Are obese adolescents too young for bariatric surgery?

Childhood obesity has increased dramatically since the 1970s. Obese adolescents are more likely to suffer from type 2 diabetes, hypertension, non-alcoholic steotohepatitis, sleep apnea, choleolithiasis and premature death as adults.

Researchers surveyed a national random sample of pediatricians and family physicians for their opinions on referring adolescents for bariatric surgery. They discovered half of these physicians would not consider it for adolescent patients.

"We still have a lot to learn about the long term effects of bariatric surgery among adolescents," says Susan Woolford, M.D., M.P.H., medical director of the Pediatric Comprehensive Weight Management Center at the University of Michigan, "But recent studies suggest that it can be helpful to improve the health outcomes of severely obese adolescents."

"Physicians worry whether the risks will outweigh the benefits," adds Woolford, who is also an assistant professor in the department of pediatrics and communicable diseases at U-M. "How long adolescents will be able to sustain the weight loss and what the psychological outcomes would be in their future, are questions that are still being explored. If findings are similar to those in adults, there could be significant weight loss and health benefits."

Physicians who support the possibility of bariatric surgery for adolescents may do so because studies have indicated that obesity in adolescents has long-term health effects even if patients eventually lose weight, the authors write. Adolescent years can also be difficult socially and emotionally for extremely obese youth.

"With the increasing media presentations of surgeries for weight loss among the general public and Hollywood celebrities, more obese adolescents and their parents are likely to consider it," the authors write. Primary care physicians should be prepared to discuss this treatment option with families.

"Primary care physicians are on the front line of obesity treatment," says Woolford, "Their attitudes regarding bariatric surgery may affect whether or not an adolescent pursues the procedure."

The study also found almost all physicians endorsed participation in a monitored weight loss program as a prerequisite for bariatric surgery, though the minimum suggested duration for participation varied from three months to over 5 years.

For adolescents, participating in these programs could be helpful by providing time to make a stable decision regarding surgery and to adopt healthy habits that will improve their post-operative course, but the delay in surgery could also lead to further weight gain.

The authors suggest further studies should explore primary care physicians' knowledge regarding the risks and benefits of bariatric surgery for adolescents and the basis upon which they make referral decisions regarding bariatric surgery for their obese patients.

Along with Woolford, Sarah J. Clark, M.P.H., Achamyeleh Gebremariam, M.S., Matthew M. Davis, M.D., M.A.P.P. and Gary L. Freed, M.D., M.P.H., all of the University of Michigan.