Is Weight-Loss Surgery an Option for Preteens and Teens?

A 15-year-old weighing 270 pounds, an 18-year-old weighing nearly 400 pounds; they are both fighting a war they can’t win on their own―severe obesity.

According to national data, 4.5 million children in the United States are classified as “severely obese”―a number that has nearly doubled since 1999.

And unlike kids who may need to lose a few pounds, traditional dieting and exercise are not going to help these kids―who may also suffer from a host of other physical health problems such as diabetes, sleep apnea, and high blood pressure at very young ages. They need something more.    

Weight-loss surgery is one of the only evidence-based, safe, and effective ways shown to help preteens and teens struggling with severe obesity. The most common weight-loss surgery in the U.S.―the gastric sleeve and gastric bypass―help people lose about 30% of their bodyweight and keep it off. Unfortunately, it is widely underutilized by those who could benefit from it most.

The American Academy of Pediatrics (AAP) policy statement provides evidence and support for greater access for the procedure for adolescents with the condition.

At its core, severe obesity in children is what the AAP calls an “epidemic within an epidemic.”

According to the Centers for Disease Control and Prevention (CDC) 17% of children and adolescents struggle with obesity; that’s more than 12 million young people! And while many like to point fingers on who is to blame, researchers now see obesity as a genetic disease. Essentially, certain genes and traits make us more susceptible to overeating and gaining a lot of weight. Throw in the popularity of fast food, saturated fat, processed foods, and sugary beverages, and you have the 4.5 million children who are diagnosed with severe obesity. 

“Severe” obesity is defined as having a body mass index (BMI) that is = 120% of the 95th percentile for age and sex on the standard growth curve; this is generally of 35kg/m2 or greater.  

Children with severe obesity who are experiencing other weight-related health problems need effective treatment options.

“Is bariatric surgery right for my child?”

This question should be the primary focus in any shared-decision-making process; the decision to have any surgery―at any age―should be based on the risks of the surgery itself versus the risks of not having it. 

The AAP recommends a team-based approach to care for children with chronic conditions such as severe obesity.  Thorough evaluation and thoughtful, ongoing discussions about excess weight with primary care providers, specialists, and surgical teams―as well as mental health care providers and dietitians―are critical for making a shared decision on whether to have weight loss surgery.

When it comes to bariatric surgery for adolescents, there are risks for vitamin deficiencies and surgical complications. However, the reason to do surgery in the first place is to improve their long-term health as they grow into adulthood―a huge benefit! Bariatric surgery also appears to be as safe and effective for young patients as it is for adults.

Where to have the surgery? The AAP recommends bariatric surgery be performed at centers that have extensive pediatric surgical experience and full support from pediatric specialists who can fully evaluate and care for patients with severe obesity before and after surgery. Parents can search here for accredited weight-loss programs for adolescents.

When insurance is a problem.

Access to weight-loss surgery is a huge barrier across the US; insurance coverage―or lack thereof―plays a large role.

A 2014 study reported less than half (47%) of severely obese children had insurance that covered the surgery; “Under 18 years” was cited as the most common reason for coverage denial. Sadly, we also know adolescents from homes struggling to make ends meet and those of certain racial and ethnic minorities are the least likely to have access to weight-loss surgery.

The AAP recommends insurance companies cover bariatric surgery and all pre-operative and post-operative care. The AAP also recommends avoiding setting arbitrary age limits for coverage; rather the procedure should be considered for patients diagnosed with severe obesity.

The Obesity in Action Coalition has great tips on the specific exclusion and inclusion language to look for in your insurance policy. Parents can also send a copy of the AAP policy statement to their insurance company.  

Life after weight-loss surgery.  

There are specific nutrition and activity recommendations that must be followed after surgery; many programs and insurance companies actually require patients to learn about these things before even being considered for the surgery. It’s a big responsibility.

There is always uncertainty and variation at any age in terms of how people respond to bariatric surgery. Even from patients from the same family can respond differently.   

Adolescence may actually be the best time to have bariatric surgery; outcomes are encouraging.  

One study found 95% of teens who had Type 2 diabetes saw their diabetes resolve after receiving bariatric surgery and nearly 80% normalized their high blood pressure. These turnaround rates are better than what is documented among adults.

Another study found that up to eight years after surgery, teens typically lost about 30% of their original bodyweight and were seeing other incredible health benefits―including a higher sense of well-being and lower rates of depression and exclusion previously felt as a result of their weight.  

If your child is severely obese and suffering from additional health problems, weight-loss surgery may be an option. Talk with your child’s doctors. Remember, you are your child’s best health advocate.

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