Making Peace with Bariatric Surgery for Teens
The medical benefits of bariatric surgery for teens with severe obesity has become increasingly clear as trials such as the Teen-LABS study are providing more data on long-term outcomes. In Lancet Diabetes & Endocrinology this month, two more studies (here and here) provide evidence for long-term benefits.
But the more difficult hurdle is subjective resistance to this life-changing surgical care for teens. A rather pure expression of this resistance comes in online commentary. Here’s an example from “Clara,” posted on a bioethics news site:
NEVER should surgery be the answer for obesity. The same child (or adult) who cannot control his eating to lose weight will not be able to control his eating to keep from further damaging his body. Put the person on a Paleo diet and see how many pounds and inches he will be able to lose in a short amount of time, and then help him stay on this kind of diet as a lifestyle.
Access to Care
With such flawed thinking in the background, health plans have an easy time stalling or denying coverage for adolescents who need this surgery. Lengthy negotiations result in years of delays, while the complications of severe obesity become more entrenched. In a glaring example, Kirk Reichard of the Nemours children’s hospital tells the New York Times that Delaware Medicaid has denied coverage for all but one adolescent who has ever needed the procedure. Thomas Inge and colleagues documented these issues with a paper they published in Obesity.
Gaining access to care is not the only difficulty.
Having faced so many difficulties with severe obesity, it’s easy to expect that surgery will solve more problems than it actually can. Tiffany Hunter, who had surgery when she was 15, explained to the New York Times:
Being overweight, you think being skinny will solve all your problems. It doesn’t. It makes new problems that you don’t know how to deal with. You think everyone will immediately like you because of how you look on the outside.
Getting through adolescence is hard. But it can seem impossibly hard with the added burden of obesity. Slowly but surely, we must come to terms with providing good, evidence-based care for children with severe obesity.
For thoughtful reporting on bariatric surgery for teens in the New York Times, click here.
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February 26, 2017