NEWBERRY, FL -- Oct. 29, 2019 -- The American Academy of Pediatrics (AAP) has released a new policy statement, "Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices," calling for greater access to metabolic and bariatric surgery for children and adolescents with severe obesity, describing the surgery as "one of the few strategies that has been shown to be effective in treating the most severe forms of the chronic disease."
The American Society for Metabolic and Bariatric Surgery (ASMBS), the largest organization for bariatric surgeons in the nation, has endorsed the new policy statement, which recommends pediatricians refer patients to high-quality multidisciplinary centers that have extensive pediatric surgical experience and where pediatric specialists can evaluate and care for patients before and after metabolic and bariatric surgery. The statement also says public and private health insurance should cover the procedure and follow-up care.
"A significant body of evidence has been developed that shows metabolic and bariatric surgery is a safe and effective treatment for severe obesity in children and adolescents and age alone should not be a barrier to treatment," said Eric DeMaria, MD, President, ASMBS. "The ASMBS and AAP share a goal in increasing access to evidence-based treatments that reduce the burden of severe obesity and related diseases including type 2 diabetes, heart disease and hypertension, which are occurring more often in younger patients."
In 2018, the ASMBS updated its own pediatric metabolic and bariatric surgery guidelines from 2012 due to the significant increase in data supporting its use. The guidelines state that metabolic and bariatric surgery should be considered standard of care for children with severe obesity and that "children who suffer from obesity are at a significant disadvantage if they are denied metabolic and bariatric surgery."
The AAP policy statement was published on Oct. 27 in the journal Pediatrics. According to the AAP, severe obesity among youth is an "epidemic within an epidemic" and "portends a shortened life expectancy for today's children compared with those of their parents' generation." According to the group, lifestyle modification has achieved moderate short-term success among young children and those with less severe forms of obesity, but no studies demonstrate significant and durable weight loss among youth with severe obesity. Nearly 4.5 million adolescents in the U.S. have severe obesity.
A recent study in The New England Journal of Medicine found adolescents with severe obesity may experience even greater benefits than adults. The Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) found five years after gastric bypass, teens were more likely to experience diabetes (86% vs. 53%) and hypertension (68% vs. 41%) remission.[1]
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About Obesity
The Centers for Disease Control and Prevention (CDC) reports 93.3 million or 39.8 percent of adults in the U.S. had obesity in 2015-2016.[2] The ASMBS estimates about 24 million have severe obesity, which for adults means a body mass index (BMI) of 35 or more with an obesity-related condition like diabetes or a BMI of 40 or more. In 2017, 228,000 bariatric procedures were performed in the U.S., which is about 1 percent of the population eligible for surgery based on BMI.
About Metabolic and Bariatric Surgery
Metabolic/bariatric surgery has been shown to be the most effective and long-lasting treatment for severe obesity and many related conditions and results in significant weight loss.[3] The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques.[4] The risk of death is about 0.1 percent[5] and the overall likelihood of major complications is about 4 percent.[6] According to a study from the Cleveland Clinic's Bariatric and Metabolic Institute, laparoscopic bariatric surgery has complication and mortality rates comparable to some of the safest and most commonly performed surgeries in the U.S., including gallbladder surgery, appendectomy and knee replacement.[7]
About the ASMBS
The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of severe obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with severe obesity. For more information, visit http://www.asmbs.org.
[1] Inge, T. H. et al. (2019). Five-year outcomes of gastric bypass in adolescents as compared with adults. N Engl J Med. 2019;380:2136-2145. https://www.nejm.org/doi/full/10.1056/NEJMoa1813909.
[2] https://www.cdc.gov/obesity/data/adult.html
[3] Weiner, R. A., et al. (2010). Indications and principles of metabolic surgery. U.S. National Library of Medicine. 81(4) pp.379-394. https://www.ncbi.nlm.nih.gov/pubmed/20361370
[4] Encinosa, W. E., et al. (2009). Recent improvements in bariatric surgery outcomes. Medical Care. 47(5) pp. 531-535. Accessed October 2013 from http://www.ncbi.nlm.nih.gov/pubmed/19318997
[5] Agency for Healthcare Research and Quality (AHRQ). (2007). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Accessed October 2013 from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb23.jsp
[6] Flum, D. R., et al. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 361 pp.445-454. Accessed October 2013 from http://content.nejm.org/cgi/content/full/361/5/445
[7] Gastric Bypass is as Safe as Commonly Performed Surgeries. Health Essentials. Cleveland Clinic. Nov. 6, 2014. Accessed October 2017 https://health.clevelandclinic.org/2014/11/gastric-bypass-is-as-safe-as-commonly-performed-surgeries/
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PEDIATRICS