A multidisciplinary approach to the adolescent bariatric surgical patient

Presented at the 34th Annual Meeting of the American Pediatric Surgical Association, Fort Lauderdale, Florida, May 25–28, 2003.
https://doi.org/10.1016/j.jpedsurg.2003.11.025Get rights and content

Abstract

Purpose

Pediatric obesity is an epidemic in the United States. As of yet, no surgical programs specifically dedicated to the management of clinically severely obese adolescents exist. The purpose of this report was to describe the establishment and early experience of a multidisciplinary Comprehensive Weight Management Center (CWMC) in a free-standing children’s hospital.

Methods

With input from an ethicist, gastroenterologist, pulmonologist, endocrinologist, and adolescent medicine physician, guidelines for patient selection, evaluation, and bariatric surgical management were developed and implemented. Roux-en-Y gastric bypass (RYGBP) surgery has been performed using open and laparoscopic techniques.

Results

The average age and body mas index (BMI) for 79 patients referred to the CWMC has been 16 years and 54 kg/m2, for boys and 17 years and 51 kg/m2 for girls. Twenty-five percent have been considered appropriate for RYGBP, 25% have not met criteria for surgery, and 50% are being evaluated. Ten patients who have undergone RYGBP had comorbidities of their obesity, including type 2 diabetes mellitus (DM), obstructive sleep apnea syndrome (OSAS), pulmonary embolism, hypertension, dyslipidemias, and depression. Clinically significant weight loss with resolution of comorbidities has occurred in all patients. Significant complications have included leak from the gastric remnant, DVT, partial roux limb obstruction, and micronutrient deficiency.

Conclusions

RYGBP is an effective means to treat obesity-related morbidity in the adolescent. A multidisciplinary team of pediatric specialists is needed for optimal preoperative decision making and postoperative management. Results have been satisfactory and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population.

Section snippets

Materials and methods

Health Works! is a behavioral treatment program at Cincinnati Children’s Hospital Medical Center for pediatric obesity. This physician-supervised interventional weight management program combines the expertise of dieticians, psychologists, and exercise physiologists to treat childhood obesity. To address the needs of patients who do not achieve or sustain weight loss, bariatric surgery was integrated into a comprehensive weight management center (CWMC).

Institutional consensus for CWMC

Results

Since introduction of the CWMC in late 2001, physician referrals have numbered 79 overall (Fig 1). The average BMI of girls in this referral group (n = 48) was 51 kg/m2, whereas the average BMI of boys (n = 31) was 54 kg/m2 (Fig 2). Fifty percent of referrals have been from within a 30-mile radius of Cincinnati, whereas 50% have been long-distance patients.

Using clinical guidelines (Table 1), 25% of all adolescents referred have been considered appropriate candidates for bariatric surgery.

Discussion

Our initial experience suggests that there are a great many adolescents with clinically severe obesity who are interested in a bariatric surgical option to attain a more healthy weight. The evaluation process is more complicated in severely obese adolescents than adults because (1) adolescents have not always made their best attempts at nonsurgical weight loss and can loose weight more effectively with behavioral/dietary measures than adults,32 (2) are often still growing and may be adversely

References (40)

  • C.L. Ogden et al.

    Prevalence and trends in overweight among US children and adolescents, 1999–2000

    JAMA

    (2002)
  • R.P. Troiano et al.

    Overweight children and adolescentsDescription, epidemiology, and demographics

    Pediatrics

    (1998)
  • S.Y. Kimm et al.

    Obesity development during adolescence in a biracial cohortThe NHLBI Growth and Health Study

    Pediatrics

    (2002)
  • R.C. Whitaker et al.

    Predicting obesity in young adulthood from childhood and parental obesity

    N Engl J Med

    (1997)
  • T.J. Parsons et al.

    Childhood predictors of adult obesityA systematic review

    Int J Obes Relat Metab Disord

    (1999)
  • S.S. Guo et al.

    Body mass index during childhood, adolescence and young adulthood in relation to adult overweight and adiposityThe Fels Longitudinal Study

    Int J Obes Relat Metab Disord

    (2000)
  • W.H. Dietz

    Health consequences of obesity in youthChildhood predictors of adult disease

    Pediatrics

    (1998)
  • S. Sonne-Holm et al.

    Risk of early death in extremely overweight young men

    Br Med J (Clin Res Ed)

    (1983)
  • A. Must et al.

    Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935

    N Engl J Med

    (1992)
  • K.R. Fontaine et al.

    Years of life lost due to obesity

    JAMA

    (2003)
  • Cited by (167)

    • Adolescent metabolic and bariatric surgery: what does the data show?

      2023, Annals of Laparoscopic and Endoscopic Surgery
    View all citing articles on Scopus
    View full text