Denying Care to Teens with Severe Obesity

Two bits of recent research add to our concern about care denied to teens with severe obesity. One study compares bariatric surgery to intensive medical care. Teens with type 2 diabetes and severe obesity had much better outcomes with bariatric surgery. But another shows that very few teens (0.7%) with severe obesity actually receive the surgery.

We have to wonder. Are children and youth with severe obesity receiving adequate care for a lifetime of health?

Better Control of Diabetes

Much as we have seen in adults, bariatric surgery offers the possibility 0f better diabetes control for teens with type 2 diabetes. Thomas Inge and colleagues compared outcomes for matched groups of teens with severe obesity and type 2 diabetes from two study groups. One group – from the Teen LABS study – received bariatric surgery. The other group came from the TODAY study. They received intensive medical care for their diabetes, including intensive lifestyle coaching.

The difference in outcomes after two years is stark. After medical and lifestyle management alone, both obesity and diabetes grew worse. Both A1C and BMI increased. But after bariatric surgery, both BMI and A1C went down. Weight, diabetes control, and other complications of obesity improved.

To be clear, surgery was not a one-and-done proposition. Of the 30 teens who had surgery, seven of them (23%) had a follow-up surgery. Anyone who knows anything about bariatric surgery knows it’s not an easy solution. But for most people, it’s a gateway to much improved health and a much better life.

Evidence of Care Denied

Fatima Cody Stanford and colleagues presented the other study Monday at ENDO 2018. In that study, they found that few teens and young adults who might need bariatric surgery receive the option. They examined medical records for 2.5 million youth with severe obesity in a network of eight academic centers. Only 0.7% of those young people received bariatric surgery.

Stanford said these data should wake us up to a harsh reality:

We must ensure that children and young adults get the appropriate care for severe obesity. Early intervention reduces the likelihood of obesity complications. It can help bring a remission. Would we deny appropriate care for a patient with severe heart disease or cancer? No. So we must not deny it for severe obesity, either.

The system – really every one of us – is failing to care for children and teens with severe obesity. More than five million children and teens have severe obesity. However, fewer than 50 centers are equipped to care for them. Experts and policymakers have eloquent words of concern about childhood obesity.

But what are we doing to ensure that children and teens receive the care they need?

Click here for the study by Inge et al and here for the study from ENDO 2018. For perspective on one teen’s journey with bariatric surgery, click here.

Nathalie, photograph © Garen Dibartolomeo for ConscienHealth

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March 20, 2018