Surgery May Benefit Severely Obese Teens

Weight-loss surgery such as gastric bypass may offer hope of safe weight loss for severely obese adolescents who have failed to lose weight with the help of a multi-specialty team, according to a report from an expert panel.

Weight-loss surgery such as gastric bypass may offer hope of safe weight loss for severely obese adolescents who have failed to lose weight with the help of a multi-specialty team, according to a report from an expert panel.In the journal Pediatrics, Dr. Thomas H. Inge and colleagues outline the consensus reached by participants at a meeting of surgeons and pediatricians specializing in the treatment of overweight and obese children. The paper makes recommendations for evaluating and selecting suitable patients for surgery, the type of surgical treatment, and long-term follow-up monitoring.”It is my hope that (this report) may open up opportunities for those engaged in pediatric weight management that were not previously there,” Inge, from Cincinnati Children’s Hospital Medical Center, Ohio, told Reuters Health. “By suggesting that a multidisciplinary team must be in place for surgery to be considered, this might well lead to the development of such programs.”To be considered for surgery, adolescents should be very severely obese (with a body mass index or BMI of 40 or greater), have attained a majority of skeletal maturity (13 years of age or older for girls and 15 or older for boys) and have obesity-related conditions “that might be remedied with durable weight loss,” the authors write.After candidates for weight-loss surgery undergo medical evaluations, they should be referred to centers that have “multidisciplinary weight management teams experienced in meeting the distinct physical and psychological needs of adolescents.”Prior to surgery, all candidates and their parents should have comprehensive psychological evaluations, the panel recommends, and surgery should not be considered unless the patient has failed less drastic options.In addition to describing the particulars of so-called bariatric surgery, doctors must make clear the considerable risks involved, including the risk of death. Moreover, both patients and parents should understand the lifelong need for strict adherence to guidelines for nutrition and physical activity.”Adolescent bariatric surgery should be performed only at facilities capable of treating adolescents with complications of severe obesity,” the authors advise.”I am the principal investigator of the FABS (Follow-up of Adolescent Bariatric Surgery) study,” Inge added. “This study is multi-center and seeks to determine the long-term outcomes of surgical intervention in this age group,” he explained.”In our experience of 35 cases of laparoscopic gastric bypass here in Cincinnati, we have been impressed with the correction of metabolic, medical, and psychological disturbances that these teens present with,” Inge concluded.He hopes that other centers “also take the time and necessary deliberation to establish programs that will ensure high quality care delivery to these deserving young people.”(Source: Reuters Health, Pediatrics, July 2004)