AAP Guidelines — The Backlash Grows, Part 5

Yesterday we mentioned Dr. Danielle P. Burton, who has more to say about the recently revised guidelines of the American Academy of Pediatrics. The document grants only “sparse discussion” to eating disorders, and Dr. Burton continues:

[The guidelines] do not mention the medical complications of eating disorders, which are numerous and far exceed the medical complications of obesity… Eating disorders represent a lethality that far outweighs that of obesity, and at a much younger age.

Does this sound crazy? Perhaps, but she cites research showing that people with anorexia are 18 times more likely to die by suicide, and those with bulimia are seven times more likely to die by suicide than other individuals of the same age and gender.

And, she says, the guidelines “fail to mention that the risk factors for developing an eating disorder are closely related to those for developing obesity.” Which in both cases seems to advance the argument for doing something more than just treating the symptoms. Whether a patient is obese or has an eating disorder or both, it’s all part of the same problem that does not appear to be handled very effectively at present.

The knife

In the field of juvenile bariatric surgery, it seems that the potential for iatrogenic or healer-caused harm is very present. Online forums supply plenty of examples, and complete articles from experienced patients sometimes appear, like the eloquently titled “I Had Weight-Loss Surgery at 17, and It Worked — but It Didn’t Address My Real Problem,” published by Slate.com. Headlines are sometimes awkward, and it is likely that the young woman’s other problems were also real. What we seem to be talking about here are basic, first-cause situations.

The author’s story

Amy Scheiner was diagnosed as obese at age eight, and by 16 was pre-diabetic. At 17, she underwent bariatric laparoscopic banding, or lap-band surgery. It was not a magic bullet. She writes,

[B]y the time I was 23, I had begun having side effects from the surgery, such as frequent vomiting, heartburn, and inability to eat. After an upper endoscopy, I found out I had gastritis, esophagitis, and gastroesophageal reflux disease… It was then I realized that the surgery that was supposed to cure my obesity problem had done a poor job of addressing the underlying issue, which comprised a tangle of mental health and environmental challenges.

Amongst all the doctors and diet experts the author met with, none had ever asked “what was wrong in my family, in my mind, or in the culture… My weight was a symptom of the dysfunction around me.” Consequently, she started therapy, but then bounced from binge-eating disorder to hyper-vigilance, excessive exercising, extreme calorie restriction, and purging. This went on until she was dangerously dehydrated and vomiting blood, and still in semi-denial. “I knew I was sick, but at least I was thin.”

As an adult, Scheiner describes how her entire young life was defined by her physical size, leading to an unhealthy obsession with weight. Although the doctors promised her that having surgery at 17 would make her happier, it did not — but only left her with “more problems to untangle as an adult.” She goes on to say,

I worry for the children who will have permanent bariatric surgeries before they really understand their relationship with food, and self-worth.

Your responses and feedback are welcome!

Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” Psychology Today, 03/04/23
Source: “I Had Weight-Loss Surgery at 17, and It Worked—but It Didn’t Address My Real Problem,” Slate.com, 02/01/23
Image by Wonder woman073/CC BY 2.0

AAP Guidelines — The Backlash Grows, Part 4

Last time, this page explored more deeply the concept of iatrogenesis as it relates to the newest American Academy of Pediatrics guidelines. Not surprisingly, in the realm of long-lasting trauma, there is more to say. A lot of it is said by a pediatrician and psychiatrist Dr. Danielle P. Burton, who is herself in recovery from an eating disorder:

Including weight loss pharmacology and bariatric surgery in the AAP obesity guidelines is premature, irresponsible, and dangerous. The dangers of these guidelines increasing suicidality and perpetuating eating disorders are much greater than the risks associated with being overweight or obese.

Dr. Burton is not happy with the AAP’s “sparse discussion of eating disorders” and goes on to say that among teens, suicide is one of the three leading causes of death, the others being accident and homicide. She wrote:

The potential of these guidelines to increase suicide risk is multifactorial. The first is a direct cause: One study, published in January of this year, found that bariatric surgery increases the risk of suicide, especially in the youngest patients.

The second cause is indirect. By promoting fatphobia, these guidelines are likely to increase the risk of adolescents developing eating disorders.

Jessica Mui reports that the organization Medical Students for Size Inclusivity has requested that the AAP rescind the guidelines and re-examine its premises. This grassroots advocacy group of medical students is also worried about potential harm because “children will learn that their bodies are a pathology rather than a variation on the normal spectrum of body shapes and sizes.” The concern here is that kids will regard normal weight gain as a personal failure, which may irrevocably harm their sense of self-worth.

And yet, it would be enormously better to concentrate on eating disorders and do everything possible to cure them early, than to decree, “This this person is obese, let’s bring out the pills or the scalpel.”

Would it not be more beneficial to get the person un-obese in some way that doesn’t pile on additional trauma? Wouldn’t it be preferable to help him or her to unlearn the false coping skills that created obesity in the first place? And incidentally, how can we find in this person’s experience a way to help little kids not ever have to go there?

Your responses and feedback are welcome!

Source: “The Hidden Danger in the AAP’s New Obesity Guidelines,” PsychologyToday.com, 03/04/23
Source: “Size-inclusive medicine: a response to AAP’s guidelines for the treatment of children and adolescents with obesity,” KevinMD.com, 03/01/23
Image by Simone Lovati/CC BY-SA 2.0

AAP Guidelines — The Backlash Grows, Part 3

Since the beginning of the year, when the American Academy of Pediatrics issued new advice, emotions have been stirred up, and Childhood Obesity News has been looking at some of the repercussions. Many of the interested parties refer to the guidelines as “aggressive.” Some mean it as a compliment; others, not so much. Personalities who see everything as a battle say that the chronic illness of obesity must be treated like an enemy, with aggressive intervention. This can be mistaken for an attack on obese people.

The culture on the whole seems to prefer to let problems fester, and then attack them vigorously. It is surprising that we have not yet been asked to enlist in a full-scale War on Obesity. (Oops, it seems that we were, back in 2006. But that is a topic for another day.)

Conversely, many practitioners and influencers believe in loving attentiveness, followed if necessary by an intervention that is timely, gentle, and persistent.

Emotionally loaded

We have touched on the concept of insensitivity, along with the shocking lack of training that leaves some medical professionals saying too much, saying the wrong things, or not saying anything at all, when a different response would be more appropriate and useful. We have also explored what happens when the concept of iatrogenic, or healer-caused harm, enters the picture.

Virginia Sole-Smith has a new book coming out, titled Fat Talk: Parenting in the Age of Diet Culture. In a recent New York Times op-ed she wrote,

[W]e cannot solve anti-fat bias by making fat kids thin. Our current approach only teaches them that trusted adults believe the bullies are right, that a fat body is just a problem to solve.

In other words, this is supposed to be about reducing bias and stigma. Sole-Smith points out that we don’t blame kids for having asthma or other chronic conditions, and that blaming them for their weight is counterproductive, to say the least.

Practitioners and parents feel outrage, or something close to it, when contemplating the possible dangers to children, including “irreparable harm.” An uncredited author described two major criticisms of the guidelines:

1. They do not mention or caution pediatricians around eating disorders and disordered eating
2. Focusing on weight does not lead to health. It leads to shame and unhealthy behaviors

Many kids are highly likely to feel shame or self-doubt when they sense an adult is judging or criticizing their weight or food relationship, especially someone in a professional capacity. It is staggering the number of individuals I encounter who… can link the beginning of their disordered eating behaviors to a conversation with a doctor who negatively talked about their weight.

Your responses and feedback are welcome!

Source: “Why the New Obesity Guidelines for Kids Terrify Me,” NYTimes.com, 01/26/23
Source: “The AAP’s new childhood obesity guidelines are dangerous. Here’s what to do,” Inergency.com, 03/01/23
Image by Scott Maxwell/CC BY-SA 2.0

AAP Guidelines — the Backlash Grows, Part 2

This post is a continuation of yesterday’s, whose general topic is the increasing unrest over the latest guidelines published by the American Academy of Pediatrics. In particular, we are now discussing the various sorts of damage that healthcare professionals can unwittingly or carelessly bring about.

Iatrogenic harm can be produced not just by bacteria or a scalpel, but by words, and even without words. Yes, the spoken and unspoken communications of a physician, nurse, or other staff members can also cause significant damage. One website for medical professionals says,

Less well recognized are the potentially harmful influences of the knowledge, values, beliefs, and attitudes of well-intentioned health care providers and patients themselves, upon patient outcomes.

Another source quotes these thoughts from Arthur J. Barsky, M.D.:

Some of the information that physicians convey to their patients can inadvertently amplify patients’ symptoms and become a source of heightened somatic distress… One mediator of this variability between symptoms and disease is the patient’s thoughts, beliefs, and ideas… Although cognitions may not cause symptoms, they can amplify, perpetuate, and exacerbate them, making symptoms more salient, noxious, intrusive, and bothersome.

In the worst cases, this is the stuff of malpractice lawsuits. The Journal of Ethics explains a fine distinction:

Iatrogenesis refers to harm experienced by patients resulting from medical care, whereas negligence is more narrowly conceived as deviation from standard care. While all harm resulting from negligence is iatrogenic, not all iatrogenic injury is negligent.

Now, speaking of symptoms and disease, one problem pointed out by Dr. Pretlow and many others is the tendency of some clinicians to skip too speedily over the history and variety of symptoms. They head straight for the preconceived and possibly erroneous “answers,” which in perhaps too many cases tend to be either drugs or surgery. A sort of mass amnesia takes over and causes many healthcare professionals to forget that something came first, before symptoms.

In common parlance, we call that thing a cause. As Dr. Pretlow says,

Even with the new recommendations, only the symptoms are still being treated, not the underlying cause.

When a ship begins to sink, the water that sloshes around the sailors’ ankles is the indicator that something is wrong — the symptom. Naturally, some of the crew grab buckets and start bailing, and of course, others get to work on fixing the sails. But isn’t it a good idea to first locate the holes through which the water pours in, and plug them? When the underlying cause of the patient’s obesity remains unaddressed, how much good can be accomplished by a weight-loss drug regimen, or even bariatric surgery?

Sadly, failure to ponder the symptoms, along with the proclivity to leap to a demanding and costly solution, could in some cases be fairly characterized as iatrogenic harm. And nobody wants that.

Your responses and feedback are welcome!

Source: “Iatrogenesis,” HIGN.org, undated
Source: “The Iatrogenic Potential of the Physician’s Words,” JAMANetwork.com, 12/26/17
Source: “When Is Iatrogenic Harm Negligent?,” AMA-assn.org, August 2022
Image by driver Photographer/CC BY-SA 2.0

AAP Guidelines — the Backlash Grows, Part 1

Rather than settling down, it appears that resistance against the guidelines recently issued by the American Academy of Pediatrics grows more vehement as time passes.

Of course, some individuals and groups had plenty to say before January even ended. The Academy for Eating Disorders (AED) warmed up by calling the document a “major shift in perspective,” although diligent readers of past AAP publications believe it was easy to see this coming. Their statement ended by asking the AAP to revise this last edition of the clinical practice guidelines for obesity, and to include input from “key stakeholders” such as eating disorder professionals and actual patients who have lived through these problems and processes.

The AED has three main objections, and one of them is that the Guideline does not have much to say about screening or treatment referral for people afflicted by eating disorders. There is “no clear course of action for healthcare providers to take if an eating disorder is suspected or identified.” This is especially important because it is exactly the type of problem that needs to spotted and derailed early on.

Sensitivity

Another concern is that it does no good to recommend that clinicians approach the topic of weight in a sensitive manner, when they are offered no training on how to do that. Furthermore, there is a lack of long-term data on pharmacological and surgical interventions among the pediatric population. Rather than concentrating on individual-level changes like drugs and surgery, the group would much prefer to see more emphasis on structural reconstruction, like changes in food policy, the reduction of food insecurity in the population, and the reduction of stigmatizing attitudes in people’s minds.

Also criticized the lack of information on how “eating disorders can and do emerge after weight-loss surgery.” Another objection is, to put it delicately, “we wonder about the independence of the AAP recommendations given the financial reliance on pharmaceutical companies that is often required to investigate medication efficacy.”

The AED quotes the Hippocratic Oath, especially the part about “First, do no harm.” And mention of the oath leads into another ancient concept, iatrogenesis, derived from the Greek words for healer and causation. The AED feels that all the explicit focus on weight loss, in the ideas and practices being advocated, carries the potential for iatrogenic effects on some patients.

In the medical universe, that is a very scary word, partly because it has shades of meaning. In the most benign sense, it refers to problems that are not considered to be in the natural course of an injury or illness; harm that results from diagnostic procedures or medical treatment but without any intention. Charging a doctor with causing an infection would be a whole different level of an accusation than charging a hospital ward with causing one.

(To be continued…)

Your responses and feedback are welcome!

Source: “The Academy for Eating Disorders Releases a Statement,” Newswise.com, 01/26/23
Image by Johan Lange/CC BY 2.0

What They Say About Bariatric Surgery for Kids — Part 2

A lot of news stories elicit massive commentary when first published, but only some of them sustain interest for very long. In the past weeks, Childhood Obesity News has explored many angles of the American Academy of Pediatrics opus, “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity.”

We looked at a piece called “Children with obesity should get proactive treatment, including medication, surgery: new guidelines.” The word choice in that headline is indicative of how the reactions fall into categories. Some ask for treatments that are not just proactive, but aggressive. Others go further and insist on treatments that work. This might lead to a discussion based on the question, “Define work?”

If a weight-loss method involves expensive and potentially harmful endless dependency on pharmaceuticals, can it fairly be said to work? Can an intervention be honestly defined as effective, if it involves the removal of a major organ? Does it really work if it requires a lifetime of walking a nutritional tightrope? Can a person take in enough essential vitamins to compensate for the missing body parts, and at the same time not eat enough food to stretch the remaining stomach and invalidate the surgery?

Putting the cart before the horse

That good old saying is about doing things backward. Let’s be real. Tennis elbow could be eliminated by amputating the entire arm. Certain behaviors can be stopped by slicing out part of a person’s brain. Weight can be lost by taking a drug that may considerably increase the underpants laundry bill.

But just because a thing can be done, does not mean it should be done. And, important as these questions are, there is something even more basic going on. As Dr. Pretlow expresses it,

Even with the new recommendations, only the symptoms are still being treated, not the underlying cause.

Exactly. This fairly obvious fact has been noticed by laypersons and healthcare professionals alike, both immediately and in the ongoing second wave of responses. If more attention were paid to the underlying causes, we would not have to worry about the potential for various ugly complications like the ones listed by Christine Byrne in her article for Self.com, including…

[…] gastroesophageal reflux disease, chronic nausea and vomiting, the inability to eat certain foods, weight gain or failure to lose weight, low blood sugar, malnutrition, ulcers, bowel obstruction, and hernias.

And when certain statistics are aired, concern rises:

The guidelines also state that between 13 and 25% of those who get bariatric surgery will need a follow-up procedure within five years.

Your responses and feedback are welcome!

Source: “Children with obesity should get proactive treatment, including medication, surgery: new guidelines,” 6abc.com, 01/10/23
Source: “The New Obesity Guidelines for Kids Are Appalling,” Self.com, 02/02/23
Image by Stephen Edmonds/CC BY-SA 2.0

What They Say About Bariatric Surgery for Kids — Part 1

Recently, we followed early reactions to January’s American Academy of Pediatrics guidelines, then offered a retrospective look at what had been said here about the topic, previous to those new guidelines, with a comprehensive catalog of various aspects and angles (the pages known as Bariatric Surgery Roundups, #1 through #6). This has obviously been a hot topic for a long time.

Here is a look at some additional pieces that have appeared in the press in the recent past. The older gastric band method, in vogue until around 2008, was less invasive and less permanent than some other styles of weight-loss surgery, but had high complication and failure rates. As patient Amy Scheiner described,

A reversible, inflatable device was placed around the top portion of my stomach, creating a smaller “pouch” and limiting the amount of food I could consume.

By way of contrast, the current favored option, the gastric sleeve or sleeve gastrectomy, is done laparoscopically, with generally five small incisions. About 80% of the stomach is removed. The hospital stay is short (a day or two), and the overall recovery time is not long.

On the other hand, the lasting metabolic changes might not all be positive. The big problem is, it’s not like having a broken arm casted until it mends, and then the child goes on their merry way, good as new. The surgical option requires genuine long-term (as in, life-long) commitment and inflexible adherence to strict nutritional requirements. As Gina Kolata noted in The New York Times,

You have it the rest of your life. You cannot reverse it. You can’t say, I want my old intestines back. It’s gone.

Specialist Monika Ostroff is the executive director of the Multi-Service Eating Disorders Association. She has worked with many patients who developed eating disorders after bariatric surgery, some of whom were operated on as teenagers. Ostroff says that the surgery completely changes the way in which a person can nourish their physical body, from food amounts and types to their method of chewing. If patients are not adequately prepared for these radical changes, disaster can ensue.

The “forever” aspect is a very big deal to some people. Dr. Katy Miller (a hospital medical director in charge of adolescent medicine) was quoted:

[I]t is a very serious surgery that carries profound impacts for the rest of a patient’s life.

Your responses and feedback are welcome!

Source: “I Had Weight-Loss Surgery at 17, and It Worked — but It Didn’t Address My Real Problem,” Slate.com, 02/01/23
Source: “An Aggressive New Approach to Childhood Obesity,” NYTimes.com, 01/26/23
Source: “New childhood obesity guidance raises worries over the risk of eating disorders,” NPR.org, 02/15/23
Source: “New Guidelines Underscore How Complicated Childhood Obesity Is for Patients and Providers,” NYTimes.com, 01/20/23
Image by faungg’s photos/CC BY-ND 2.0

Guidelines Backlash, the Biggies — Surgery, Part 3

Today’s post serves a dual purpose, being also the Sixth Bariatric Surgery Roundup. Obviously, it’s not as if weight-loss surgery for kids had never been discussed prior to the publication of new guidelines from the American Academy of Pediatrics at the beginning of this year.

“Conscience and Consent”
In an era when court cases about sexual reassignment surgery are being argued, bariatric surgery might seem rather tame. Still, both kinds change the body irreversibly and bring lifelong consequences.

“Does It Have to Be Surgery?”
Despite what may seem like a too-hearty endorsement of bariatric surgery, the AAP has always held that it would be preferable for childhood obesity to be corrected in some other way. The organization would like to emphasize this point: Surgery or no surgery, the obese patient who is serious about change will, either way, have to adhere to a limited diet forever.

“Bariatric Surgery and Race”
Even though minority children and teens are statistically more likely to be overweight or obese, the majority of weight-loss surgeries are performed on white patients. It seems that figuring out the reasons for this disparity might be rather important.

“Evaluation for Metabolic and Bariatric Surgery”
This post explains the green light, yellow light, and red light system of evaluating a surgical candidate.

“Bariatric Surgery’s Progress”
A major drawback is the lack of long-term followup studies. In the short term, the failure rate seems to hover around 20%. Children and teens do not even have fully-formed personalities in the first place, and they tend to emerge from major surgery with the same emotional problems that led to obesity in the first place.

“Bariatric Surgery in a Less than Ideal World”
A discussion of the studies that have been completed about the medical and psychosocial effects on people who had undergone bariatric surgery as children and teens. The definition of “complications” includes the need for subsequent surgeries of the same kind. Sometimes, the problem is traceable to insufficient nutrition, particularly a shortage of calcium, iron, and various vitamins. Additionally, at the two-year mark after the completion of such surgeries, it was found that almost one in five of the young patients showed signs of clinical depression. Obviously, both nutritionists and psychologists are very important members of the clinical team.

“Can Best Be Improved On?”
In the great majority of cases, Type 2 diabetes ceases to be a problem after bariatric surgery. The opportunity to end all that misery should thrill the fiscal conservative, because if uncorrected, all those co-morbidities will cost even more than the operations.

“The Aspirations of Bariatric Surgery”
Another post includes more about the multidisciplinary team concept, and includes words from Dr. Pretlow:

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.

“Contemplating Bariatric Surgery”
This one is basically a review of a horrifying and hilarious article whose author suggests that “death on the operating table can start to sound like the best-case scenario.”

Your responses and feedback are welcome!

Image by Yeison Varón Velásquez

Guidelines Backlash, the Biggies — Surgery, Part 2

For all practical purposes, today’s post is also known as the Fifth Bariatric Surgery Roundup. In other words, Childhood Obesity News has looked into this subject diligently, because it is so impactful. Those who are in favor of recommending bariatric surgery at a younger age say that the longer obesity is allowed to flourish in a child, the more difficult it will be to reverse that trend and get back to a healthy weight — and that is a valid point.

Another, and even more valid point, is that non-surgical methods should be tried earlier and more earnestly. The American Academy of Pediatrics is doing the best it knows how with new recommendations for more weight-loss drugs and earlier surgery. Meanwhile, Dr. Pretlow is working toward a world where both pharmaceuticals and bariatric surgery become exceedingly rare.

“Bariatric Surgery and Very Young Children”
Obesity was officially defined as a disease only about 10 years ago. To leap so quickly from that, to blithely recommending life-altering surgery for kids, seems rather precipitous. Let’s quote Dr. Pretlow on this one:

If non-surgical methods were effective, then bariatric surgery would be unwarranted. Therefore, we need to figure out exactly why non-surgical methods are ineffective, and create non-surgical methods that ARE effective, like addiction-based and displacement-based methods.

“Bariatric Surgery for Children”
Back in 2019 when this post was published, many professionals believed that “marketing weight loss surgery to children is wrong because it is invasive and dangerous, and can irreversibly transform the metabolic system.” And many still agree. For instance, Dr. David L. Katz opined,

Epidemic childhood obesity is a cultural crisis. Turning to the literal cutting edge of biomedical advance to address it is not a solution, but an abdication.

“Bariatric Surgery for Children — A Desperate Case”
This post relates a disturbing story of a sleeve gastrectomy performed on a child less than a year old, and what made it particularly horrific is that it did not work, possibly because her parents continued to supply “chips, biscuits, chocolates, and ice cream.” The youngster’s stomach expanded, leading to a second sleeve gastrectomy when she was seven.

“Weight-Loss Surgery and Non-Adults”
Some of the difficulty with assessing the usefulness of these procedures for children lies in the disparity between different methods of defining success — for instance, measuring loss in terms of excess body weight, versus loss relative to baseline weight. Despite the uproar over the AAP’s recent endorsement of surgery for kids, it has already been employed in extreme cases for very young children for years, even in the USA.

“Who Is Ready for Bariatric Surgery?”
In this post, we noted how enthusiastically Saudi Arabia has embraced surgical solutions for obesity, and how the government willingly pays for it under the citizens’ standard insurance policy.

“Why Operating on Children and Teens Is Okay”
This post reviewed some of the history of the trend toward acceptance of bariatric surgery for children and young people. Even before the recent headline-grabbing new AAP guidelines, that organization had stated that there is “no evidence to support the application of age-based eligibility limits.”

Your responses and feedback are welcome!

Image by Nutritional Doublethink/CC BY-SA 2.0

Guidelines Backlash, the Biggies — Surgery, Part 1

As we have seen, plenty of experts have a lot to say about the concept that kids as young as 12 (and in extreme cases, even younger) should be prescribed weight-loss drugs. It turns out to be a pretty controversial topic. But that debate almost fades into the background when compared to the real shocker. For patients as young as 13, bariatric surgery also is now on the table.

Before approaching this subject in light of the new American Academy of Pediatrics guidelines, let’s look back on some previous Childhood Obesity News discussions. So far, there have been three related “roundups.” The first was titled “Many Aspects of Bariatric Surgery for Teens.” The second was “Another Teen Surgery Compendium,” and the most recent was “The Third Bariatric Surgery Roundup.” A multitude of angles have already been covered but there is, astonishingly, still much more to consider. So today’s post wears two hats. It is also, officially, the Fourth Bariatric Surgery Roundup. Here goes:

“Bariatric Surgery, Qualifications, and Conscience”
“MBS” stands for metabolic and bariatric surgery, and for an adult, five major decision criteria must be taken into consideration. When the candidate is a minor child, issues become much more complicated.

“Bariatric Surgery and Consent”
Even a highly motivated mature adult, who is willing to practice total compliance, can find some aspects of post-operative care barely manageable. What happens when the patient is not even old enough to drive or vote?

“Bariatric Surgery and the Mind”
Adherence to post-op dietary and medication regimens is vital to success. What happens when the patient is cognitively impaired, psychiatrically unstable, or developmentally disabled? What happens when that already troubled patient is a minor child?

“More on Bariatric Surgery and the Mind”
When the patient is young and the procedure involves far-reaching lifestyle changes, forever can be a long, long time. What happens if a complication like substance abuse later enters the picture?

“Still More on the Mind and Bariatric Surgery”
One expert says, “Co-morbid psychosocial and emotional problems of obesity generally act as causal or maintaining factors of obesity and thus significantly affect the treatment outcome.” Weight-loss surgery alone does not straighten out any mental or emotional kinks the patient may have possessed in their pre-surgical life.

“Body, Mind, and Bariatric Surgery”
Just a couple of years before the controversial decision to endorse surgery for young obese patients, the American Academy of Pediatrics issued a couple of significant reports on the subject.

“The Evolution of Thought about Pediatric Bariatric Surgery”
Bariatric surgery is not only about reducing appetite. It is an investment in the future. Some experts feel that the only real justification for inflicting this kind of surgery on a child is that it will prevent a severity of obesity that ushers in one or more complications, known as co-morbidities.

Your responses and feedback are welcome!

Image by Nutritional Doublethink/CC BY-SA 2.0