More severely obese kids should get surgery, MD group says

Even some severely obese preteens should be considered for weight loss surgery, according to new recommendations.

guidance issued Sunday by American Acemy of Pediatrics is based on a review of medical evidence, including several studies showing that surgery in teens can result in marked weight loss lasting at least several years, with few complications. In many cases, related health problems including diabetes and high blood pressure vanished after surgery. While most of those studies involved teens, one included children younger than 12 and found ill effects on growth, policy says.

“Safe and effective is mess here,” said Dr. Sarah Armstrong, a Duke University pediatrics professor and policy’s le author.

Armstrong said children who have t gone through puberty may t be mature eugh to understand life-changing implications of surgery but that alone shouldn’t rule it out. She doesn’t do surgery but works at a center that offers it; youngest patient was 14. It’s t a quick fix, she said. “It’s a lifelong decision with implications every single day for rest of your life.”

Nearly 5 million U.S. children and teens are severely obese, a near doubling over 20 years. Many have alrey developed related health problems including diabetes, high blood pressure, sleep apnea and liver disease. But most kids don’t get obesity surgery, mainly because most public and private health insurance doesn’t cover it or y live far from surgery centers, Armstrong said. Costs can total at least $20,000.

Resistance from pediatricians is ar obstacle. Many prefer “watchful waiting,” or think surgery is risky or will alter kids’ growth. Some don’t recommend surgery because y think “weight is a personal responsibility rar than a medical problem,” new policy states. Dr. Rebecca Carter, an assistant professor of pediatrics at University of Maryland School of Medicine, said new recommendations give pediatricians better guidance about which patients should be referred and evaluated.

Recent data show that pediatric obesity surgery rates have tripled in almost 20 years but still aver fewer than 2,000 operations each year. acemy’s recommendation say children and teens are generally eligible for surgery if ir body mass index is 40 or higher, or at least 35 if y have related major health problems. se criteria may vary by and , Armstrong said. y are similar to criteria for surgeons from American Society for Metabolic and Bariatric Surgery. A BMI of 30 and above is considered obese.

Faith Newsome was a typical patient. At 5 feet, 8 inches and 273 pounds, her BMI was almost 42 and she h high blood pressure and prediabetes when she h gastric bypass surgery at Duke at 16. After about a year, she h shed 100 pounds and those health problems disappeared. She slimmed down eugh to become active in sports, shop for prom dresses and gain a better self-im. But to avoid malnutrition she takes vitamins, must eat small meals and gets sick if she eats foods high in fat or sugar. Her BMI, at just under 30, puts her in overweight range.

w 21 and a senior at University of rth Carolina in Chapel Hill, Newsome is quick to answer wher she has regrets.

“Never,” she said. “Teens should be able to discuss every option with ir doctors, and surgery should be one of those options.”