Developing Criteria for Pediatric/Adolescent Bariatric Surgery Programs

Michalsky, Marc P.; Krämer, Robert; Fullmer, M A; Polfuss, Michele; Porter, Renee; Ward-Begnoche, Wendy; Getzoff, Elizabeth A.; Dreyer, M; Stolzman, Stacy; Reichard, Kirk W.

doi:10.1542/peds.2011-0480f

Cited by 69 publications

(36 citation statements)

References 11 publications

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“…314,315 Perioperative and longer term risks must be acknowledged, 309,316 and bariatric surgery among severely obese adolescents is a viable option, 317,318 but further research is required to determine the long-term effectiveness of this approach.…”

Section: Bariatric Surgery For Obesity and Risk Factor Reduction In Pmentioning

confidence: 99%

An evolving scientific basis for the prevention and treatment of pediatric obesity

et al. 2014

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The 2013 Pennington Biomedical Research Center’s Scientific Symposium focused on the treatment and management of pediatric obesity and was designed to (i) review recent scientific advances in the prevention, clinical treatment and management of pediatric obesity, (ii) integrate the latest published and unpublished findings and (iii) explore how these advances can be integrated into clinical and public health approaches. The symposium provided an overview of important new advances in the field, which led to several recommendations for incorporating the scientific evidence into practice. The science presented covered a range of topics related to pediatric obesity, including the role of genetic differences, epigenetic events influenced by in utero development, pre-pregnancy maternal obesity status, maternal nutrition and maternal weight gain on developmental programming of adiposity in offspring. Finally, the relative merits of a range of various behavioral approaches targeted at pediatric obesity were covered, together with the specific roles of pharmacotherapy and bariatric surgery in pediatric populations. In summary, pediatric obesity is a very challenging problem that is unprecedented in evolutionary terms; one which has the capacity to negate many of the health benefits that have contributed to the increased longevity observed in the developed world.

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Section: Bariatric Surgery For Obesity and Risk Factor Reduction In Pmentioning

confidence: 99%

An evolving scientific basis for the prevention and treatment of pediatric obesity

et al. 2014

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“…1, (15,16)). Despite only limited evidence for bariatric interventions, the authors aim to provide guidance for clinical scenarios of complicated obesity in the presence of advanced NAFLD when all of the established therapy has failed.…”

Section: Introductionmentioning

confidence: 99%

Indications and Limitations of Bariatric Intervention in Severely Obese Children and Adolescents With and Without Nonalcoholic Steatohepatitis

Nobili

Vajro

Dezsőfi

et al. 2015

J. pediatr. gastroenterol. nutr.

103

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Morbid obesity is strongly associated with nonalcoholic fatty liver disease (NAFLD), which is one of the most common causes of chronic liver disease worldwide. The present best treatment for NAFLD and nonalcoholic steatohepatitis (NASH) is weight reduction through lifestyle modification. Because of frustrating inefficiency of such a therapeutic approach, bariatric surgery is increasingly performed in adolescents as an alternative option for weight reduction. Standards of care and consensus for indications are, however, scarce. We explore the indications and limitations of bariatric surgery in children with severe obesity with and without NASH and aim to provide guidance for the exceptional indications for adolescents with extreme obesity with major comorbidity that may benefit from these controversial interventions. Present evidence suggests that bariatric surgery can decrease the grade of steatosis, hepatic inflammation, and fibrosis in NASH. Uncomplicated NAFLD is not an indication for bariatric surgery. Roux-en-Y gastric bypass is considered a safe and effective option for adolescents with extreme obesity, as long as an appropriate long-term follow-up is provided. Laparoscopic adjustable gastric banding has not been approved by the Food and Drug Administration for use in adolescents and therefore should be considered investigational. Finally, sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults, still need to be considered investigational. Temporary devices may be increasingly being used in pediatrics; however, future studies, including a long-term risk analysis of patients who undergo surgery, are much needed to clarify the exact indications for bariatric surgery in adolescents.

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“…Adolescents currently constitute a very small proportion of the total number of bariatric surgeries; estimated to be less than 1% (770 total procedures) based on hospital discharge rates in 2003 (Tsai et al, 2007). Rates were similar based on data collected in 2010 in the American Society for Metabolic and Bariatric Surgery (ASMBS) centre-of-excellence programmes (Michalsky et al, 2011). However, numbers have increased signifi cantly in recent years; 3-fold between 1996 and 2003 (Tsai, et al, 2007).…”

Section: Adolescent Bariatric Surgerymentioning

confidence: 93%

Bariatric surgery in adolescents: What's the rationale? What's rational?

Austin

Smith

Ward

2012

International Review of Psychiatry

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Rates of obesity in adolescents continue to rise, and available lifestyle and pharmacological interventions have had limited success in reducing excess weight and risk for comorbid health issues. However, ongoing health risks, psychosocial issues, and increased risk of mortality place these adolescents in jeopardy and warrant ongoing investigation for available treatments. Bariatric surgery for adults has had positive medical and psychological outcomes. However, bariatric surgery is a relatively new option for adolescents. Initial fi ndings suggest positive results for excess weight loss and psychosocial improvements, but not without possible risks. Selection of appropriate candidates is essential in the process, specifi cally considering developmental maturity, family support, and resultant disease burden without surgery. Surgery is not a panacea for the obesity epidemic. Outcome studies are limited and long-term results are unknown, but for extremely obese adolescents, bariatric surgery is promising and should be considered a viable option for appropriate adolescent candidates.

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Developing Criteria for Pediatric/Adolescent Bariatric Surgery Programs

Cited by 69 publications

References 11 publications

An evolving scientific basis for the prevention and treatment of pediatric obesity

An evolving scientific basis for the prevention and treatment of pediatric obesity

Indications and Limitations of Bariatric Intervention in Severely Obese Children and Adolescents With and Without Nonalcoholic Steatohepatitis

Bariatric surgery in adolescents: What's the rationale? What's rational?

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