Adolescent Bariatric Surgery Takes Off in CanadaMonday, February 8, 2010
Anyone dealing with pediatric obesity knows that there is now an increasing number of massively obese kids for whom behavioural and/or medical weight management will simply not cut it. It is therefore no surprise that an increasing number of kids and their families are now looking to surgeons for help.
To address this demand, Toronto’s Hospital for Sick Children last week announced the creation of a centre for pediatric and adolescent bariatric surgery (see report on CTV).
While to some readers this may seem shocking, extreme, drastic, and will likely provoke much head shaking amongst people who simply do not get that calling for more prevention efforts will be of no benefit to these kids, the reported outcomes for pediatric obesity surgery (at least in the short term) are actually quite good.
Thus, Ai Xuan Holterman and colleagues from Rush University, Chicago, IL, recently reported their experience with bariatric surgery in morbidly obese adolescents in the Journal of Pediatric Surgery.
This looked at the more than one year outcomes in twenty 14-17 year olds undergoing plaparoscopic adjustable gastric banding (LAGB). BMI at baseline was around 50 and was associated with hypertension (45%), dyslipidemia (80%), insulin resistance (90%), metabolic syndrome (95%), and biopsy-proven nonalcoholic steatohepatitis (88%).
At mean follow-up of 26 months, mean excess weight loss was around 30% and the metabolic syndrome was resolved in 63% and 82% of the patients at 12 and 18 months, respectively. Hypertension normalized in all patients, along with improvement in lipid abnormalities and quality of life scores.
LABG is relatively safe with few perioperative complications. Nevertheless, long-term complications including band slippage, erosions, and other problems remain a concern. Furthermore, LABG patients have to follow stringent dietary regimens to be successful. Despite these reservations, LABG certainly currently appears to be the procedure of choice both because it is theoretically reversible and has such low perioperative complication rates.
While we of course all wish that there was no need to reach for such drastic treatments in kids, the reality is that an increasing number of severely obese adolescents and kids will no doubt benefit and will get a real chance at regaining control over their weight and lives.
I predict that Toronto’s Sick Kids is very unlikely to remain the only place in Canada that performs pediatric bariatric surgery for long.
Monday, February 8, 2010
These patients need the best treatment possible, including surgery.
Prevention is too late for these kids, however it’s needed for younger kids, the overweight-and-still-gaining kids who without help will be bariatric surgery patients in a few years. Doctors know that. Parents, even caring parents, can be blind, figuring their chubby child doesn’t really have a problem unless he looks worse than someone on The Biggest Loser.