title: Bariatric surgery for severely overweight adolescents: concerns and recommendations.
abstract: As the prevalence of obesity and obesity-related disease among adolescents in the United States continues to increase, physicians are increasingly faced with the dilemma of determining the best treatment strategies for affected patients. This report offers an approach for the evaluation of adolescent patients' candidacy for bariatric surgery. In addition to anthropometric measurements and comorbidity assessments, a number of unique factors must be critically assessed among overweight youths. In an effort to reduce the risk of adverse medical and psychosocial outcomes and increase compliance and follow-up monitoring after bariatric surgery, principles of adolescent growth and development, the decisional capacity of the patient, family structure, and barriers to adherence must be considered. Consideration for bariatric surgery is generally warranted only when adolescents have experienced failure of 6 months of organized weight loss attempts and have met certain anthropometric, medical, and psychologic criteria. Adolescent candidates for bariatric surgery should be very severely obese (defined by the World Health Organization as a body mass index of > or =40), have attained a majority of skeletal maturity (generally > or =13 years of age for girls and > or =15 years of age for boys), and have comorbidities related to obesity that might be remedied with durable weight loss. Potential candidates for bariatric surgery should be referred to centers with multidisciplinary weight management teams that have expertise in meeting the unique needs of overweight adolescents. Surgery should be performed in institutions that are equipped to meet the tertiary care needs of severely obese patients and to collect long-term data on the clinical outcomes of these patients.
authors.affiliation: Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229, USA. thomas.inge@cchmc.org
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Inge
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Krebs
authors.forename: Victor F
authors.initials: VF
authors.lastname: Garcia
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Skelton
authors.forename: Karen S
authors.initials: KS
authors.lastname: Guice
authors.forename: Richard S
authors.initials: RS
authors.lastname: Strauss
authors.forename: Craig T
authors.initials: CT
authors.lastname: Albanese
authors.forename: Mary L
authors.initials: ML
authors.lastname: Brandt
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Hammer
authors.forename: Carol M
authors.initials: CM
authors.lastname: Harmon
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Kane
authors.forename: William J
authors.initials: WJ
authors.lastname: Klish
authors.forename: Keith T
authors.initials: KT
authors.lastname: Oldham
authors.forename: Colin D
authors.initials: CD
authors.lastname: Rudolph
authors.forename: Michael A
authors.initials: MA
authors.lastname: Helmrath
authors.forename: Edward
authors.initials: E
authors.lastname: Donovan
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Daniels
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000592:standards; D015391:Gastroplasty / Q000592:standards; D006801:Humans; D007258:Informed Consent; D008297:Male; D016743:Mental Competency; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D033282:Parental Consent; D010353:Patient Education as Topic; D018579:Patient Selection; D011183:Postoperative Complications