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Physicians are looking for ways to combat rising rates of obesity. Getty Images
  • The American Academy of Pediatrics (AAP) is warning more needs to be done to fight the rising rates of severe obesity.
  • Currently, nearly 19 percent of children are considered to have obesity.
  • Now experts at the AAP want physicians to consider bariatric or gastric surgery for young patients.

To take on the growing epidemic of childhood obesity in the United States, the AAP supports expanded access to weight loss surgery for adolescents.

The AAP issued their first official policy statement on the subject over the weekend after a comprehensive review of the available data on the safety and effectiveness of metabolic and bariatric surgery in youth populations.

Authors of that policy statement warn of the rising rates of severe obesity. That’s defined as having a body mass index (BMI) equal to or greater than 35, which they call “an epidemic within an epidemic,” and one that can rarely be treated through the use of lifestyle and diet interventions alone.

Nearly 14 million children and adolescents in the United States, about 18.5 percent, are considered to have obesity. However, the AAP policy statement highlights the growing number with severe obesity.

According to the report, rates of severe obesity have nearly doubled since 1999. There are approximately 4.5 million children today who are considered to have severe obesity, or roughly one-third of the total population of children with obesity.

Severe obesity poses unique health problems as difficulties for treatment.

“Those kids are a really special group because they not only have such severe degrees of excess weight that they are unlikely to be able to lose that and be healthy by adulthood, but they also have developed the consequences of obesity, really serious health consequences, like diabetes and sleep apnea,” said Dr. Sarah Armstrong, a professor of pediatrics at Duke University and first author of the AAP’s policy statement.

“We’re not necessarily talking about risk for disease as adults. We’re talking about these children suffering with these diseases now,” she said.

Traditionally, the first line of treatment for obesity, especially in children and adolescents, is lifestyle interventions, including things like eating healthier foods and increasing exercise.

However, for individuals with severe obesity, these interventions may simply not be enough on their own.

That’s where the use of metabolic and bariatric surgery comes in. There are a variety of such procedures, but the three most common are Roux-en-Y gastric bypass (considered the gold standard for treating severe obesity in adults and adolescents alike), vertical sleeve gastrectomy, and laparoscopic adjustable gastric band.

Until recently, data on the safety and efficacy of such procedures in adolescent populations has been scant, but the AAP now says it has sufficient data to expand recommendations for patients who meet the right criteria.

The policy statement calls metabolic and bariatric surgery “a safe and effective strategy for groups of youth with severe obesity.”

To expand access, the AAP policy statement makes several key recommendations:

  • Both public and private insurers cover metabolic and bariatric surgery, preoperative, and postoperative care among pediatric patients.
  • Pediatricians should make timely referrals for surgery with patients with severe obesity.
  • Increase awareness of the safety and efficacy of metabolic and bariatric surgery among families and pediatricians alike.

Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, welcomes the AAP’s policy statement.

“Having performed bariatric surgery on teens for many years, there are few things as rewarding… Bariatric surgery has become safer, and teens that have had surgery, performance improves in school, they become more socially confident, and have greater optimism about their future,” he said.

“Morbid obesity is a tremendous barrier. Surgery improves medical and emotional performance,” Roslin said.

To form this conclusion, researchers culled data from a number of studies, including the Teen-LABS study, the largest ongoing youth cohort study of bariatric surgery to date. It enrolled 242 patients across five locations in the United States.

In the multiple studies cited by the AAP, adolescent patients who underwent metabolic and bariatric surgery showed improvements in both weight reduction and resolution of other associated health problems, such as high blood pressure and high cholesterol.

Nonetheless, these surgeries remain underutilized among adolescents.

And surgery isn’t for everyone.

“To be clear, the academy continues to support all the ongoing efforts to improve healthy food access and physical activity for all children, so weight loss surgery would not be for and is not now intended as a public health strategy,” Armstrong said.

For a select group of children and adolescents, it may be the only option. In light of that, Armstrong hopes that with the AAP’s guidance, such procedures will become more easy to obtain for those who really need them.

Other experts told Healthline they were generally supportive of the AAP’s new policy statement.

Dr. Michael Grosso, chief medical officer and chair of pediatrics at Northwell Health’s Huntington Hospital in New York, said the statement was “very important for primary care pediatricians and other professionals seeking to provide the best, evidence based care for their patients.”

However, he noted: “Severe obesity in adolescents is the ultimate ‘rock and a hard place’ dilemma. Most general pediatricians like myself are accustomed to focusing on healthy choices as the best, safest, and most natural approach to managing weight problems.”