Why Operating on Children and Teens Is Okay

In the previous post, Childhood Obesity News looked at a quotation from the American Academy of Pediatrics (AAP) that some people find a bit scary. In discussing children’s eligibility for bariatric surgery, the report said,

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.

AAP also published a separate article to emphasize this point, titled “American Academy of Pediatrics Recommends Greater Access to Surgical Treatments for Severe Obesity.” Sarah Armstrong, M.D., FAAP, and lead author of the policy statement, says,

[M]edical care is unlikely to significantly change the trajectory for most children with severe obesity.

Bariatric surgery is characterized as “one of the few strategies that has been shown to be effective in treating the most severe forms of the chronic disease” and also as “widely underutilized.” The explanation follows:

In children and adolescents with less severe forms of obesity, lifestyle modifications have shown moderate success. But these strategies have not worked as well for young people with severe obesity, which is defined as having a body mass index (BMI) of at least 120% of the 95th percentile for age and sex, which roughly equals 35kg/m2 or greater.

Since we live together in a society, attention is also paid to the current situation, where variables like race, ethnicity, and income tend to influence both a child’s need for intervention and the likelihood that she or he will receive that intervention. If the patient is qualified according to the defined parameters (like BMI specifications), society is obliged to figure out how to deliver help.

One way to fulfill this obligation, according the AAP policy, is to set aside the notion of an “arbitrary” age limit, as long as other criteria are met. HealthyChildren.org concurs, with this caveat:

There are specific nutrition and activity recommendations that must be followed after surgery; many programs and insurance companies actually require patients to learn about these things before even being considered for the surgery. It’s a big responsibility.

It’s also a big “if.” The uncredited writer concedes that uncertainty is unavoidable at any age, and that even patients from the same family are apt to differ in their responses to that responsibility. One of those differences, as we have seen, is in a realm of compliance.

The writer also cites research suggesting that adolescence is a good time for bariatric surgery, and that teens fare much better that adults. One study found that surgery can, in most cases, normalize the young patient’s blood pressure and make Type 2 diabetes almost disappear. Another documented that teens could lose as much as 30% of their original body weight, and keep their weight down as long as eight years afterward. Other benefits are less depression and an increased sense of well-being.

Your responses and feedback are welcome!

Source: “Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices,” AAPPublications.org, December 2019
Source: “American Academy of Pediatrics Recommends Greater Access to Surgical Treatments for Severe Obesity,” AAP.org, 10/27/2019
Source: “Is Weight-Loss Surgery an Option for Preteens & Teens?,” HealthyChildren.org, 10/27/19
Image by Bryce Johnson/Flickr