As the childhood obesity epidemic grows, more teenagers are turning to weight-loss surgery to shed pounds and prevent health problems in adulthood, but this option is still not being used enough in younger patients, a new study has found.
Annual bariatric procedure rates among adolescents with obesity in the U.S. doubled from 2010 to 2017, growing from 2.29 to 4.62 per 100,000 teens during that time period, according to the report, published Monday in Pediatrics.
The most popular procedure was a laparoscopic sleeve gastrectomy, which involves removing about 80% of the stomach.
The findings are based on information about 12- to 19-year-olds undergoing bariatric procedures, as recorded in the National Inpatient Sample, a large U.S. healthcare database.
Even though weight-loss surgery is a safe and effective way to treat pediatric obesity, it’s underused for teens, researchers wrote. They noticed an especially “dramatic underutilization” that persists among Black and Hispanic kids, who are most affected by obesity.
More research is needed to figure out why it’s happening, said study co-author Dr. Baddr Shakhsheer, a pediatric surgeon at St. Louis Children’s Hospital in Missouri and assistant professor of surgery at the Washington University School of Medicine.
Part of it may be fear of the procedure by patients and their families, he noted. Other potential barriers include insurance coverage, provider concerns and societal misconceptions, the study found.
About 26% of Hispanic children and almost 25% of Black children have obesity, compared to 16% of white children and 9% of Asian children, according to the Centers for Disease Control and Prevention.
But the typical weight-loss surgery patient in the study was white. She was also female, privately insured and, on average, 18 years old.
When teens do get weight-loss surgery, the effects can be overwhelmingly positive, Shakhsheer noted.
“They’re really life-changing. These patients not only benefit medically and physiologically, but in terms of their quality of life — it increases dramatically,” Shakhsheer told TODAY.
“Obesity is already wreaking havoc on these children, and I think that we’re recognizing it now earlier. The sooner we intervene, the better quality and longevity of life we can provide for these patients.”
No minimum age
Surgery is the most effective treatment option for many teens with severe obesity, but there’s “a striking trend of underutilization,” particularly for low-income teens, the American Academy of Pediatrics noted in a statement in 2019. It called for better access for younger patients.
There is no minimum age for the procedure, Dr. Sarah Armstrong, the lead author for the AAP policy statement and chief of general pediatrics and adolescent health at Duke University, previously told TODAY.
It can be considered if a child’s BMI is 40 or higher, or at least 35 if they have comorbidities such as fatty liver disease and diabetes.
The right patient for the procedure is one who understands what it does and what its potential side effects are, and who has the psychological and health support to get through it to reap the maximum benefits, Shakhsheer said.
Dr. Jason Balette, a bariatric surgeon with Memorial Hermann The Woodlands Medical Center in Texas, said stopping obesity early, before it can lead to organ damage and other health problems, is a better long-term option for teens. His practice has performed weight-loss surgery for patients as young as 16.
“It’s gaining more acceptance in society for kids, for adolescents, for adults, for everybody,” Balette, who was not involved in the new study, told TODAY.
“I don’t think weight-loss surgery should be the first resort, but I certainly think it requires the team — the pediatrician, the dietitians, the surgeon — looking at each individual case as a whole and seeing how weight-loss surgery is incorporated along with diet and exercise.”
He didn’t know why minority groups were less likely to receive the procedure than their white counterparts, but wondered whether it’s a matter of education about what surgical intervention can accomplish.
“As the word gets out that weight-loss surgery, particularly in the adolescent population, is a good thing, I think that those forces will definitely allow more interest and therefore more access,” Balette said.
Doctors and healthcare institutions need to reach out to local communities — especially the underprivileged populations — to make sure that people understand that these therapies are available, Shakhsheer added.