A new policy statement says weight loss surgery like gastric bypass should be available to kids and teens who need it. Here's what experts are saying.

By Sally Kuzemchak, MS, RD
November 08, 2019
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Weight loss surgery should be made more available to kids and teenagers who need it, according to a new policy statement from the American Academy of Pediatrics (AAP). But not everyone agrees with the recommendations.

In the policy statement, the AAP says that bariatric surgery such as gastric bypass can help improve the health of kids and teens with severe obesity, meaning a BMI of 35 or higher. About 4.5 million children in the U.S. have severe obesity, and the highest rate (14 percent) is among 16-19 year olds. Rates for severe obesity among kids and teens have almost doubled since 1999.

The AAP calls severe obesity in youth an "epidemic within an epidemic," leading to a higher risk for chronic conditions like type 2 diabetes, fatty liver disease, and hypertension, as well as depression, poor quality of life, and a shortened life span. They say there's no evidence that changes to diet and exercise habits lead to significant weight loss for children with severe obesity.

Issues With Adolescent Bariatric Surgery

"There are an increasing number of people with severe obesity. And they are sick," says Christopher Bolling, M.D., chairperson for the AAP Section on Obesity and one of the statement's authors. "Bariatric surgery is an effective and safe option for many of them, but there are many barriers to them receiving needed therapy."

According to the statement, youth from lower socioeconomic groups are more likely to have severe obesity yet have less access to treatments like surgery. Even when families have access, many kids and teens who need the surgery are denied insurance coverage for it because of their age. They also note that some health care providers are reluctant to recommend surgery to young patients and prefer to use a "watchful waiting" approach.

But Dr. Bolling says that waiting isn't necessarily safe—and that there can be damage to the liver, lungs, kidneys, GI tract, and endocrine system in the meantime. "How long should we withhold effective therapy for patients who are seriously sick and suffering from a disease that has almost no chance of resolving on its own?" he asks.

The AAP says insurance providers should not exclude patients on the basis of age. Though the majority of candidates for surgery will be teens, the statement cites one study of children as young as 11 receiving the surgery. More important than age is the severity of obesity and other illnesses it's causing, says Dr. Bolling. In the largest ongoing study of youth and weight loss surgery, the average loss was more than a quarter of body weight, and the surgery resolved conditions like type 2 diabetes and high blood pressure for the majority of patients.

What Critics of Adolescent Bariatric Surgery Say

But some health professionals have serious reservations about the approach. The National Eating Disorders Association issued a statement in response to the AAP's, expressing concern that there's little long-term data on the safety of bariatric surgery for kids—and pointing out that children in lower socioeconomic groups may not have access to necessary post-surgery health care and nutritional supplementation. They also say the new AAP statement contradicts its own 2016 policy statement about preventing obesity and eating disorders among teens that discourages dieting and promotes healthy lifestyle behaviors and positive body image instead.

"Surgery requires lifelong attention to malnourishment and support," cautions dietitian Rebecca Scritchfield, author of Body Kindness. "A concerned and scared parent is making a body choice for their child that the child will have to live with forever." She says she'd be especially cautious about surgery during puberty (ages 8-14), when weight can fluctuate as the body changes.

The surgery itself also has complications and risks, though the AAP says most of these are minor. In one study, about 8 percent of teens had major complications after surgery and about 3 percent required re-operation before being discharged from the hospital. As with adults, deficiencies in vitamins and minerals are common after bariatric surgery. The most recent mortality rate reported for young patients is .3 percent.

Bariatric Surgery Shouldn't Be a Kid's First Option

It's important to remember that the AAP recommendations aren't for every child who is considered overweight, says Cincinnati pediatric dietitian Amy Cole Reed. "Bariatric surgery should never be the first line of defense," she says. "But some children and teens have exhausted all efforts and have reached a point of severe obesity and have other conditions that can be life-threatening. Whenever the life of a child is at stake, I believe it is our responsibility to make parents aware of the option for bariatric surgery."

She says that families should be referred to a specialized multidisciplinary team for evaluation and education. "Severe obesity is not only caused by what someone eats," she says. "We need to treat the whole child."

Sally Kuzemchak, MS, RD, is a Contributing Editor for Parents magazine and a registered dietitian who blogs at Real Mom Nutrition, a no-judgements zone about feeding a family. She is the author of The 101 Healthiest Foods For Kids and Cooking Light Dinnertime Survival Guide. You can follow her on Facebook, and Instagram. In her spare time, she loads and unloads the dishwasher. Then loads it again.

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