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Pediatricians Recommend Greater Access to Surgery for Obese Children

Recognizing that severe obesity is a serious and worsening public health crisis in children and adolescents, the American Academy of Pediatrics (AAP) is calling for greater access to metabolic and bariatric surgery, one of the few strategies that has been shown to be effective in treating the most severe forms of the chronic disease.

In a new policy statement, “Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices,” the AAP describes severe obesity among children and adolescents as an “epidemic within an epidemic,” one that portends a dramatically shortened life expectancy for today’s generation compared to their parents.

Few strategies have proven effective in helping people who have the most severe forms of obesity to lose weight. 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 percent of the 95th percentile for age and sex.

Recent evidence shows that surgical treatment is safe and effective, but it is widely underutilized.

“Children with severe obesity develop health problems earlier than those with lesser degrees of obesity, including diabetes, high blood pressure, fatty liver disease, and sleep apnea,” said pediatrician Sarah Armstrong, MD, FAAP, lead author of the policy statement and a member of the Executive Committee of the AAP Section on Obesity. “While lifestyle changes remain the mainstay of treatment, medical care is unlikely to significantly change the trajectory for most children with severe obesity.”

Studies of adolescents and young people who have undergone bariatric surgery have found significant long-term reductions in weight and comorbid chronic diseases. In one study that followed adolescents up to 12 years post-surgery, it found an average 29 percent reduction in BMI for patients undergoing one type of surgery, and significant reductions in diabetes and high blood pressure. By contract, adolescents enrolled in a lifestyle modification program saw their BMIs increase.

“The last decade of evidence has shown surgery is safe and effective when performed in high-quality centers, with the primary care pediatrician and family in a shared decision-making process,” said Dr. Armstrong. “Surgery needs to be an option for all qualifying patients, regardless of race, ethnicity or income.”

The AAP recommends pediatricians refer patients to high-quality multidisciplinary centers that have extensive pediatric surgical experience and where pediatric specialists can evaluate and care for patients before and after surgery. Insurance should cover the procedure and follow-up care, according to the AAP. The AAP also recommends avoiding setting arbitrary age limits; rather the procedure should be considered for any patient with severe obesity who meets the criteria for surgery.

“The decision to have metabolic and bariatric surgery should be based on the health and needs of the individual patient,” said pediatric surgeon Marc Michalsky, MD, FACS, FAAP, FASMBS, one of the authors of the policy statement. “This should be a thoughtful, collaborative decision made between the patient, their parents and their medical and surgical team, based on their body mass index, other health conditions and quality of life.” 

Information for parents on bariatric surgery is available at HealthyChildren.org.

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Source: American Academy of Pediatrics

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