A new policy statement from the American Academy of
Pediatrics (AAP) recommends that some severely obese preteens should be
considered for weight loss surgery. The new guidance is based on a review of
medical evidence showing that surgery in teens can result in lasting weight
loss with few complications. The paper has been published in the journal Pediatrics.
Over the last decade, studies have shown that weight-loss
surgery is safe and effective for children and teens when performed in
high-quality centers. Recent data shows that pediatric obesity surgery rates
have tripled in the past 20 years, but are still averaging fewer than 2,000
operations each year. There are nearly 5 million severely obese children and
teens in the U.S., with severe obesity defined as having a body mass index
(BMI) of at least 120 percent of the 95th percentile for one’s age and sex.
The new recommendation is meant to give pediatricians better
guidance about which patients should be referred and evaluated. It says
children and teens are generally eligible for surgery if their BMI is 40 or
higher. The BMI limit drops to 35 if they have related major health problems,
such as diabetes, high blood pressure, sleep apnea, or liver disease.
Studies cited in the paper included one study that followed
adolescents for up to 12 years post-surgery. That study found that after
surgery, the patient’s BMI dropped 29 percent, on average, and cases of
diabetes and high blood pressure fell significantly. On the other hand, severely
obese children who only made lifestyle changes were found to have gained weight
in the long term.
Many of the children who could benefit from obesity surgery
don’t undergo the procedure because most public and private health insurance won’t
cover it. Costs can total $20,000 or more. In its policy statement, the AAP
said that insurance should cover both the surgery and follow-up care in order
to enable more children with severe obesity to undergo the procedure.