Washington: After observing serious problem of obesity and worsening public health, especially among children and adolescents, in a new study conducted by the American Academy of Pediatrics (AAP) has recommended greater access to metabolic and bariatric surgery for effective treatment of diseases.
The has been published in the journal — ‘Pediatrics.’
In the study, the AAP describes severe obesity among children and adolescents as an “epidemic within an epidemic,” one that portends a dramatically shortened life expectancy for today’s generation compared to their parents.
Few strategies have proven effective in helping people who have the most severe forms of obesity to lose weight. Among children and adolescents with less severe forms of obesity, lifestyle modifications have shown a moderate success.
But these strategies have not worked as well for young people with severe obesity, which is defined as having a body mass index (BMI) of at least 120 per cent of the 95th percentile for age and sex, which roughly equals 35kg/m2 or greater. Recent evidence shows that surgical treatment is safe and effective, but it is widely underutilised.
“Children with severe obesity develop health problems earlier than those with lesser degrees of obesity, including diabetes, high blood pressure, fatty liver disease, and sleep apnea,” says paediatrician Sarah Armstrong, MD, FAAP, lead author of the policy statement.
“While lifestyle changes remain the mainstay of treatment, medical care is unlikely to significantly change the trajectory for most children with severe obesity,” adds Armstrong, also a member of the Executive Committee of the AAP Section on Obesity.
“The last decade of evidence has shown surgery is safe and effective when performed in high-quality centres, with the primary care paediatrician and family in a shared decision-making process. Unfortunately, we see significant disparities in which patients have access to bariatric surgery.
Surgery needs to be an option for all qualifying patients, regardless of race, ethnicity or income.”
Studies of adolescents and young people who have undergone bariatric surgery have found significant long-term reductions in weight and comorbid chronic diseases. In one study that followed adolescents up to 12 years post-surgery, it found an average 29 per cent reduction in BMI for patients undergoing one type of surgery, and significant reductions in diabetes and high blood pressure. By contrast, adolescents enrolled in a lifestyle modification program saw their BMIs increase.
Recent data from the National Health and Nutrition Examination Survey report the prevalence of severe obesity in youth at 7.9 per cent. Among 12- to 15-year-olds, 9.7 per cent have severe obesity, and among 16- to 19-year olds, it is 14 per cent. This is roughly double the prevalence in 1999.
The AAP recommends paediatricians refer patients to high-quality multidisciplinary centres that have extensive pediatric surgical experience and where pediatric specialists can evaluate and care for patients before and after surgery.
Insurance should cover the procedure and follow-up care, according to the AAP. The AAP also recommends avoiding setting arbitrary age limits; rather the procedure should be considered for any patient with severe obesity who meets the criteria for surgery.
“The decision to have metabolic and bariatric surgery should be based on the health and needs of the individual patient,” said pediatric surgeon Marc Michalsky, MD, FACS, FAAP, FASMBS, one of the authors of the policy statement.
“This should be a thoughtful, collaborative decision made between the patient, their parents, and their medical and surgical team, based on their body mass index, other health conditions and quality of life.”
Currently, access to bariatric surgery is often limited by a lack of insurance coverage, as well as a scarcity of qualified centres. Patients from lower socioeconomic groups and racial and ethnic minorities suffer the highest-burden of severe obesity, yet are least likely to have metabolic and bariatric surgery.
AAP recommends paediatricians, government, medical centres, and insurers work on strategies to reduce barriers and improve access to surgery so that more children and adolescents can receive the health care they need.