Pediatric Pearls: Bariatric Surgery in Adolescents
A 14-year-old boy with obesity presents to his pediatrician's office to discuss options for weight loss. He has had class 3 obesity for the majority of his life. His comorbid obstructive sleep apnea is causing fatigue and moodiness, making it difficult to perform well in school. He asks if there are any other options for weight loss that he has not yet tried.
How would you advise your patient?
(Answer and discussion on next page)
Scott T. Vergano, MD, is a pediatrician in the Department of Pediatrics, Children’s Hospital of the King’s Daughters, Norfolk Virginia.
The Research
This recent piece from JAMA2 and the report on the National Institutes of Health-Funded Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study from Pediatrics3 discuss expanding the use of bariatric surgery to include adolescents. The JAMA article quotes experts in the fields of obesity and bariatric surgery who recommend extending the option for surgery to younger and less morbidly obese adolescents. The Teen-LABS study, including 242 adolescents from US bariatric surgery centers, found equal responses to surgical intervention in younger (aged 13-15 years) and older (aged 16-19 years) adolescents. Experts recommend that adolescents be considered for bariatric surgery, regardless of age, if they meet criteria of the American Society for Metabolic and Bariatric Surgery: class 3 obesity, defined as a body mass index (BMI) of at least 40 kg/m2 or 140% of the 95th percentile for their age and sex, or class 2 obesity, defined as a BMI of 35 to 39 kg/m2 or at least 120% to less than 140% of the 95th percentile with a comorbidity, including hypertension, type 2 diabetes, obstructive sleep apnea, severe fatty liver disease, or idiopathic intracranial hypertension.
The Takeaway
Obesity is a complex medical condition for which I have not found easy solutions. Enrollment in comprehensive educational and motivational programs can be helpful, but access is extremely limited and participation requires intensive commitment from families and significant motivation from children and adolescents. I have referred only 2 adolescents who were obese for bariatric surgery throughout my career. Given the recommendations of the experts above, perhaps it would be appropriate for me to raise the possibility of bariatric surgery with patients different from those 2 teenagers—both of whom were older and morbidly obese, and lifestyle interventions over several years had proven unsuccessful.
Bottom Line - It is clear that few adolescents are being referred at this point, as the JAMA article reports fewer than 1600 adolescent procedures are performed per year in the United States.