Bariatric Surgery in Children
Kandace Kichler
HISTORICAL BACKGROUND
In 2013, the American Medical Association officially recognized obesity as a disease.
Bariatric surgery is widely accepted as safe and effective in adults suffering from morbid obesity, and reduction in comorbidities has been established with operative intervention.1
However, the transfer of this treatment option to the pediatric or adolescent population is limited and controversial.
DEFINITIONS
The American Academy of Pediatrics (AAP) considers any child between the 85th and 95th percentile of BMI (body mass index) as “overweight.” Above the 95th percentile of BMI is considered “obese”2 (Figure 18.1).
The International Pediatric Endosurgery Group considers bariatric surgery for adolescents with BMI greater than or equal to 40, or greater than or equal to 35 with serious obesity-related comorbidities (similar to guidelines for adult patients with morbid obesity).
EPIDEMIOLOGY AND ETIOLOGY
Incidence: Over the past 30 years, the United States has seen an almost 3-fold increase in children who fall into the “overweight” category. Among children aged 2 to 19 years, more than 20% of the pediatric population is considered obese.2
It is estimated that up to 80% of obese teenagers will go on to become obese adults as they continue to gain weight into adulthood.1
Obesity-related conditions and comorbidities increase with the prevalence of the disease in the pediatric population. These include, but are not limited to, diabetes, hypertension, obstructive sleep apnea, nonalcoholic fatty liver disease, and metabolic syndrome2 (Figure 18.2).
 Figure 18.1 Body mass index-for-age percentiles for boys 2 to 20 years of age. Overweight in children and adolescents is defined by body mass index (weight in kilograms divided by the square of height in meters) at or above the 95th percentile for children of the same age and sex. (Source: Centers for Disease Control and Prevention. About BMI in Children and Teens. 2007. Available online at www.cdc.gov/nccdphp/dnpa/obesity/defining.htm. Calculator for determining BMI available at http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx.) |
 Figure 18.2 Health risks of obesity in adolescents and young adults. (Reprinted with permission from Neinstein LS, Katzman DK. Neinstein’s Adolescent and Young Adult Health Care: A Practical Guide. Philadelphia, PA: Wolters Kluwer; 2016. Originally adapted from Xanthakos SA, Daniels SR, Inge TH. Bariatric surgery in adolescents: an update. Adolesc Med Clin. 2006;17(3):589-612.) |
Etiology: Many theories are hypothesized for the etiology of obesity, but it is become more evident that this disease is multifactorial.
Some environmental causes include decreased daily exercise and increased intake of fast food and processed foods.
Familial predisposition is also evident, as many individuals suffering from obesity are not the sole member of their family with the disease.
Few genetic syndromes such as Prader-Willi syndrome, melanocortin 4 receptor deficiency, and Albright’s hereditary osteodystrophy are associated with childhood obesity.
PATIENT SELECTION
Children suffering from obesity will have increased BMI, subcutaneous fat, and waist circumference.
In many practices, bariatric surgery is not considered for the adolescent population until a BMI of 50 or greater, with obesity-related comorbid conditions, is identified.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
