September is National Childhood Obesity Awareness Month!

Obesity in children continues to be a major health problem, but there has been progress.  In the last decade surgery for severe obesity in children has become accepted as a standard of care.  The American Academy of Pediatrics has revised its guidelines from surgery being “considered” in 2012 to “accepted treatment” in 2019. ASMBS has endorsed these evidence-based best practices.1

Who will provide metabolic and bariatric surgical care for children?  Lewit et al.2 note that few pediatric surgeons perform bariatric procedures (all sleeve gastrectomy) in the United States, and most of those who do work with another surgeon, likely an experienced adult bariatric surgeon. Clearly more surgeons need to offer bariatric surgery to pediatric patients.

At the Annual Meeting in Dallas, ASMBS members addressed the unmet need for more surgeons to consider lowering the age for which they will perform bariatric and metabolic surgery to younger than 18 years:

Jeremy Aidlen, MD, pediatric surgeon at the University of Massachusetts, reported that 4.5 million US children have class II obesity (BMI ≥ 120% of the 95 th percentile for age and sex) or higher, yet current estimates note that only 1,600 pediatric metabolic and bariatric surgery cases are performed annually in the US (the majority of which are in patients 18 years or older). Practitioners remain reluctant to refer pediatric patients with severe obesity for bariatric surgical intervention. Insurance companies remain resistant to authorizing surgery for children, and for multiple reasons, race and socioeconomic status—factors which are associated with the highest rates of obesity—are associated with less access to bariatric surgery. Watchful waiting, he noted, leads to higher BMI.

Giovanny Dugay, NP, who practices at New York Presbyterian, sees adolescent patients as they age into his adult bariatric surgery program. He addressed the importance of care continuity, highlighting the need for continued dietary and lifestyle adjustments to maintain healthy weight and fitness. He discussed the issues one could expect to encounter in any patient who has had a bariatric operation (e.g., vitamin deficiencies, weight regain, band management for those who had bands previously placed,) and reminded us that the principles of care remain the same despite the major changes in lifestyles that adolescents experience as they become young adults.

Ann Rogers, MD has maintained an adult bariatric surgery practice at Penn State for many years. She spoke from experience about the importance of pediatric team members—nutritionists, endocrinologists, social workers, gastroenterologists—to ensure the best care for young people who are contemplating bariatric surgery. Ann noted that in order to meet the needs of those who would benefit from an operation, metabolic and bariatric surgeons should work to expand their practice bandwidth to include patients younger than 18, implementing the 2018 standards outlined by Pratt et al.3, and acknowledging the extra work that may be required to get surgery approved.

Singh and Chernogluz have pointed out a key factor for parents to consider metabolic and bariatric surgery for their child with obesity is counseling by the pediatric provider.4 In addition to the recently published policy statement, the soon to be updated childhood obesity clinical practice guideline from the AAP is anticipated to provide additional guidance for primary care providers.

The Pediatric Committee of the ASMBS is committed to expanding safe, effective surgical care for children with severe obesity to help those young people who would benefit most from care. Soon there will be a Childhood Obesity Surgery Toolkit on the ASMBS website to help both adult and pediatric bariatric surgeons expand their practices to accommodate our youngsters seeking care.

2 Lewit RA, Harmon CM, Ricca R, Rich BS, Raval MV, Weatherall YZ. Bariatric surgery practice patterns among pediatric surgeons in the United States. J Pediatr Surg. 2022 Jul 15:S0022-3468(22)00452-3. doi: 10.1016/j.jpedsurg.2022.07.003. Online ahead of print.PMID: 35927071
3Pratt JSA, Browne A, Browne NT et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surg Obes Relat Dis.2018;14:882-901.
4Singh UD, Chernoguz A Parental attitudes toward bariatric surgery in adolescents with obesity. Surg Obes Relat Dis. 2020;16:406-413