But What About the Children?

When I read the book about how to have a whiz-bang Blog, the first thing they said to do was to have a catchy title.  This one is kind of random, but it gets the point across.

As I write this entry, there really are two ways I can go with this one, so here's part 1.

Childhood Obesity and Surgery

You've heard all the statistics and seen the evidence these days.

Constant is the news regarding childhood obesity rates soaring, associated Diabetes also skyrocketing, and even Michelle Obama is in on the situation trying to clean up school lunches to help slow the pending epidemic.

We all know about adults with obesity, and its comorbidities, and it is frightful to consider what this group of kids / adolescents have in store for them over time if they can't get their behaviors back in check, such as increased regular energy expenditure / exercise, consistent portion control and more optimal and wholesome diets overall.

Anyone can pick their favorite aspect of the equation that needs to be altered in order to ensure improved health overall, both now and for future well being.  You may even have championed programs in your office based on your view of the main cause of childhood obesity, and the causative factors that bring about the problem. You've gotta start somewhere!

So the question is often asked- "What about kids or adolescents and surgery?"

More than 20 million adults and 2 million children and teenagers in the USA have extreme obesity (body mass index ≥ 40 kg/m²), a condition associated with premature morbidity and mortality. In adults, bariatric surgery results in prolonged weight control and improvement in serious obesity comorbidities . Bariatric surgery performed late in the course of comorbid conditions may not be as effective as surgery performed earlier. Based on these factors, we proposed that surgery for extreme adolescent obesity may be a beneficial option for highly selected teenagers, but large-scale prospective studies using reliable and valid measures that are systematic assessed are still lacking.

The data is currently being compliled, as the NIH is following 250 cases longitudinally.  The Teen- Longitudinal Assessment of Bariatric Surgery (LABS) was started in April 2006. Federally funded studies such as Teen-LABS are needed to provide answers to clinical and economic questions about the benefits and drawbacks of bariatric surgery in adolescents.


I came across an excellent article from the New York Times last year, as they followed the journey of an overweight adolescent who ended up having a LapBand placed.  Just as interesting, the article not only follows her for a year after surgery, but goes through some of the issues surrounding younger patients and surgery for weight loss: cost, insurance reimbursement, ethics of the procedure, behavior modification necessary, lack of success with other non-surgical methods and where that is headed if unchecked, the psychosocial nature of the adolescent patient, and what friends think of the whole situation (maybe the most important for her!).  In addition, find the link for the editorials written after the article to get a taste of just how polarizing an issue surgery for weight loss in adolescents really is.

Currently, at our office, we have approval to do surgery on patients that are 18 years or older.  There are programs, usually in academic centers, that do handle pediatric cases, usually as a part of a  multidisciplinary pediatric center for weight loss.

So, now for a tease for part 2....

The comorbidity that flies under the radar that is a challenge to treat, and is usually a diagnosis of exclusion after work-up is performed.

We commonly see this in result of successfully treating an obese female in our office quite a bit, whether it was an issue that was treated or formally diagnosed in the past. Sometimes that result is intentional, and sometimes not.

Part 2 will be about Infertility.