Bariatric Surgery in Youth: Start of a Great Shift

It is indeed happening. A great shift has begun in pediatric obesity care and a new study in Pediatrics measures the beginning of it with an increase in bariatric surgery for youth. Between 2010 and 2017, the rate of bariatric surgeries for pediatric patients doubled, according to this study.

But let’s be clear. This is growth on a very small base. Having access to bariatric surgery seems to require a measure of privilege. In their paper presenting these findings,
Allie Steinberger and colleagues write:

“Pediatric MBS [metabolic and bariatric surgery] is underutilized nationally with disproportionately lower rates among minority groups. Despite incremental progress, further investigation into the racial and social determinants that limit access to pediatric weight loss surgery is critical.”

White Females, Private Insurance

In this study of data from the National Inpatient Sample, researchers found that the rate of surgeries went from 2.29 to 4.62 per 100,000 adolescents in the U.S. But most of the young people with access to bariatric surgery are white females with private health insurance. This flies in the face of the fact that obesity is a chronic disease that disproportionately burdens racial and ethnic minorities and families with low socioeconomic status.

In other words, the kids who need it most have the least access to such care. This is unmistakably wrong.

The Great Shift

Nonetheless, a great deal of change is already in progress. All of the growth identified by this study occurred before 2019, when the American Academy of Pediatrics issued a policy statement that favored the use of bariatric surgery in the care for youth with severe obesity. The Academy now tells parents:

“Weight-loss surgery is one of the only evidence-based, safe, and effective ways shown to help preteens and teens struggling with severe obesity.”

This view comes because long-term studies suggest outcomes are generally good for youth who have this surgery when they need it.

On top of that, more change is coming. Better treatment options are coming. New guidelines from the American Academy of Pediatrics, due next month, will mark the beginning of a further, huge shift in the approach to pediatric obesity. Professor Aaron Kelly told people at an ObesityWeek symposium:

”What I see as being most important is a sea change in fundamentally how they’re viewing obesity. That is, that it’s a chronic, refractory, relapsing disease, and that watchful waiting is no longer appropriate.”

In short, when obesity is having a big effect on the lives and health of kids, it’s not OK to deny them effective care. That’s been happening for way too long and the sooner it stops, the better.

Click here for the new study in Pediatrics and here for further perspective on it. For more reporting on the new guidelines coming from the Academy, click here.

Frouzette and Her Father, painting by Raoul Dufy / WikiArt

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November x, 2022