Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity

Abstract

Severe obesity affects the health and well-being of millions of children and adolescents in the United States and is widely considered to be an "epidemic within an epidemic" that poses a major public health crisis. Currently, few effective treatments for severe obesity exist. Metabolic and bariatric surgery are existing but underuse treatment options for pediatric patients with severe obesity. Roux-en-Y gastric bypass and vertical sleeve gastrectomy are the most commonly performed metabolic and bariatric procedures in the United States and have been shown to result in sustained short-, mid-, and long-term weight loss, with associated resolution of multiple obesity-related comorbid diseases. Substantial evidence supports the safety and effectiveness of surgical weight loss for children and adolescents, and robust best practice guidelines for these procedures exist. DEFINITION OF SEVERE OBESITY AND EPIDEMIOLOGY This technical report uses the term "pediatric" in reference to a person under 18 years of age. Although the term "adolescent" may be defined differently in various studies and clinical settings, this technical report uses "adolescent" to refer to a person aged 13 to 18 years. Although BMI percentile for age and sex is widely used to define weight status in the pediatric population regarding underweight, normal weight, overweight, and obesity, the BMI percentile, BMI z score, and several other established methods of measurement have significant limitations when applied to populations at the highest and lowest ends of the obesity spectrum. In addition, these measures often do not change greatly even when significant weight loss occurs. For these reasons, the preferred method of reporting weight status in severe obesity is as a percentage over the 95th BMI percentile for age and sex. 1 Although adults with class 2 obesity have an absolute BMI of 35 or higher, direct correlation within the pediatric population requires some additional consideration. Specifically, because BMI values increase over time from age 2 to 18 years, the use of absolute BMI is generally not considered an

Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US

“…A recent policy statement from the American Academy of Pediatrics (AAP) recommended improved access for pediatric patients "to multidisciplinary programs that provide high quality pediatric metabolic and bariatric surgery" with no lower age limit given emerging long-term outcome data (15,16,48). With this shift in policy comes an even greater role for pharmacotherapy treatment as prior studies have found that AOMs serve as a useful adjunct in postsurgical patients following bariatric surgery to treat inadequate WL or weight regain (49)(50)(51)(52)(53).…”

“…According to the most recently available data from the NHANES, the prevalence of severe obesity from 2015 to 2016 was 1.9% among children and adolescents 2 to 19 years old, with 4.5% of adolescents age 16-19 years old affected by severe obesity (1). While strides have been made toward encouraging the utilization of metabolic and bariatric surgery (MBS) for pediatric patients with severe obesity, with definitive guidance from organizations such as the American Academy of Pediatrics (AAP) and the American Society of Metabolic and Bariatric Surgery (ASMBS) (14)(15)(16)(17), there remains a gap in care for patients who have been refractory to lifestyle modifications but do not meet criteria for MBS.…”

Epidemiology, Predisposing Factors, Biomarkers, and Prevention Mechanism of Obesity: A Systematic Review

“…Surgery. Metabolic and bariatric surgery in the pediatric population provides evidence-based effective treatment of severe obesity and related comorbid diseases in the USA [87].…”

Racial Disparities in Obesity Treatment Among Children and Adolescents

“…There are many barriers regarding consideration of MBS among children and adolescents with severe obesity. While access to care is multifactorial, race and socioeconomic status is are important considerations in regard to insurance authorization for surgery [114]. Just under 50% of pediatric patients who qualify for surgery receive insurance coverage initially following request for authorization [114,115].…”

“…While access to care is multifactorial, race and socioeconomic status is are important considerations in regard to insurance authorization for surgery [114]. Just under 50% of pediatric patients who qualify for surgery receive insurance coverage initially following request for authorization [114,115]. While age less than 18 years old is the most common reason for denial, Perez and colleagues have shown authorization for bariatric surgery is most common among White females with private insurance [115].…”