More teens are getting weight loss surgery
Experts: Procedure only one solution to obesity
A new study has found the rate of weight loss surgery among teenagers has doubled in recent years, but experts argue the procedure is still severely underused in the United States.
Although dietary counseling and physical activity are important to any weight loss strategy, experts say obesity is a complex disease and treatment may require medical interventions in adults and teens alike.
Though research shows obesity rates are increasing among teens, experts say a number of structural and societal barriers – including stigma, insurance coverage, and a lack of awareness and education – continue to impede early treatment.
Experts say surgery is not right for everyone. Treatment for obesity is highly individualized and may incorporate medication or nutritional, psychological and exercise counseling.
“There are some individuals who are not suited for those things or they may be suited for one thing over another,” said Dr. Konstantinos Spaniolas, director of the Stony Brook Medicine Bariatric and Metabolic Weight Loss Center in Long Island, New York. “It’s often times a complex decision.”
Surgery trends in teens
The rate of weight loss procedures among adolescents ages 12 to 19 has doubled from 2010 to 2017, according to a study published Monday in Pediatrics, a journal by the American Academy of Pediatrics.
Researchers analyzed national data looking at metabolic and bariatric surgeries in the United States and found rates increased from 2.29 procedures per 100,000 population to 4.62. Study authors also found:
⬤ The average age of patients who had undergone the procedure decreased slightly from 18.10 in 2010 to 17.96 in 2017.
⬤ Patients were primarily white (45%), female (75.4%) and privately insured (53.4%) in 2017.
⬤ The percentage of teens with a BMI greater than 50 grew from 4.2% to 16.2%.
The American Society for Metabolic and Bariatric Surgery estimates about 1,600 pediatric bariatric and metabolic
surgeries are performed in the United
States a year, most commonly in those over 18.
This is “nowhere close to the appropriate utilization,” said Dr. Evan Nadler, director of the weight loss surgery program at Children’s National Hospital in Washington, D.C., who is unaffiliated with the study.
The Centers for Disease Control and Prevention defines obesity in the pediatric population as a body mass index (BMI) at or above the 95th percentile, according to the agency’s growth charts.
The American Society for Metabolic and Bariatric Surgery surgery can be recommended in children and adolescents with a body mass index (BMI) over 120% of the 95th percentile – which is considered severe obesity – plus a major health problem, or a BMI over 140% of the 95th percentile.
Racial and ethnic disparities
The study also highlights wide racial and ethnic disparities in weight loss surgery utilization, despite these marginalized groups experiencing higher rates of obesity.
In 2017, about 45% of adolescents who had weight loss surgery were white, 25.9% were Hispanic and 14.6% were Black. While the percentage of Hispanic teens saw an increase from 2010, the percentage of Black patients decreased.
Rates of obesity are highest among minority groups. From 2017 to 2018, study authors said the obesity prevalence for Hispanic and Black children ages 2 to 19 years was 25.6% and 24.2%,
respectively, compared with 16.1% for white children.
“Dramatic underutilization of surgical weight loss treatment has persisted among Black and Hispanic children in particular, despite irrefutable indications and multiple studies reporting favorable post-surgical outcomes and complications,” study authors said.
Health experts say lack of representation may partly be due to access and distrust in the medical system.
Stigma gets in the way
The CDC says about 6.1% of U.S. children and teens ages 2 to 19 have severe obesity, according to data collected from 2017 to 2018 in the National Health and Nutrition Examination Survey.
Health experts say early treatment helps avoid obesity-related health conditions as an adult – conditions including high blood pressure and cholesterol, Type 2 diabetes, breathing problems such as asthma and sleep apnea, joint problems and damage to organs.
But stigma and bias continue to be the biggest obstacles to adolescents receiving early weight loss treatment, experts say.
That is especially true when it comes to medications and surgical procedures.
“People are told by their friends and colleagues that it’s the ‘easy way out,’ ” Nadler said.
“They don’t understand (obesity) is a multifactorial disease that comes with multiple different flavors and requires individualized treatment,” not just diet and exercise.
Experts say the health care system itself is also a barrier:
⬤ Medicaid doesn’t cover weight loss medications.
⬤ Private insurance sometimes requires authorization for weight loss programs, medications and surgery.
⬤ Supply of weight loss drugs is limited and doesn’t meet demand.
⬤ “Pediatric providers are lagging behind adult providers with their knowledge and acceptance of weight treatments and interventions,” Nadler said.
Other options for weight loss
Surgery is not the only effective treatment at teens’ disposal.
Although experts say the procedure has been found to be safe and effective, many people may not want to take on common risks of surgery such as blood clots, infection, vitamin deficiency or bleeding.
Pharmaceutical company Novo Nordisk last week announced results of their latest clinical trial assessing the effectiveness of their weight loss drug semaglutide, sold under the brand name Wegovy.
Adolescents who received a weekly injection of the drug lost an average of 14.7% of their starting body weight, while those who got a placebo gained 2.7% of their initial weight.
Health experts say patients who take other medications on the market typically lose an average of 5% to 12% of their body weight.
“A medication like (Wegovy) is something we have been missing for a very long time,” Spaniolas said.
“They bridge the gap between older medications that had less effect as well as surgical interventions that can have more of an impact.”
Semaglutide mimics a naturally occurring hormone that tells the brain when the body is full after a meal.
The drug also slows down digestion so food stays in the stomach longer. The mechanisms work together to reduce appetite and increase fullness.
“Obesity is a chronic disease and it’s likely going to require all the interventions in some combination to come out with the best outcomes,” Nadler said. “It’s important to treat the disease of obesity as soon as it is impacting the mental or physical health of the child, regardless of age.”