Pediatric Metabolic and Bariatric Surgery

Steinhart, Adi; Tsao, Deborah D.; Pratt, Janey

doi:10.1016/j.suc.2020.12.007

Cited by 10 publications

(8 citation statements)

References 72 publications

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“…Recent clinical practice standards from the European Association for Endoscopic Surgery are very similar to the recommendations put forward by the ASMBS. Possible candidates for MBS include individuals with a BMI of 40 kg/m 2 , those with a BMI of 35-40 kg/m 2 and comorbidities, and those with a BMI of 30-35 kg/m 2 who have poorly managed type 2 diabetes possibly with arterial hypertension despite adequate pharmacological therapy [8].…”

Section: Discussion Of Mbs For Use In Children and Adolescentsmentioning

confidence: 99%

“…In addition, the guidelines recommend that surgery should be considered after a comprehensive evaluation by a multidisciplinary team and implementation of a referral program designed to direct patients to facilities that provide specialized focused metabolic and bariatric surgical services [6]. Despite robust evidence indicating the safety and efficacy of MBS, it remains underutilized among the pediatric population [8]. Young people who are thinking about having metabolic or bariatric surgery are held to stricter criteria than adults.…”

Section: National and International Practice Guidelinesmentioning

confidence: 99%

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Improving Access to Child and Adolescent Weight Loss Surgery: A Review of Updated National and International Practice Guidelines

Elkhoury¹,

Elkhoury²,

Gorantla³

2023

Cureus

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The rise of childhood obesity is a growing concern due to its negative impact on health. Metabolic bariatric surgery (MBS) has gained popularity as an effective and adequate intervention for children and adolescent patients living with severe obesity. Nonetheless, access to MBS for this population is still limited. The objective of this paper is to conduct a comprehensive review of the latest national and international practice guidelines and improve access to MBS for children and adolescents. The paper focuses on the recommendations from the 2023 American Academy of Pediatrics (AAP) and 2022 guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Recently updated guidelines from the ASMBS and IFSO aim to improve access to MBS for children and adolescents and recommend patient selection, preoperative evaluation, and postoperative care. While lifestyle changes, medication, and behavioral therapy are commonly prescribed, they often fail to achieve permanent weight loss and its maintenance. Weight-loss surgeries like sleeve gastrectomy (SG) and gastric bypass (RYGB) show promising results in managing severe obesity in adolescents. SG has become the preferred method for treating severe obesity in adolescents, surpassing RYGB. Weight stigma is also explored in this review, revealing its negative effects on individuals who are overweight and underweight. Furthermore, telehealth is identified as an increasingly valuable tool for managing pediatric obesity, as it can improve access to care, particularly for those in remote areas where physicians trained to treat childhood obesity and the shortage of bariatric surgeons experienced in treating younger adolescents and pediatricians with advanced training are major obstacles.

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Section: Discussion Of Mbs For Use In Children and Adolescentsmentioning

confidence: 99%

Section: National and International Practice Guidelinesmentioning

confidence: 99%

Improving Access to Child and Adolescent Weight Loss Surgery: A Review of Updated National and International Practice Guidelines

Elkhoury¹,

Elkhoury²,

Gorantla³

2023

Cureus

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“…Arguments in favor of an early surgical approach are based on the evidence that the efficacy of surgery is reduced over time and that adolescent obesity is more intractable and sustained than obesity in adults [ 66 , 67 ]. The recent American Society of Metabolic and Bariatric Surgery (ASMBS) guidelines outline the inclusion criteria for pediatric and adolescent bariatric surgery; with the significant improvement in long term data, they are less controversial than previous guidelines which often presented ethical concerns and scarcity of long-term data [ 58 , 68 ]. It must be noted that the criteria for being considered for metabolic and bariatric surgery as a pediatric patient are stricter than those used for adults.…”

Section: Eligibility Criteria For Bariatric Surgerymentioning

confidence: 99%

Bariatric Surgery in Adolescents: To Do or Not to Do?

et al. 2021

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Pediatric obesity is a multifaceted disease that can impact physical and mental health. It is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors. In most cases lifestyle and behavioral modification as well as medical treatment led to poor short-term weight reduction and long-term failure. Thus, bariatric surgery should be considered in adolescents with moderate to severe obesity who have previously participated in lifestyle interventions with unsuccessful outcomes. In particular, laparoscopic sleeve gastrectomy is considered the most commonly performed bariatric surgery worldwide. The procedure is safe and feasible. The efficacy of this weight loss surgical procedure has been demonstrated in pediatric age. Nevertheless, there are barriers at the patient, provider, and health system levels, to be removed. First and foremost, more efforts must be made to prevent decline in nutritional status that is frequent after bariatric surgery, and to avoid inadequate weight loss and weight regain, ensuring successful long-term treatment and allowing healthy growth. In this narrative review, we considered the rationale behind surgical treatment options, outcomes, and clinical indications in adolescents with severe obesity, focusing on LSG, nutritional management, and resolution of metabolic comorbidities.

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“…Unfortunately, other parts of the world are rapidly catching up to these disturbing statistics. Even more disturbing is the fact that childhood obesity is also rising rapidly (discussed in [5][6][7]), findings that portend early development of severe health risks in young populations. Some organizations have supported the designation of obesity as a disease, but whether it is a disease or a condition that has consequences for subsequent increased risk for diseases such as type 2 diabetes, cardiovascular disease, cognitive decline, and development and progression of musculoskeletal diseases such as osteoarthritis, sarcopenia, and bone diseases, remains to be clarified.…”

Section: Introduction 1the Current Situationmentioning

confidence: 99%

“…It should be noted that it is not just obesity in adults that is concerning, but also obesity in childhood and adolescence which is also of epidemic proportions [6,7]. Certainly dealing with food deprivation during growth can have long term consequences regarding height, weight, the musculoskeletal system (i.e.…”

Section: Introduction 1the Current Situationmentioning

confidence: 99%

Obesity, the Obesity Epidemic, and Metabolic Dysfunction: The Conundrum Presented by the Disconnect between Evolution and Modern Societies

Hart¹

2021

JBiSE

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Currently, there is an obesity epidemic in the developed world, with both adults and children being affected. The consequences of this epidemic on health and health outcomes have impact at multiple levels, and it is increasing. The basis for this epidemic, which appears to have emerged with significance ~40 -50 years ago, is unknown but is believed by many to have much of its basis in poor diets and inactivity/sedentary behaviour. Analysis of the human genome has revealed >100 loci which exhibit risk for development of obesity. Why there are so many loci, and how they benefited humans evolutionarily are unknown. In spite of these limitations, there are urgent needs for effective short-term interventions to assist those with obesity, as well as longer-term needs to effectively prevent development of obesity. For the former, personalized exercise programs, use of prebiotics, optimal nutrition and surgical interventions can be effective for some individuals but more interventions that address cause are also needed. For longer term solutions more detailed genetic and epigenetic understanding of risk will be required. An attractive speculation is that the genomic risk factors for obesity (>100 identified) have been retained evolutionarily to address acute metabolic needs and current conditions have converted such risks to a chronic state, making reversal more difficult and with more consequences, including possible epigenetic modifications of risk genes. Other contributing factors to chronic obesity could also relate to chemical disruptors in the environment over the past 50+ years which may impact metabolic regulation via the established risk genomic risk factors or new variants. Therefore, to

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Pediatric Metabolic and Bariatric Surgery

Cited by 10 publications

References 72 publications

Improving Access to Child and Adolescent Weight Loss Surgery: A Review of Updated National and International Practice Guidelines

Improving Access to Child and Adolescent Weight Loss Surgery: A Review of Updated National and International Practice Guidelines

Bariatric Surgery in Adolescents: To Do or Not to Do?

Obesity, the Obesity Epidemic, and Metabolic Dysfunction: The Conundrum Presented by the Disconnect between Evolution and Modern Societies

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