Weight-Loss Surgery for Children: Why Pediatricians Say It’s Underutilized

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Experts say access needs to be expanded to weight-loss surgery for children. SDI Productions/Getty Images
  • Pediatricians say weight-loss surgery can be beneficial to children with obesity.
  • However, they say the procedure is underutilized, especially among certain demographic groups.
  • Experts say access to these surgeries needs to be expanded and insurance coverage also needs to be improved.

As childhood obesity rates continue to increase, so do surgical weight-loss procedures to help treat the condition.

However, those surgeries are not keeping pace with rising obesity rates, nor are they evenly distributed demographically among children who qualify for the procedure, a new study in the journal Pediatrics reports.

Between 2010 and 2017, pediatric metabolic and bariatric surgeries (MBS) for children and teens ages 19 and under with obesity increased from 2.2 to 4.6 per 100,000 patients with the condition, researchers stated. That includes procedures such as laparoscopic sleeve gastrectomy as well as gastric bypass surgery.

At the same time, researchers said that children who received the surgery were mostly white and female, even though pediatric obesity rates are highest among minority groups.

“Pediatric MBS is underutilized nationally with disproportionately lower rates among minority groups,” the study authors concluded.

“There are many barriers to weight-loss surgery not just for adolescents, but also for adults: insurance coverage, socio-economic barriers, and lack of information all impede access to surgery,” Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California, told Healthline.

“The study is not different from other studies that show that bariatric surgery is underutilized in all segments of the population. Furthermore, the study reinforced the barriers mentioned greatly contribute to much fewer people having the surgery,” he added.

Weight-loss surgery for children a ‘last option’

Weight-loss surgery for children and teens is a relatively new recommendation, with the American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee and the American Academy of Pediatrics (AAP) only updating their guidelines in 2019 to expand the inclusion of these procedures as a treatment for childhood obesity.

“Pediatric obesity is a complex health issue that requires a multidisciplinary approach to successful treatment,” the study authors noted. “Only recently has surgical intervention become an integral part of this algorithm for children.”

“Surgery is a last option,” Dr, Daniel Ganjian, a pediatrician at Providence Saint John’s Health Center in California, told Healthline. “First, we try nonpharmacologic measures like proper diet and exercise, then we will try medications, and reserve surgery as a last line intervention when all else has failed, and patients have medical/psychological problems due to their obesity.”

The benefits of children’s weight-loss surgery

After those options have been exhausted, weight-loss surgeries can give children with obesity a better chance at healthier outcomes, experts say — provided they have the right support system.

“In adolescents, a stable, supportive family is also very important to help them recover mentally, emotionally, and physically,” Ali said. They must also be able to understand the significant lifestyle change that is necessary after surgery.”

“As with any surgery, there are risks, though the risks are very low,” he added. “It also requires significant changes in eating habits that may be difficult for the average teenager to adapt to.”

Improving access to weight-loss procedures

Aside from racial disparities, the researchers also noted that most children who underwent MBS had private insurance, which also correlated with greater economic stability.

“In the present analysis, children undergoing MBS were predominantly privately-insured. However, enrollment in government-funded insurance programs such as Medicaid and Medicare increased over the study period, representing incremental progress in improving access to publicly insured youth,” the study others wrote.

“The lack of access to pediatric surgeons who have training and experience with this surgery, as well as the cost if the patient’s insurance will not cover the entire costs [are a barrier],” Ganjian said. “We have to make sure that anyone who medically needs the surgery should have access to it, and insurers should pay for it.”

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