Bariatric surgery for adolescents: How young is too young?

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Bariatric surgery for adolescents: How young is too young?

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Volume 12
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Issue 4
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Childhood obesity in the US has skyrocketed over the last 40 years.  The number of obese children increased, and so has the severity of obesity, putting millions of US children at risk for health problems such as type 2 diabetes, sleep apnea, liver disease and hypertension.

Bariatric surgery is sometimes considered as a possible treatment option for severe obesity.   Despite its benefits, bariatric surgery carries potential risks, which are not fully defined for adolescent patients.   There is no standard age at which bariatric surgery is presented as an option to severely obese adolescents.

The C.S. Mott Children’s Hospital National Poll on Children’s Health asked parents about their views on bariatric surgery for severely obese adolescents.

Minimum age for bariatric surgery

Overall, less than a third of parents thought bariatric surgery should be an option for adolescents younger than 18 years old. Black and Hispanic parents were more likely than white parents to consider bariatric surgery for younger adolescents (Figure 1).  In contrast, 13% of parents felt bariatric surgery should not be an option at any age – including 1 in 5 Black parents.  Among all groups, the most common viewpoint was that bariatric surgery should be delayed until the adolescent is 18 or older.

In addition to the racial differences, parents who know someone who has considered bariatric surgery, or have considered it for themselves, were more likely to view surgery as an option for adolescents under 18.

Weight loss efforts prior to bariatric surgery

Participation in a weight loss program is recommended prior to bariatric surgery.  In this poll, 70% of parents thought adolescents’ pre-surgery weight loss program participation should be one year or longer; 17% thought 6 to 12 months; and 13% felt it is acceptable for adolescents to have less than 6 months or no weight loss program at all prior to bariatric surgery.  Non-white parents and those with personal experience considering bariatric surgery were more likely to endorse a shorter time in a weight loss program prior to surgery.  

Bariatric Surgery for Adolescents

Highlights

  • Over two-thirds of parents feel bariatric surgery should not be an option for adolescents under age 18.
  • Non-white and low-income parents, and those with personal experience considering bariatric surgery, are more likely to consider this option for adolescents under age 18. 
  • Most parents think adolescents should participate in a weight loss program for at least a year prior to consideration of bariatric surgery.

Implications

As the prevalence of severe obesity has increased, so has the number of bariatric surgeries performed in the US.  Medical guidelines suggest that adolescents as young as 13 might be considered for bariatric surgery after at least 6 months of intensive weight loss efforts.  During this time patients and their parents have the opportunity to implement lifestyle changes that are important to postoperative success.  

This includes adopting a low-fat, low-calorie diet, and implementing a regular exercise routine. Continuing these behaviors and taking regular supplemental vitamins and proteins following surgery are required to avoid life-threatening complications.  It is critically important that adolescents and their parents understand the risks and benefits of bariatric surgery and are fully committed to following all medical recommendations.  Therefore, decisions about bariatric surgery for adolescents require careful consideration.

This poll showed that in general, parents are reticent about bariatric surgery for adolescents and are cautious regarding the need for long term weight loss efforts before progressing to bariatric surgery.  However, non-white parents appear more willing to consider bariatric surgery for adolescents, and after a shorter interval of weight-loss effort. This  more-expansive  view of bariatric surgery may be due to their greater experience with the effects of obesity or  because they believe other treatment options are not readily accessible or effective.  Further work is required to explore the optimal circumstances under which severely obese adolescents might benefit from surgery. 

Press Releases

Majority of parents reticent about bariatric surgery for adolescents; prefer longer pre-surgery weight-loss program. Minority and low-income groups are more receptive.

Data Source

This report presents findings from a nationally representative household survey conducted exclusively by Knowledge Network, Inc. (KN), for C.S. Mott Children’s Hospital via a method used in many published studies.  The survey was administered in January 2011 to a randomly selected, stratified group of parents  age 18 and older (n= 1,551) from the KN standing panel that closely resembles the U.S. population.  The sample was subsequently weighted to reflect population figures from the Census Bureau.  The survey completion rate was 54% among parent panel members contacted to participate.  The margin of sampling error is ± 2 to 9 percentage points.

Findings from the C.S. Mott Children's Hospital National Poll on Children's Health do not represent the opinions of the investigators or the opinions of the University of Michigan.  The University of Michigan reserves all rights over this material.

Citation

Davis MM, Woolford SJ, Singer DC, Butchart AT, Clark SJ. Bariatric surgery for adolescents: How young is too young? C.S. Mott Children’s Hospital National Poll on Children’s Health, University of Michigan. Vol 12, Issue 4, May 2011. Available at: http://mottpoll.org/reports-surveys/bariatric-surgery-adolescents-how-young-too-young.

Contributing Faculty

Susan J. Woolford, MD, MPH

Poll Questions