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Heavy obese children need to undergo surgery, says MD group



Even some highly obese predecessors need to be considered for weight loss surgery according to new recommendations.

The guide, issued Sunday by the American Academy of Pediatrics, is based on a review of medical evidence, including several studies showing that surgery in teens can lead to noticeable weight loss of at least several years, with few complications. In many cases, the associated health problems, including diabetes and high blood pressure, disappeared after surgery.

While most of these studies involved teenagers, one included children under the age of 12 and did not detect any adverse effects on growth,

"The safe and effective message is here," said Dr. Sarah Armstrong , a professor of pediatrics at Duke University and a leading author of politics.

Armstrong said that children who have not passed puberty may not be mature enough to understand the changes that change life surgery, but that age alone should not rule it out. She does not have surgery, but works at a center that offers her; the youngest patient is 14.

It's not a quick decision, she said. "It's a lifelong decision with consequences every day for the rest of your life."

Nearly 5 million American children and teenagers are severely obese, nearly doubling over 20 years. Many have already developed related health problems, including diabetes, high blood pressure, sleep apnea and liver disease. But most children do not get surgery for obesity, mainly because most state and private health insurance does not cover it or live far away from surgery centers, Armstrong said. The cost can be at least $ 20,000.

Pediatrician resistance is another obstacle. Many prefer "waiting carefully" or think the surgery is risky or will change the growth of children. Some do not recommend surgery because they believe that "weight is a personal responsibility, not a medical problem," the new policy states.

Dr. Rebecca Carter, associate professor of pediatrics at the University of Maryland, School of Medicine, said the new recommendations gave pediatricians better guidance on which patients should be referred and evaluated

Recent evidence suggests that the incidence of obesity surgery in children have tripled in almost 20 years, but still average less than 2000 surgeries each year.

An academy recommendation states that children and teens are usually eligible for surgery if their body mass index is 40 or higher, or at least 35 if they have major health issues. These criteria may vary by gender and age, Armstrong said. They are similar to the criteria for surgeons by the American Society for Metabolic and Bariatric Surgery. BMI of 30 or more is considered obesity.

Vera Newsom was a typical patient. At 5 feet, 8 inches and 273 pounds, her BMI was nearly 42 and had high blood pressure and prediabetes when she underwent gastric bypass surgery at Duke at 16 years old. After about a year she lost 100 pounds and these health problems disappeared, She lost weight enough to go in for sports, buy ball gowns and get a better image. But to avoid malnutrition, she takes vitamins, needs to eat small meals and becomes ill if she eats foods high in fat or sugar. Her BMI, just under 30, puts her in the overweight range.

Now 21 years old and a senior at the University of North Carolina at Chapel Hill, Newsome is in a hurry to say no regrets.

"Never," she said. "Teens should be able to discuss each option with their doctors and surgery should be one of those options.

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Follow AP Medical Writer at @LindseyTanner.

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