The Woman and the Child

Bariatric Surgery in Children as Well as Teens

As severe obesity has grown to take a toll on a growing number of children and teens, clinical care is evolving. In 2019, the American Academy of Pediatrics said it plainly. Youth with severe obesity need better access to bariatric surgery. The authors of that position statement conceded that most of the young patients for these procedures are teens, not children. But now, in the Journal of the American College of Surgeons, we have data to demonstrate that a gastric sleeve procedure can be safe and effective for children as well as teens.

This ten-year study is the largest and longest of its kind in this population.

Substantial Benefit

This was a prospective cohort study, of course, because randomly assigning children to receive surgery is hard to do. Gastric sleeve surgery is not a decision that many parents will leave up to a coin toss. Aayed Alqahtani and his colleagues studied 2,054 children and teens for ten years after having gastric sleeve surgery.

This research found substantial benefits. To begin with, these children maintained impressive improvements in their weight status – an average of 71% excess weight reduction after ten years. Furthermore, complete resolution of type 2 diabetes came in 74 percent of the patients with this condition. High blood pressure and unhealthy lipid levels resolved in 64 and 59 percent of those patients, respectively.

No Effect on Growth

Of course, surgery of any kind carries risks. But in this cohort, only one percent of patients experienced an adverse event. There was no mortality associated with the surgery.

Perhaps, though, the most important safety finding in this study relates to growth trajectories for these youth. Concerns about doing bariatric surgery in children have revolved around concerns about having an effect on normal growth. But in this cohort, the researchers found no evidence to support that concern. Growth in height for these children was unaffected, based on assessment of z-scores for height.

Important Decisions

This is indeed an important study that gives pediatricians and families important information. But it certainly doesn’t mean that decisions about bariatric surgery for children with severe obesity will suddenly be easy. In the AAP policy statement, Sarah Armstrong and colleagues describe the process for making decisions quite well:

“Eligibility for metabolic and bariatric surgery should be determined through a thoughtful process that considers the values of the patient and family and preference for the type of bariatric surgical procedure. These decisions may only occur after a thorough review of the effect of obesity on the adolescent’s physical and emotional health and an understanding of the risks, benefits, and long-term implications of each procedure type.”

These are important decisions that will have profound effects on a child’s prospects for a healthy life. So the good news here is that we now have much better information to support these decisions.

Click here for the study in JACS. For further reporting, click here and here. For added perspective from the AAP technical report on this subject, click here.

The Woman and the Child, painting by Fernand Leger / WikiArt

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September 29, 2021

One Response to “Bariatric Surgery in Children as Well as Teens”

  1. September 29, 2021 at 8:25 am, Allen Browne said:

    And now we have effective,safe, pharmacotherapy with the GLP-1 analogs and combinations. We have tools of weight management for the first time in history. Now we need to figure out how to make them accessible to the children and their families. Delaying treatment for this serious disease is immoral, unethical, uneconomical, and just plain wrong.