Bariatric surgery rates increase among children

According to data from the National Health and Nutrition Examination Survey, childhood obesity rates have increased from 17.7% to 21.5% over the last decade. Other studies have also found that weight gain among children grew significantly during the pandemic.

As obesity rates rise among young people, healthcare organizations and providers have pushed for increased access to treatments for children and adolescents. In 2019, the American Academy of Pediatrics (AAP) released a policy statement calling for increased access to bariatric surgery for pediatric patients.

Metabolic and bariatric surgery alter both the stomach and intestines to reduce food intake and change how the body absorbs food, which can then help with weight loss. Although the surgery is often effective and long-lasting, only around 1% of eligible patients get it, partly due to its high cost and lack of insurance coverage.

In a new study published in JAMA Pediatrics, researchers found that rates of bariatric surgery among children ages 10 to 19 increased by almost 20% from 2020 to 2021. Surgery completion rates increased among all children, as well as children in different ethnic subgroups.

According to the researchers, AAP's 2019 policy statement encouraging more access to bariatric surgery likely played a significant role in the increase in surgeries among pediatric patients.

"The AAP has highlighted the need to educate pediatricians about the benefits of MBS [metabolic and bariatric surgery] for qualified patients," the researchers wrote. "Historically, MBS has been underused in youths due to barriers, including low referral rates, limited access, and poor insurance coverage."

Overall, the researchers said the findings "suggest cautious optimism regarding the decreasing barriers to MBS for those U.S. youth in need."

Commentary

Sarah Messiah, an author of the JAMA Pediatrics study and a professor at the University of Texas Health Science Center at Houston, said that "[b]ariatric surgery hasn't necessarily been accepted or embraced by the pediatric community or pediatricians," but AAP's recommendations helped "break down some of those barriers."

AAP has moved towards more proactive treatment recommendations for children with obesity. In January, the organization released new, comprehensive obesity guidelines, which called for "immediate, intensive obesity treatment for each patient."

Under the new guidance, AAP suggested that intensive behavioral and lifestyle adjustments should be implemented to address childhood obesity. The group also recommended anti-obesity medications and surgery for the first time.

"We now have evidence that obesity therapy is effective. There is treatment, and now is the time to recognize that obesity is a chronic disease and should be addressed as we address other chronic diseases," said Sandra Hassink, medical director of the AAP Institute for Healthy Childhood Weight and co-author of the new guidelines.

"There is no evidence that 'watchful waiting' or delayed treatment is appropriate for children with obesity," Hassink said.

Although some healthcare providers have suggested that bariatric surgery may be too aggressive for young people, research suggests that people who received bariatric surgery as teenagers ended up being healthier in the long run than people who waited until they were adults to get the surgery.

In the new guidelines, AAP recommends providers discuss weight loss surgery with individuals ages 13 and older with severe obesity.

"The sooner the better for many things," said Joan Han, a professor and chief of the division of pediatric endocrinology and diabetes at Mount Sinai Kravis Children's Hospital. "There is research that shows that getting bariatric surgery sooner can reverse health issues like Type 2 diabetes and high blood pressure, which is why surgery should be considered for pediatric patients."

"The data at this point is overwhelming that it's effective," Messiah said. "It helps these adolescents lose weight. It helps them get healthier. Why should we wait?" (Monaco, MedPage Today, 5/30; Peng/Court, Fortune/Bloomberg, 5/30; Morrison, Daily Mail, 5/30; Toy, Wall Street Journal, 4/19)

The  American Academy of Pediatrics (AAP) on Monday published new  guidance  in  Pediatrics  advising  pediatricians and pediatric healthcare providers to provide "immediate, intensive obesity treatment to each patient" as soon as they are diagnosed. Read the full story below.