Rejecting Delayed Care for Teens with Severe Obesity

Children at the WindowIt has long been true that health systems delay care for teens with severe obesity. Health plans stall and do their best to avoid paying. Many pediatricians are uncomfortable with the subject. Parents are unsure of what to do and often feel blame for their child’s medical condition. Guilt and blame breed denial and delay.

So most often, years pass, the condition progresses, and suffering becomes great before these young people get a referral to effective care.

Signs of Change

Mary Chris Jaklevic writes in JAMA describing movement toward earlier referral to bariatric surgery for adolescents who need it. She points to a 2019 policy statement from the American Academy of Pediatrics (AAP). It describes surgery as a safe and effective option. It also recommends against arbitrarily restricting access to surgery based solely on age.

Janey Pratt chairs the ASMBS pediatrics committee and sums up the emerging view:

“What we should be considering is, does the child have obesity? Is the obesity adversely affecting their quality of life, their health? If so, let’s treat it.”

Sarah Armstrong, lead author on the AAP policy, noted that questions about consent for surgery have been a hurdle in the past. But she described this as an implicit expression of bias:

“Obesity is a medical condition, so we should apply the same ethical considerations to patient autonomy, assent, and informed shared decision-making as we do to other conditions.”

The Lived Experience

At Massachusetts General hospital, says Fatima Cody Stanford, the teens coming for surgery tend to get their referrals only after their condition has grown extremely severe. The average adolescent has a BMI of 55, which is ten points higher than adults getting surgery there. Thus, many of them have developed complications like type 2 diabetes and sleep apnea. Health systems give these teens a harder time, says Stanford.

A new paper by Veronica Johnson et al explores the narratives of young people who have had bariatric surgery. These personal stories bring a deeper meaning to the cold, hard data about the risks and benefits of bariatric surgery for teens. One of these young people writes:

“I had surgery in March of my sophomore year in high school and 6 months later, I was 100 pounds lighter. My weight loss led to subtle, profound differences in my interactions and relationships with my friends, peers, and faculty. After surgery, I was able to focus on socializing with my friends without the weight of my obesity interfering. Gradually, I accrued confidence and increased self-esteem.”

Health systems have long avoided properly dealing with the health effects of severe obesity in young people. Too often all these these children and their parents receive is blame and shame.

It is time to step up and deal with obesity as the medical condition it is. These young people have promising lives ahead of them. Offering them control over obesity removes an impediment.

Click here for the article in JAMA and here for the paper by Johnson et al.

Children at the Window, painting by Ferdinand Georg Waldmüller / WikiArt

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May 31, 2021