May 31, 2023
Millions of children and teenagers in the U.S. are experiencing obesity, leaving them at a higher risk of developing adverse health issues as they age. A new study suggests that bariatric surgery has become a more common treatment as families grapple with how to mitigate the health dangers associated with the disease.
The number of adolescents ages 10–19 who underwent metabolic or bariatric weight loss surgery increased by about 19% in 2021 from the previous year, according to a study published in the Journal of the American Medical Association on Tuesday. The number of weight loss surgeries among adolescents has risen substantially since 2016, increasing over the first two years of the pandemic even as surgeries among adults declined.
Severe obesity is the fastest-growing category of childhood obesity in the United States, the study found. The severe obesity rate climbed from 5.6% in 2015 to 6.5% in 2016, impacting 4.8 million kids and teens. The chronic disease is more prevalent among Black and Hispanic youth, researchers found.
Lifestyle changes alone are often not enough to reduce the health risks associated with obesity. For that reason, many people turn to bariatric surgery, which alters parts of the stomach and intestines that impact how the body absorbs food, often leading to changes in food intake and making people feel less hungry.
"The data shows us that adolescents and their families are indeed interested in pursuing surgery as a treatment option if they are given access and a good candidate," Sarah Messiah, co-author of the study and a pediatric obesity researcher at UTHealth Houston School of Public Health, told CNN. "Many studies show that cardio-metabolic disease risk factors track strongly from childhood to adulthood."
While bariatric surgery is an option for children and teenagers who are experiencing severe obesity, intense behavioral and lifestyle changes should be the first treatment approach, according to guidelines issued by the American Academy of Pediatrics earlier this year.
The guidelines, which are meant to aid physicians in exploring treatment options for obesity, focus heavily on nutrition support and behavioral therapy. The first treatment approach for children ages 6 and older involves working with health care providers to adopt lifestyle changes.
Since obesity is a chronic disease, treatment is most effective when patients receive at least 26 hours of face-to-face counseling during the year, though this may pose difficulties for some families, particularly those without reliable access to health care, nutritious foods and transportation.
Experts recommend that children and adolescents with severe obesity, particularly those already experiencing health issues related to their weight, be evaluated for bariatric surgery. Candidates are often screened for physical maturity, lack of correctable causes of obesity, emotional stability and failed attempts at losing weight through lifestyle interventions, according to Mayo Clinic.
Bariatric surgery in kids and teens has been linked to a reduced risk of heart disease, improvement or remission of type 2 diabetes, resolution of sleep apnea, lower risk of developing fatty liver disease and quality-of-life improvements, according to UCLA Health. For some adolescents, bariatric surgery can lead to improvements in self esteem, depression and anxiety, particularly as it relates to social pressures.
A 2019 study from the AAP found that kids and teens who underwent bariatric surgery lost – and kept off – an average of 30% of their weight over a five-year period, reducing the risk of developing weight-related illnesses like high blood pressure and elevated cholesterol.
The new AAP guidelines were met with some backlash from health care providers and social organizations, with some lambasting the health experts for recommending medication-based and surgical treatments for children, Healthline reported.
Critics say the guidelines could fuel eating disorders and contribute to weight stigma. Some have criticized the AAP for recommending bariatric surgery and anti-obesity medications for kids and teens without any long-term data for how those treatments impact them as they age, USA Today reported.
"Weight is a sensitive topic for most of us, and children and teens are especially aware of the harsh and unfair stigma that comes with being affected by it," Dr. Sarah Hampl, lead author of the AAP guidelines, said in January. "Research tells us that we need to take a close look at families — where they live, their access to nutritious food, health care and opportunities for physical activity — as well as other factors that are associated with health, quality-of-life outcomes and risks."
As with all surgical interventions, bariatric surgery is not for everyone. Since bariatric surgery reduces the size of the stomach, patients may struggle to eat and digest food, develop nutrient deficiencies and experience unintentional weight gain as they recover from surgery, according to the Columbia University Irving Medical Center.
Bariatric surgery is not recommended for children and adolescents who have had untreated or poorly controlled substance use issues, have eating disorders or who are pregnant, according to Harvard Medical School.