The Mercury News

Severely obese preteens should get surgery, doctors group says

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Even some severely obese preteens should be considered for weight loss surgery, according to new recommenda­tions.

The guidance issued today by the American Academy of Pediatrics is based on a review of medical evidence, including several studies showing that surgery in teens can result in marked weight loss lasting at least several years, with few complicati­ons. In many cases, related health problems, including diabetes and high blood pressure, vanished after surgery.

Although most of those studies involved teens, one included children younger than age 12 and found no ill effects on growth, the policy says.

“Safe and effective is the message here,” said Dr. Sarah Armstrong, a Duke University pediatrics professor and the policy’s lead author.

Armstrong said that children who have not gone through puberty may not be mature enough to understand the life-changing implicatio­ns of surgery but that age alone shouldn’t rule it out. She doesn’t do surgery but works at a center that offers it; the youngest patient was 14.

It’s not a quick fix, she said. “It’s a lifelong decision with implicatio­ns every single day for the rest of your life.”

Nearly 5 million U.S. children and teens are severely obese, a near doubling over 20 years. Many have developed related health problems, including diabetes, high blood pressure, sleep apnea and liver disease.

But most kids don’t get obesity surgery, mainly because most public and private health insurance doesn’t cover it or they live far from surgery centers, Armstrong said. Costs can total at least $20,000.

Resistance from pediatrici­ans is another obstacle. Many prefer “watchful waiting,” or think surgery is risky or will alter kids’ growth. Some don’t recommend surgery because they think “weight is a personal responsibi­lity rather than a medical problem,” the new policy states.

Dr. Rebecca Carter, an assistant professor of pediatrics at the University of Maryland School of Medicine, said the new recommenda­tions give pediatrici­ans better guidance about which patients should be referred and evaluated.

Recent data show that pediatric obesity surgery rates have tripled in almost 20 years but still average fewer than 2,000 operations each year.

The academy’s recommenda­tions say children and teens are generally eligible for surgery if their body mass index is 40 or higher, or at least 35 if they have related major health problems.

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