Should bariatric surgery be performed in adolescents?
Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications.
Department of Gastrosurgical ResearchInstitute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden.|Research DepartmentThe Royal College of Surgeons of England, London, UK.
Andrew J
AJ
Beamish
Vestische Hospital for Children and Adolescents University of Witten/Herdecke Department of Pediatric EndocrinologyDiabetes, and Nutrition Medicine, Datteln, Germany.
Thomas
T
Reinehr
D000293:Adolescent; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery; D063766:Pediatric Obesity / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss