Bariatric Surgery as a Last Resort for Teens and Children

SurgeryasaLastResortforTeensandChildrenThe epidemic of childhood obesity has brought an increase in obesity-related diseases including type 2 diabetes and nonalcoholic fatty liver disease (NAFLD). Of course, weight reduction through lifestyle change and diet is the best treatment for these conditions, but the long-term results are often disappointing. According to the Journal of Pediatric Gastroenterology and Nutrition, bariatric surgery — as a last resort when conservative interventions have failed — can improve liver disease and other obesity-related health problems in severely obese children and adolescents.

Although studies are limited, recent evidence suggests that in carefully selected patients an early intervention by bariatric surgery can strongly reduce the risk of adulthood obesity and obesity-related diseases, including NAFLD. Because of limited research data and the known risks of the procedure, the appropriate use of bariatric surgery in pediatric patients remains unclear.

Some believe that bariatric surgery should be limited to two groups of pediatric patients: those with body mass of 35 or higher (severe obesity), with severe NAFLD or other obesity-related medical conditions; and those with body mass index 40 or higher (morbid obesity), and mild medical conditions.

Several additional factors must be taken into account when considering bariatric surgery, including the patient’s physical and psychological maturity, desire to undergo the procedure, previous attempts at weight loss, and ability to comply with follow-up medical care. Also, which type of bariatric surgery should be performed? In adult patients, gastric bypass procedures (especially Roux-en-Y) are the most commonly used. However, concerns over the complex nutritional deficiencies occurring after these surgical procedures have limited their use in children and adolescents.

Temporary devices like the intragastric balloon are appealing for use in younger patients, as the effects are fully reversible. However, the data is limited on the use of these procedures in adolescents. The same is true for alternative procedures such as laparoscopic adjustable gastric banding and sleeve gastrectomy. All of these approaches should be considered investigational in pediatric patients.

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