Children and teenagers in need of losing extreme amounts of weight could find themselves more often being advised to consider surgery, as a new study proclaims certain operations are safe for kids as young as 10 years old and calls for greater access to the procedures.
Metabolic and bariatric surgery is safe for preteens and teens with morbid obesity, who would otherwise face potential lifelong risks of death associated with the condition, noted the research presented at the American Academy of Pediatrics (AAP) 2019 National Conference and Exhibition.
"Our study helps shed light on the safety of bariatric surgery, especially for young adolescents," said the presenting author of the study Dr. Robert Swendiman to the AAP. “As clinicians we must balance the risks of surgery versus prolonged exposure to the ill effects of obesity in children."
Bariatric surgery, or weight loss surgery, involves altering a patient’s stomach size either with a gastric band, through the removal of a portion of the stomach or by resecting and rerouting the small intestine to a small stomach pouch. Those who undergo the procedure often see significant long-term weight loss.
Authorities say it is one of the few strategies that has been shown to be effective in treating the most severe forms of the chronic disease.
“Children with severe obesity develop health problems earlier than those with lesser degrees of obesity, including diabetes, high blood pressure, fatty liver disease, and sleep apnea,” Dr. Sarah Armstrong, who led the authoring of an AAP policy statement on the topic, told AAP. “While lifestyle changes remain the mainstay of treatment, medical care is unlikely to significantly change the trajectory for most children with severe obesity.”
The researchers analyzed more than 3,700 cases involving patients ages 10-19 who underwent weight loss surgery and found less than 2% of patients experienced complications and 3.5% of patients needed to be readmitted to the hospital. No deaths were reported in the first 30 days after surgery, the study found.
"Our findings demonstrate that the perioperative risks are really quite low for sleeve gastrectomy," Swendiman said. "So, for the right patients, surgery may provide an important option for improving their health."
There are still risks associated with the major operation, including temporary excessive bleeding, bowel obstruction and hernias, according to the Mayo Clinic. And the surgery is not the end-all, be-all answer for those in need of serious weight loss.
“It is a lifestyle change,” 24-year-old Michaela Suffy, who went from 260 pounds to 150 pounds after getting a sleeve gastrectomy when she was 19, told the New York Post. “You have to maintain it forever. The weight can creep back.”
There are additional issues to consider following surgery as well.
Jewel Francis-Aburime is working to raise money on GoFundMe to undergo excess skin removal surgery after losing 250 pounds following a sleeve gastrectomy she underwent at 18.
“Your standard of what you want for yourself will keep raising,” she said. “But when you’re at 400 pounds you think, ‘I don’t care if I have loose skin, it’s still going to be better than now.’”
Insurance companies mandate possible candidates for bariatric surgery meet several benchmarks before they will sign off on the procedure. The patient must undergo an extensive psychological evaluation, have a body mass index of 40 to 50, complete an X-ray to determine bone maturity and participate in ongoing trips to the nutritionist.
Other hurdles exist as well.
According to the AAP, “patients from lower socioeconomic groups and racial and ethnic minorities suffer the highest burden of severe obesity yet are least likely to have metabolic and bariatric surgery.”
“The last decade of evidence has shown surgery is safe and effective when performed in high-quality centers, with the primary care pediatrician and family in a shared decision-making process,” Armstrong said. “Unfortunately, we see significant disparities in which patients have access to bariatric surgery. Surgery needs to be an option for all qualifying patients, regardless of race, ethnicity or income.”