Obesity is a serious problem amongst all age groups, and we are seeing obesity affect younger individuals in higher numbers. It is estimated that 18% of American adolescents and 9% of Canadian adolescents are obese. In adults, bariatric (weight loss) surgery is increasing recognized as an important treatment option for adults who suffer from severe or complicated obesity, in whom all other treatment options have been unsuccesful. As such, the question is being raised as to whether adolescents with severe obesity should be considered for weight loss surgery.
This complex issue was discussed at the Canadian Obesity Summit last weekend in Montreal. I had the pleasure of hearing several speakers from both the US and Canada, sharing their experiences on this issue.
Dr Evan Nadler, pediatric surgeon at the George Washington University School of Medicine & Health Sciences, discussed the various types of weight loss surgeries and the known data to date. So far, preliminary evidence suggests that lap banding may be the most appropriate surgery to consider in this age group. Early data suggests that the risks of gastric bypass surgery may be unacceptably high amongst teens, and there is little data regarding sleeve gastrectomy. All three of these surgeries are being actively studied.
Dr Jill Hamilton, pediatric endocrinologist at the Hospital for Sick Children in Toronto presented the STOMP (SickKids Team Obesity Management Program), an innovative program which provides multidisciplinary support to adolescents with obesity, and for the appropriate candidate, bariatric surgery. Five patients have been operated so far (with the first ones being done in October 2010), and this is the only pediatric Canadian site that is currently exploring this area.
Dr Beth Dettner, PhD and psychologist who works with the adolescents in the STOMP program, provided a poignant review of the psychological complexities of this population. There are several challenges involved in selecting the appropriate teen for bariatric surgery: assessing for psychological conditions like depression, anxiety, and eating disorders, assessing family functioning and support for surgery, patients’ and parents’ understanding of the surgery and required diet and activity behaviours, the teen’s coping skills, and their motivations for surgery are all key components.
I found this to be an absolutely fascinating workshop, and I have a deep and renewed respect for the challenges that face adolescents with obesity, and their health care professionals as they work with these patients to find the most appropriate and successful treatment options. Elements ranging from the high prevalence of binging and purging behaviours (as high as 30%), to the potential impact of gastric bypass surgery on accrual of peak bone mass, to the possibility of parental coercion to have the surgery, to the challenges of compliance with follow up, to specific motivations for desired weight loss (and the list goes on) all need special consideration in this population, and must be very carefully weighed against the potential weight, health, and psychosocial benefits that can result from successful bariatric surgery.
Dr. Sue © 2011 www.drsue.ca firstname.lastname@example.org
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