Bariatric Surgery in Children and Adolescents- How Safe is it?
A tenfold rise in the number of children and adolescents with morbid obesity from 1975 to 2018 has become a global alarm!
Childhood Obesity is becoming an increasing owing to the widespread presence of the obesity-associated co-morbidities that includes diabetes, metabolic syndrome, psycho-social impairments, and sleep apnea in juveniles. Currently, childhood obesity is rapidly becoming a major threat to the health of younger generations.
What do the statistics have to say?
One of the studies published in The Lancet revealed that the number of obese children/adolescents hiked from 11 million in 1975 to 124 million in 2016 – that’s a whopping tenfold boom. The study had analyzed the height and weight of nearly 130 million in 2016 of which 31.5 million were children aging 5-19 years of age.
Moreover, the study witnessed 216 million children being overweight. The rates of childhood obesity are plateauing at very high levels in high-income countries.
According to WHO, the areas of the world consisting of the largest number of obese children and adolescents were North Africa, the Middle East, and East Asia.
Especially in Asia, the number of childhood obesity rates has accelerated recently. Among the high-income countries, the USA had the highest obesity rates for children.
In 2016, the UK had the 73rd highest obesity rate in case of girls and 84th highest obesity rate in case of boys. The USA had the 15th highest obesity rate in the case of girls and 12th highest obesity rate in the case of boys. Currently, in developing countries, there is a 60% increase in the prevalence of childhood obesity. Therefore, childhood obesity is a truly global phenomenon of growing concern.
Prevalence of Childhood & Adolescence Obesity
The overall prevalence of childhood obesity has plateaued by more than 50% over the last decade, without any trace of sustainable decline. Nowadays, the choices, physical activity, and diet habits are largely influenced by their surroundings. Today, children are growing up in environments that change rapidly due to economic and social developments. Due to all these factors, the diet and activity patterns are hampered drastically and more children are opting for unhealthy processed foods, drinks and sedentary lifestyles.
Moreover, children get vulnerable to current marketing advertisements for processed foods and drinks. The marketing strategies that attract children have greatly contributed to increase the obesity rates in children and adolescents. Also, these unhealthy foods are available worldwide and at low-price which serves as another factor in contributing to childhood obesity rates. Unfortunately, in some cases, lifestyle interventions have shown limited success in the treatment of severe childhood obesity.
Rationale and Eligibility for Bariatric Surgery
Increased mortality for untreated childhood obesity patients, failure of lifestyle management and successful results of adolescent surgery are some of the important factors that support the rationale for bariatric surgery.
Childhood\Adolescent Bariatric Surgery has become a proven and successful therapeutic option for the treatment of obesity in childhood. Though it should only be considered when all the lifestyle modifications fail.
Experts say that considering bariatric surgery in early life will certainly decrease the surgical risks, mortality, and morbidity. Additionally, early surgical intervention will certainly alter the natural course of the obesity-associated co-morbidities that pose a risk of long-term complications.
The eligibility criteria for Bariatric Surgery:
· Must be severely obese with BMI ≥ 35/40 with obesity-related co-morbidities.
· Have failed at least 6 months of conventional attempts at weight management.
· Has demonstrated commitment to pediatric psychological evaluation.
· Be willing to and capable of adhering to nutritional guidelines post-surgery.
How safe is Bariatric Surgery in Childhood\Adolescence?
Adolescent severe obesity has many associated co-morbidities that can have long-term effects in adulthood. Bariatric surgery is the most effective treatment which not only results in major weight loss but also resolves the associated co-morbidities (Desai et al., 2016).
The American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee guidelines revealed that there is a wide range of evidence which has supported the successful use of bariatric procedures in severely obese children\adolescents. (Michalsky et al., 2012)
Have a look at a few of the following global studies that support the safety of Bariatric Surgery in Children\Adolescents.
· A retrospective study was conducted on 38 adolescents who underwent Laparoscopic Sleeve Gastrectomy (LSG).
The authors concluded that LSG is a safe and effective treatment in adolescents with morbid obesity. The procedure significantly decreased the excess of body weight and also resolved the co-morbid conditions. (Jaramillo et al., 2017) ·
A study collected data that evaluated the long term results in patients <18 years after laparoscopic Roux-en-Y gastric bypass (LRYGB). The authors concluded that LRYGB provided safe and good weight loss results along with curing the co-morbidities. (Vilallonga et al., 2016) ·
The Teen-Longitudinal Assessment of Bariatric Surgery (LABS) Study enrolled 242 adolescents (≤19 years of age) who underwent bariatric surgery from March 2007 through February 2012.
The authors concluded that weight loss surgery in adolescents showed significant improvement in the mobility and reduction in musculoskeletal pain for up to 2 years after surgery.
A systematic review evaluated the effects of bariatric surgery on lipid and glycemic metabolism, quality of life and surgical complications in obese adolescents. The authors concluded that weight loss surgery achieves significant weight loss along with lipid and glycemic control.
The procedure that produced better improvements was Roux-en-Y Gastric Bypass in comparison to other procedures. More studies have shown that bariatric surgery is associated with remission of abnormal kidney function, type 2 diabetes, and other obesity-related complications. Moreover, post-surgical nutritional deficiencies can also be corrected with dietary supplements.
Sleeve Gastrectomy is a trending procedure choice for children\adolescents based on efficacy and safety data. Though, Roux-en-Y Gastric Bypass and Sleeve Gastrectomy are performed routinely in adolescent weight loss programs. The researchers recommend doctors\surgeons to follow the guidelines of the Endocrine Society when considering bariatric surgery for children\adolescents.
The Last Word Currently, multiple studies have proved that the results of bariatric surgery in childhood\adolescence are safe, effective, and reproducible with the resolution of co-morbidities.
Additionally, there is an improvement in overall health and psycho-social well-being. Bariatric surgery in children\adolescents should only be provided by a multi-disciplinary specialist team dedicated to the comprehensive care of patients to ensure the delivery of excellent and safe clinical care.
One of the most popular destinations for bariatric surgery in the world is India. Not only the cost of bariatric surgery in India is much affordable, the surgeons in India are highly qualified and skilled and are trained at best medical schools in the world.
Bariatric surgery hospitals in India are well equipped and have state of the art infrastructure and facilities to provide the best medical care to children of all ages.