A recent study published in JAMA Pediatrics reveals that an increasing number of children and teenagers are undergoing weight loss surgery due to the rising rates of pediatric obesity. The study, conducted by researchers from the University of Texas, University of Miami Miller School of Medicine, and University at Buffalo School of Medicine and Biomedical Sciences, observed a nearly 19% rise in weight loss surgeries among youths aged 10 to 19 years between 2020 and 2021. The researchers were motivated by the American Academy of Pediatrics’ (AAP) endorsement of increased access to bariatric surgery for teens in late 2019.
The study utilized data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which accredits bariatric surgery centers in the U.S. and Canada. Lead study author Sarah Messiah, PhD, professor and pediatric obesity researcher at UTHealth Houston School of Public Health, noted that pediatricians have historically been hesitant to refer severely obese patients for bariatric surgery. However, the study found a steady increase in usage in the two years after the release of the AAP statement.
The increase in weight loss surgeries was particularly pronounced among racial and ethnic minority groups, including Hispanic/Latino and non-Hispanic Black/African American individuals. This may be because these groups are disproportionately affected by risk factors for cardiometabolic diseases like type 2 diabetes, cardiovascular disease, and some types of cancer. These risk factors include elevated blood pressure, lipids, insulin, glucose, and waist circumference.
Although the study has some limitations since it does not include all adolescents who have undergone bariatric surgery during the analyzed time period, it does encompass all adolescent patients who underwent surgery at U.S. accredited centers, which are considered the gold standard.
In January 2023, the AAP officially endorsed bariatric surgery and weight loss prescriptions for severely obese teens aged 13 and older. The four main types of bariatric surgery recommended by the Cleveland Clinic are gastric bypass, sleeve gastrectomy, gastric band, and duodenal switch. However, there was resistance to the AAP’s recommendation. Messiah emphasized the importance of supporting families who choose surgery for their adolescents to ensure the best health outcomes as they age into adulthood.
Different hospitals have varying guidelines for weight loss surgery in children. Children’s Mercy Hospital in Kansas City offers laparoscopic sleeve gastrectomy for children who meet certain criteria. Cincinnati Children’s Hospital in Ohio offers bariatric surgery for severely obese adolescents who haven’t had success with behavioral and nutritional approaches to weight loss. Nationwide Children’s Hospital in Columbus, Ohio, offers gastric bypass and gastric sleeve surgeries for children who meet certain weight requirements.
Opinions and experiences regarding pediatric weight loss surgery vary among patients and physicians. Some medical professionals caution against misconceptions and acknowledge the necessity of surgery for many severely obese individuals. However, others share cautionary tales and concerns about the irreversible nature of these procedures, potential complications, and the importance of exhausting all medical options before resorting to surgery.
Dr. Sue Decotiis, a triple board-certified weight loss physician in New York City, warns about the potential dangers and irreversible nature of bariatric surgery in children and teens. She highlights the alteration of the GI tract anatomy and the impact on eating regular meals and consuming high-nutrition, high-fiber food. Dr. Decotiis recommends exploring dietary changes and possible medication options before considering surgery, especially for teens with severe obesity. She stresses the importance of exhausting all medical alternatives due to the irreversible nature of surgery.
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