS collaboration demonstrated a substantial improvement in psychosocial well-being in adolescents 2 years post-gastric bypass vs controls. Symptoms of anxiety, depression, anger and disruptive behaviour were significantly reduced and self-esteem, self-concept and overall mood significantly improved.

But wait. Also, at the two-year mark, symptoms of clinical depression were observed in 19% of the subjects, which is almost one in five. And there were two attempted suicides. The corresponding report from Teen-LABS also documented a mixed bag of results:

Of 11 patients presenting with ≥1 mental health symptoms pre-surgery, remission was only found in 45%, although no new cases developed. These findings suggest that not all adolescents benefit psychologically from bariatric surgery, and the role of psychological screening prior to operation is essential.

Teen-LABS also sees a need for earlier intervention in the psychosocial consequences department, a sentiment shared by Dr. Pretlow. Unless underlying causes can be expressed and addressed, the likelihood of avoiding morbid obesity shrinks, as the patients continue to enlarge.

It’s complicated

Compared to adults, adolescents suffer roughly twice as many complications, an umbrella term that extends far enough to cover additional surgeries. The writers supply a protracted discussion of complications, both short- and long-term.

In some people’s minds, nutrition appears to be almost an afterthought, but ignoring it could be deadly. Without the right amounts of calcium, iron, and various vitamins, big trouble can ensue. We’re talking peripheral neuropathy, beriberi, anemia, osteoporosis — and these are only a few of the potential problems mentioned.

A familiar refrain is repeated:

This emphasises the importance of the role of the nutritionists and psychologists post-operatively to encourage compliance in this group of patients.

No matter how any one individual may feel about the issue, pediatric bariatric surgery is a growth industry that will very probably not go away, so we may as well learn to live with it, understand it, and try to put it out of business.

It’s holistic

Regarding weight loss and the resolution of co-morbidities, the writers conclude that so far, the results with adolescents are no worse than those with adults. To ensure safe and excellent clinical care, they wind up by emphasizing once more the prime importance of multi-disciplinary specialist teams.

Your responses and feedback are welcome!

Source: “What Is the Evidence for Paediatric/Adolescent Bariatric Surgery?,” NIH.gov, 08/16/17
Image by Russ Sanderlin/Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources