Morbidity in obese adolescents who meet the adult National Institutes of Health criteria for bariatric surgery.
OBJECTIVE
Some have suggested that the criteria for weight loss surgery in adolescents be stricter than those currently recommended for adults by the National Institutes of Health (NIH). The aim of the current study is to define the characteristics of adolescents who meet NIH consensus criteria for bariatric surgery in adults to determine their level of morbidity.


METHODS
Using the Medical Expenditure Panel Survey 2000-2004, children designated as meeting NIH criteria were 13 to 17 years of age with (1) a body mass index >or=40 or (2) a body mass index >35, and one or more comorbidity. We contrasted surgery candidates with noncandidates. We examined items that comprise a screener for identifying children with special health care needs. The Columbia Impairment Scale (CIS) was used to assess child functioning.


RESULTS
There were 134 children identified as candidates for bariatric surgery and 4736 noncandidates in the same age range. Candidates were more likely to have special health care needs (36% vs 23%) and more likely to have a CIS above 16 (34% vs 16%). Candidates for weight loss surgery were 2.36 times as likely to have a CIS score of 16 or higher and 1.87 times as likely to be identified as a child with special health care needs (P <or= .001).


CONCLUSIONS
We conclude that adolescents who meet NIH consensus criteria for weight loss surgery in adults require specialized health services and have functional impairment. Thus, we advocate the use of the standard adult criteria defined by the NIH as the initial screening requirements so that enhanced access to weight loss surgery for morbidly obese adolescents may be achieved.
Division of Pediatric Surgery, New York University School of Medicine, New York, NY 10016, USA. evan.nadler@med.nyu.edu
Evan P
EP
Nadler
Laurie M
LM
Brotman
Thomas
T
Miyoshi
George E
GE
Fryer
Michael
M
Weitzman
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D050110:Bariatric Surgery / Q000592:standards* / Q000706:statistics & numerical data; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D017408:Guidelines as Topic / Q000592:standards; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D008297:Male; D009316:National Institutes of Health (U.S.) / Q000592:standards; D009767:Obesity, Morbid / Q000145:classification / Q000453:epidemiology / Q000601:surgery*; D018579:Patient Selection; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology