AAP proposes expanding access to bariatric surgery for severely obese teens

According to updated recommendations from the American Academy of Pediatrics (AAP), access to bariatric surgery should be increased for patients 13–18 years of age who are severely obese. The guidelines were presented at the AAP 25 annual meetingOct. 29 in New Orleans and published in Pediatrics.

The document is based on the results of numerous studies that have proven the effectiveness of obesity surgery in pediatric patients. For example, Experts from Children’s Hospital Colorado found that that bariatric surgery resulted in equal weight loss in both adult and juvenile patients. Moreover, adolescents were able to achieve greater remission of comorbidities such as type 2 diabetes mellitus (T2DM) and hypertension.

Main provisions of the recommendations

  • Clinicians should be aware that children and adolescents with severe obesity, defined as a body mass index (BMI) ≥35 kg/m2, are at increased risk of developing liver disease, T2DM, dyslipidemia, obstructive sleep apnea, orthopedic complications, and psychiatric disorders (even compared to those with milder obesity). In this regard, pediatricians should refer such patients to highly qualified multidisciplinary centers for the treatment of this disease, including institutions that provide bariatric surgery services.
  • Parents’ best guide when deciding whether to undergo surgery is to learn about the effectiveness, risks, benefits, and long-term consequences of bariatric procedures.
  • Coordination of the pre- and postoperative periods should be a joint effort of the pediatrician, patient, parents, anesthesiologists and operating team.
  • During the postoperative period, pediatricians should monitor patients for micronutrient deficiencies and, if necessary, consider prescribing iron, folic acid, and vitamin B supplements.12.
  • In addition, postoperative monitoring involves monitoring patients for risk behaviors and mental health problems.
  • The AAP also called on pediatricians to expand access to bariatric surgery services to all eligible patients, regardless of their race, ethnicity, or socioeconomic status.

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