Bariatric Surgery In Adolescents

Bariatric surgery is commonly performed in the adult population. With long-lasting results and improvement of many obesity-related conditions, many wonder if it would be a safe procedure for the younger population.

Bariatric surgery in children and adolescents is an underutilized but highly effective and safe weight loss strategy for severe obesity. Childhood obesity is considered an epidemic within the United States because it is so prevalent.

Bariatric surgery performed in childhood and adolescents is assessed on an individual basis. Bariatric surgery seems dramatic in children at a young age, but it may be necessary after weight management fails. A pediatrician would assess food habits, activity level, blood work, and more in order to discuss treatment options. 

This article will provide information on who can benefit from bariatric surgery and which types of procedures are performed in children and adolescents.

 

Which Children Might Benefit From Bariatric Surgery?

Children who are severely obese and fail to lose weight from lifestyle modifications and dietary changes may benefit from weight loss surgery.

Up to 80% of children who are fighting childhood obesity are likely to have similar issues in adulthood. Studies show that children who are obese by the age of 12 have a very high chance of being obese adults.

Surgeons generally recommend that children should be at least 14 years old to be considered for bariatric surgery. However, insurance companies may not cover bariatric procedures in adolescents under 18 years old. 

Children should be informed that they will need to be cautious with what they eat for the weeks and months following surgery and will be required to develop a lifelong commitment to dietary and lifestyle modifications. 

Children will usually be assessed and required to take a pre-bariatric surgery questionnaire. Life-long vitamins and supplements will be necessary following surgery. The higher risk of deficiencies will require bariatric multivitamins and sometimes additional supplements, such as Vitamin B12 after surgery based on individual needs and dietary consumption. 

The selection criteria for bariatric surgery includes:

  • Failed attempts at lifestyle modification and dietary interventions
  • Body Mass Index (BMI) of 35 and higher with severe obesity-related conditions such as type 2 diabetes, severe sleep apnea, pseudotumor cerebri, or severe fatty liver disease
  • BMI of 40 and higher with minor obesity-related conditions such as high blood pressure, high cholesterol, and mild sleep apnea
  • Understanding of the commitment to dietary and lifestyle modifications after bariatric surgery
  • Complete all of the preoperative diagnostic and laboratory tests
  • Undergo psychological or psychiatric evaluation before surgery

Bariatric surgery is not recommended for the following:

  • Children with substance abuse problems that are poorly controlled or not treated
  • Those with eating disorders
  • Pregnant or planning pregnancy in the following months

 

Comorbidities In Obese Children And Adolescents

Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus usually develops later in life. It is associated with obesity and Metabolic Syndrome. Type 2 Diabetes can develop earlier in children and adolescents who are severely obese. 

This life-long disease can worsen over time and increase the risk of high blood pressure, high cholesterol, and fatty liver disease in the future.

Benefits of some bariatric surgery procedures, such as gastric bypass surgery may include Type 2 Diabetes Mellitus remission. Hormonal changes and decreased weight after bariatric surgery positively affect glucose balance and insulin sensitivity. 

Cardiovascular Disease

Childhood obesity may increase the risk for heart disease and blood vessel disease in adulthood. Weight loss associated with bariatric surgery can decrease risk factors.

There is ongoing research in this area and should be studied further in the field of Bariatric Medicine.

Obstructive Sleep Apnea

Almost a quarter of all obese children and adolescents have obstructive sleep apnea (OSA). 

OSA can cause behavioral issues, problems with focus, and excessive daytime sleepiness. Sleep apnea and bariatric surgery are associated with improvement or complete resolution of symptoms.

Nonalcoholic Fatty Liver Disease And Nonalcoholic Steatohepatitis

More than one-third of children who are obese have fatty deposits in their liver. Around 10% of obese children have liver inflammation, aka steatohepatitis. 

Over time, inflammation may develop into fibrosis and then scarring of the liver, called cirrhosis. Inflammation can improve after bariatric surgery and can also decrease scarring.

Pseudotumor Cerebri

Pseudotumor Cerebri is a condition caused by increased pressure within the head. This condition is commonly associated with obesity and symptoms including headaches, nausea/vomiting, and visual problems.

Improvement of this condition can be seen within several months after weight loss surgery.

Depression

Obesity can often be a cause of depression in childhood and adolescents. Be aware that signs and symptoms of depression can present differently in children. 

Children battling depression may have behavioral problems or physical symptoms. Self-esteem and bullying can play a huge role in the occurrence of depressive thoughts and actions.

Individuals who qualify for bariatric surgery and present with depression are to be closely monitored before and after surgery. 

Eating Disorders

Binge eating and bulimia can be common in obese children and adolescents. These eating disorders are very serious and weight loss surgery is typically not recommended unless the issue is managed and receiving the proper treatment. 

 

Common Weight Loss Procedures And Outcomes 

Many of the weight loss procedures that are performed in adults are also performed in children and adolescents. The most common operations performed in children and adolescents are gastric bypass and sleeve gastrectomy. 

As with any other procedure, there are risks. However, bariatric surgery has been shown to be safe and effective in adolescents. Bariatric surgery results in weight loss and improvement and/or remission of obesity-related conditions. 

General anesthesia is used for the bariatric procedureThe surgeon, patient and his/her family will discuss and decide which procedure would be suitable and appropriate.

Gastric Bypass Surgery

This type of procedure makes the stomach smaller and bypasses a portion of the small intestine. It physically limits the amount of food that the stomach can hold and reduces nutrient absorption. 

This procedure is not usually recommended as a first-line treatment for children and adolescents. It is commonly used as a revision surgery for those who have had little success with sleeve gastrectomy.

However, to this day, gastric bypass has been performed more often than the sleeve gastrectomy.

The benefits of this procedure may include significant weight loss and hormonal changes may cause Type 2 Diabetes remission. Complication rates are similar to those that occur in adults.

Vertical Sleeve Gastrectomy

This procedure involves removing a large portion of the stomach. This will result in a smaller stomach shaped like a banana.

This procedure has gained popularity over the last few years. Early results from studies have shown significant weight loss, low complication rates, and a decrease in comorbidities. The complication rates are also similar to adults undergoing this procedure.

Post-Bariatric Plastic Surgery

Post-Bariatric Plastic Surgery may be offered to children and adolescents. It is usually offered a few years after surgery. Common indications for plastic surgery can include skin irritation, rashes, and infections associated with excess skin.  


How To Treat Childhood Obesity

There are many treatments available for childhood obesity. Lifestyle modification and dietary interventions are usually the first line of treatment for childhood obesity. 

Parents can assist in dietary changes by providing healthier food and beverage options while encouraging regular activity and support.

There are also medication options that can assist in weight loss. These are examples of non surgical bariatric weight loss strategies. 

Unfortunately, few of these treatments are effective for severe childhood obesity. Bariatric surgery plays a role in significant weight loss and may be considered based on the individual situation. This is major surgery and the decision should not be taken lightly.

 

**This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your physician or another qualified health provider with any questions in regards to a medical condition.