Severe Teen Obesity: Care Delayed May Be Health Denied
For severe teen obesity there’s only one very effective treatment option – bariatric surgery. But seldom do patients get it while they are still teens. For one thing, only six children’s hospitals have fully accredited bariatric surgery programs in all of the U.S. With six million kids who have severe obesity, the number of centers is clearly inadequate.
Care Delayed May Be Health Denied
Now, new data published in the New England Journal of Medicine tells us that care delayed may be health denied. Teens having gastric bypass surgery have similar weight outcomes compared to teens with obesity who didn’t have the surgery until adulthood.
However, those delaying surgery into adulthood were less likely to enjoy remissions from diabetes and hypertension. In the teen group, 86 percent had diabetes in remission five years after surgery. For the delayed treatment group, only 53 percent did. For hypertension, the remission rates were 68 and 41 percent, respectively.
Cautions
A few notes of caution come from this study as well. Mortality within five years of surgery was no different between the two groups. However, the teens were more likely to have reoperations than the adults. And they were more likely to have low iron levels.
So wisely enough, Ted Adams advises in a companion editorial that:
Decisions should be made on a case-by-case basis, with the knowledge that the 5-year data look promising but that the lifetime outcome is unknown.
An Option Denied Systematically
Realistically, though, the healthcare system quietly denies most teens the option of even making a choice. With so few centers available to serve millions of patients, adequate care for severe teen obesity is out of reach. Payers make it worse by delaying approvals for teens, often all the way into adulthood.
As data for the benefits of treating severe childhood obesity becomes ever clearer, we hope that this deplorable situation will change. Denying adequate care for a severe chronic disease of childhood should make us all ashamed. We can do better for our children.
Click here for the study, here for the editorial, and here for more from the New York Times.
High School Graduation, photograph © CAPA photos / flickr
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May 18, 2019
May 18, 2019 at 10:20 am, Allen Browne said:
Of course the question is, “Why let them get to severe?”. And “ why let them live with the disease until adolescence?” Why not treat them earlier. For most diseases, earlier treatment is easier and more effective, and this paper and others hint at just that conclusion.
Allen
May 18, 2019 at 11:31 am, Joe Gitchell said:
Thank you, Ted–a very approachable summary of what I assume (too lazy/busy to read the full articles and commentaries) is very complicated but rigorous stuff.
In the spirit of Richard Feynman’s quip that he would rather have questions he can’t answer than answers he can’t question, I have a question (that takes a bit of a set-up, so please bear with me) prompted by this and viewed through the lens of nicotine science and policy.
On Wednesday, FDA hosted a Public Scientific Workshop on Youth Tobacco Cessation (https://www.regulations.gov/document?D=FDA-2019-N-1107-0001). This was their second public meeting on this topic, and this one was broader than the first (https://www.federalregister.gov/documents/2018/12/18/2018-27352/eliminating-youth-electronic-cigarette-and-other-tobacco-product-use-the-role-for-drug-therapies-new) by encompassing all tobacco products instead of exclusively focusing on treatments for vaping/ecigs.
I was also encouraged by FDA securing the involvement of two expert third parties to support this effort.
What I remain struck by is the willingness of many of those involved to ignore the implications of these two keystone sentences from then FDA Commissioner Scott Gottlieb’s address on 28 July 2017 when he unveiled FDA’s Comprehensive Plan for Tobacco and Nicotine Regulation (https://www.fda.gov/tobacco-products/ctp-newsroom/fdas-comprehensive-plan-tobacco-and-nicotine-regulation):
“For starters, given everything I just said about the vital role of the delivery mechanism, we must acknowledge that there’s a continuum of risk for nicotine delivery. That continuum ranges from combustible cigarettes at one end, to medicinal nicotine products at the other.”
I appreciate that there is and will continue to be uncertainty about where any individual product falls between these poles of the continuum, but given the findings of the Inge et al NEJM study and the dramatic benefits of treating obesity early, are we appropriately prioritizing risks and opportunities for our youth given finite resources?
Disclosures
My employer, PinneyAssociates, provides consulting services on tobacco harm minimization (including smokeless tobacco and vapor products) to RJ Reynolds Vapor Company and RAI Services Company, subsidiaries of Reynolds American Inc. Reynolds American Inc. was purchased by British American Tobacco in July 2017. I also own an interest in intellectual property for a novel nicotine medication that has not been developed or commercialized.
May 18, 2019 at 12:51 pm, Ted said:
Ouch. Stop hitting me with the discomfort of thought. Makes my head hurt, Joe.