So, we were talking about the multi-author report, “Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity,” issued by the American Academy of Pediatrics a few short months ago, and also the companion report by the same authors, “Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices.”
As previously mentioned, if the patient’s obesity is medically correctable, that is a contraindication, otherwise known as a reason not to choose weight loss surgery. Dr. Pretlow holds that childhood (including teen) obesity is correctable without surgery, with the W8Loss2Go app and program.
Another contraindication is “an ongoing substance abuse problem (within the preceding 1 year).” And yet, the argument has been made that overeating is itself a substance abuse problem to the same extent that drinking alcohol and smoking crack are substance abuse problems. If the patient had ceased, a year ago, to have a substance abuse problem with food, the patient would have lost some weight, and the surgical option might not even be “on the table.”
Confusion around weight loss surgery
An additional complication is that insurers and institutions often insist that the patient lose some weight before the surgery. But wouldn’t that prove that the obesity was correctable without surgery? By this reasoning, anyone who qualifies for surgery (by losing some weight first) would not qualify for surgery (because they have proven that weight loss without surgery is possible.)
Another contraindication is a planned pregnancy within a year and a half, or so, post-surgery. Hopefully, this is a factor that not too many teens need to take into consideration. Another official reason to resist surgery is “a medical, psychiatric, psychosocial, or cognitive condition that prevents adherence to postoperative dietary and medication regimens.”
Again, this would appear to exclude every surgical candidate. Obviously, the patient has been unable to adhere to a dietary regimen up until now. Will he or she magically start being a good, compliant patient after their insides are rearranged?
Admittedly, impacted by the huge expense and trauma of surgery, many people do accept that challenge and get their heads on straight. Others, not so much. To put it bluntly, if a person was unable to cope with things like dietary restriction before surgery, how are they a good bet for coping with any of the things that come after surgery?
The mind counts for a lot
People with medical causes for obesity also develop psychiatric and psychosocial conditions secondary to that problem. So they would be very exempt. On the other hand, doesn’t it seem like a person whose obesity is caused by psychiatric and psychosocial problems, curable by therapy, would have been cured by therapy already, and not even apply for surgery in the first place? Anyone who has not been helped, so far, by psychological therapy, would seem to be a poor risk as a potential post-op rule-follower.
All this emphasizes again how much larger a role psychologists and psychiatrists should be playing in the anti-obesity field, either to help patients manage their eating disorders so they don’t need surgery, or to prepare them adequately for the very extensive changes and challenges in life after surgery. Next time, we look at a quotation from the AAP October report:
Current longitudinal studies evaluating safety and efficacy endpoints do not apply specific age limits for the timing of surgery; thus, there is no evidence to support the application of age-based eligibility limits.
Your responses and feedback are welcome!
Source: “Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity,” AAPPublications.org, December 2019
Source: “Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices,” AAPPublications.org, October 2019
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