Walking a Labyrinth

Bariatric Surgery for Youth: Progress and Fear

The American Academy of Pediatrics is out with new guidance that says something a very few teens and their families already know. Surgery can be a safe and effective option for a young person with severe obesity. But health systems, ignorance, and bias make it hard for youth with obesity to get the care they need. Progress and fear of that progress seem to come together like a two-for-one special.

A Straightforward Position

This was not a close call. The evidence for the benefits of surgery in teens has been building for years. In fact, recent research has shown that care delayed becomes health denied. Teens with severe obesity who don’t get surgery until they’re adults get fewer benefits and suffer worse health. Remissions of diabetes are less likely. High blood pressure is more likely to persist.

For childhood leukemia, we don’t dither. But for whatever reason, health systems can get by with hemming and hawing when a youth needs treatment for severe obesity.

Preferring Inaction Over Providing Care

“I don’t think it’s the right solution,” says a fat acceptance advocate. In that construct, stigma is the only harm that comes from obesity. If only that were true.

Other resistance comes from the shame and blame crowd. “How about getting kids outside to play and run around,” says a typical twit on Twitter. He’s tall and hasn’t experienced obesity. So an advocate patiently explains: “I played outside, rode my bike, delivered papers, walked to school. But I still weighed 400 pounds by the time I graduated from high school.” Simple solutions for complex problems don’t work. Writing in Forbes, Bruce Lee sums it up quite well:

Is our healthcare system then doing “whatever it takes” to address childhood obesity, which certainly qualifies as a major crisis, a major, major epidemic? Not even close.

Clucks and tsk tsk. That’s the sound of ignorance and bias on this subject. And it’s frustrating, to say the least. For whatever reason, progress and fear come together. Take two steps forward and someone will tell you to step back. It’s human and it’s usually a mistake.

So we salute the American Academy of Pediatrics for standing in favor of better care for kids with severe obesity. It’s about time.

Click here for this new position from AAP. Here, here, and here you can find further coverage.

Walking a Labyrinth, photograph © María Helena Carey / flickr

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October 28, 2019

One Response to “Bariatric Surgery for Youth: Progress and Fear”

  1. October 28, 2019 at 11:24 am, Allen Browne said:

    Whooppeee!!! A giant step forward to help the children with obesity. It’s been a long, slow process, but we are making progress.

    However, much work remains to do:
    What about those with less than “severe obesity”?
    What about the younger children?
    What about weight loss medications?
    What about weight loss devices?
    What about education about the disease of obesity for the patients and their families, the public, the providers, the healthcare system, the policy makers and the payers?

    And what about prevention? Just now treatment is more evidence based and successful than prevention.