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September 28, 2021

Weight loss surgery should be an option for severely obese children, doctors say

New research may help temper concerns about its long-term ramifications

Children's Health Bariatric Surgery
Childhood obesity Press Association/Sipa/Sipa USA

Childhood obesity remains a serious problem in the United States. CDC data has found about 20% of children are obese. Above: An 11-year old uses a set of weighing scales.

Bariatric surgery is a proven method to help people with severe obesity lose weight and improve their overall health. But is it a safe procedure for children?

Both the American Academy of Pediatrics and the American Society for Metabolic and Bariatric Surgery recommend it for children who are unable to lose weight through diet and behavioral counseling. 

However, many doctors and parents have concerns about its potential long-term side effects.

A new study provides some reassuring long-term data. Researchers from King Saud University in Saudi Arabia found that the gastric sleeve procedure is safe and effective for children as young as 5 years old.

"Lack of long-term data and some pediatricians' fears that bariatric surgery might affect children's linear growth has led to worldwide resistance to performing weight loss procedures for children below 14 or 15 years of age," said Aayed Alqahtani, a professor of bariatric surgery at King Saud University.

"Our findings present clear evidence that should remove hesitance to perform bariatric surgical treatment in children and young adolescents who could benefit from the operation. We have a proven solution for severe obesity and its comorbidities."

The gastric sleeve surgery involves removing a part of the stomach that includes the hormone that stimulates appetite. The remaining part of the stomach is stapled together to create a sleeve that is only the size of a banana. With fewer hormones sending hunger messages to the brain, the patients eat less food.

Each of the study participants initially had tried to lose weight on a six-month program that included diet and behavior counseling. About 10% of them had type 2 diabetes or abnormal blood fats and about 15% had high blood pressure before the surgery.

In the United States, childhood obesity remains a serious problem. Between 2017 and 2018, the prevalence of obesity was 19.3% and affected 14.4 million children and adolescents, according to the U.S. Centers for Disease Control and Prevention.

Obesity increases the risk of various health conditions, including heart disease, diabetes, high blood pressure and certain cancers. It also increases the likelihood of developing digestive problems, gallbladder disease, liver problems, osteoarthritis, depression and sleep apnea. And it is a risk factor for severe COVID-19 symptoms.

When children are obese, they are at risk of developing these conditions much sooner, putting their present and future health in danger. Many children who are obese never completely lose the weight as adults, which could shorten their overall lifespans.

The Childhood Obesity Foundation says that an adult who is obese at age 40 can expect to die up to 3-6 years earlier than someone who was of normal weight at the same age.

"If you surgically intervene early, you can cure children's obesity-related diseases early and improve their quality of life, and if you wait longer, their diseases might become irreversible," Alqahtani said.

It is important to note that the surgery isn't the best solution for everyone struggling with severe obesity. Besides the potential complications related to the procedure itself, there is the risk of vitamin deficiency or weight gain. Experts say that any surgical program needs to have long-term follow-up to address exercise, diet and other lifestyle issues.

Bariatric surgery is not recommended for children who have substance abuse problems, eating disorders or are pregnant. It also is not advised for anyone who can't follow the post-surgery recommendations, including the lifestyle and eating changes. Supplements need to be taken every day.

The long-term study followed 2,500 Saudi Arabians ages 5-21 with severe obesity – defined as a body mass index 20% higher than the cutoff for obesity – for as much as 10 years after their weight loss surgeries. The procedures occurred between 2008 and 2021.

The study participants lost an average of 30% of their total weight and had reversal of type 2 diabetes and important heart disease risk factors. There were no major complications, nor were there any differences in weight loss or height trajectory for the younger kids, ages 5-14, compared the older participants.

The long-term results of the surgery also were positive. Participants maintained an average 71% loss of excess weight. More than 70% of them had complete reversal of type 2 diabetes.

The findings were published in the Journal of American College of Surgeons.

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