Closed Down School

Are We Content to Deny Children Care for Severe Obesity?

Would it surprise you to find that only four in a thousand children with leukemia have access to comprehensive cancer care? Of course it would. A total of 98 pediatric cancer centers show up on the U.S. News list of the best hospitals for pediatric cancer. But the story is very different for youth with obesity. Systematically and below the radar, our healthcare system works to deny children care for severe obesity.

A new study is JAMA Pediatrics tells us just how serious the problem is. Only four in ten thousand adolescents who might need bariatric surgery actually receive it.

Just Look at the Numbers

This might be shocking, but it’s not surprising if you look at the numbers.

Let’s start with where a family can turn for care. The most common childhood cancer is leukemia. In 2018, fewer than 5,000 youth will be diagnosed with it. In contrast, the prevalence of severe pediatric obesity is dramatically higher. The latest estimate is that six percent of children and youth have it. That adds up to five million young people.

And for those five million young people, fewer than 50 comprehensive childhood obesity treatment programs exist. That’s less than one for every hundred thousand youth affected.

So we are totally unsurprised by the findings of Cornelia Griggs and her colleagues. They studied two inpatient databases to estimate trends in the use of metabolic and bariatric surgery for adolescents. They found some increase in the very small numbers of surgeries. From a total of about 1,000 surgeries in 2005, the number grew to about 1,700. This growth came at a time when complication rates dropped from nine to two percent. The gastric sleeve – which tends to have fewer complications – became the most common procedure. Major studies documented important benefits of surgery in appropriate patients during this time. But Griggs et al note:

Despite these findings, less than 0.04% of children and adolescents with severe obesity are treated with MBS* each year.


The authors note that many factors contribute to the low rate of surgical treatment for severe childhood obesity. Patients, families, and primary care providers may overestimate the risks of surgery. At the same time, they tend to underestimate the long-term harms that severe obesity will cause.

But it’s hard to get past one of the biggest factors. Too few centers for providing comprehensive care. Griggs et al conclude:

In the end, a large population of pediatric patients with severe obesity are not referred to and/or do not have access to the best care for their disease, to include a discussion of MBS.

We can talk all day long with grave concern about childhood obesity. But if the children who most urgently need care cannot get it, all that talk seems like a lot of hypocrisy.

Click here for the study by Griggs et al.

Closed Down School, photograph © Astrid Westvang / flickr

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October 29, 2018

*MBS: metabolic and bariatric surgery

One Response to “Are We Content to Deny Children Care for Severe Obesity?”

  1. October 30, 2018 at 1:32 pm, Allen Browne said:

    While it is true – ” Patients, families, and primary care providers may overestimate the risks of surgery. At the same time, they tend to underestimate the long-term harms that severe obesity will cause.” And it is true we have too few resources available. I would suggest stigma and bias is the largest problem. The public doesn’t ask for a cure for the problem. The healthcare providers don’t ask for tools for the problem. And the patients don’t ask for help with this chronic, incurable disease that is destroying their lives and may destroy our economy. We need to eliminate the internalized bias present in all these groups. Then access to care and availability of effective tools will be a “no brainer”. And the health of the people with the disease of obesity will improve, the quality of their lives will improve, economic productivity will improve , and health care costs will go down.

    It sounds so simple.