Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices

@article{Armstrong2019PediatricMA,
  title={Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices},
  author={Sarah C. Armstrong and Christopher Bolling and Marc P. Michalsky and Kirk W. Reichard},
  journal={Pediatrics},
  year={2019},
  volume={144}
}
Severe obesity among youth is an “epidemic within an epidemic” and portends a shortened life expectancy for today’s children compared with those of their parents’ generation. Severe obesity has outpaced less severe forms of childhood obesity in prevalence, and it disproportionately affects adolescents. Emerging evidence has linked severe obesity to the development and progression of multiple comorbid states, including increased cardiometabolic risk resulting in end-organ damage in adulthood… 

Tables from this paper

Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity

TLDR
Roux-en-Y gastric bypass and vertical sleeve gastrectomy are the most commonly performed metabolic and bariatric procedures in the United States and have been shown to result in sustained short, mid, and long-term weight loss, with associated resolution of multiple obesity-related comorbid diseases.

Bariatric surgery in the treatment of adolescent obesity: current perspectives in the United States

TLDR
Metabolic and bariatric surgery is the most effective treatment available for adolescents with Class 2 and above severe obesity and has demonstrated variable degrees of sustained long-term weight loss which leads to resolution of multiple associated conditions and an improved quality of life.

Pharmacologic Weight Management in the Era of Adolescent Obesity.

TLDR
This publication focuses on recent advances in pharmacotherapy of obesity with an emphasis on medications approved for common and rarer monogenic forms of pediatric obesity, both those approved for weight reduction in children and "off-label" medications that have a broad safety margin.

High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity.

Pharmacotherapy in pediatric obesity: current evidence and landscape.

TLDR
Rigorous research and improved education of providers about weight loss medications may address the huge treatment gap in severe pediatric obesity.

Overview and Management of Childhood Obesity

TLDR
Initial management of obesity at the pediatrician’s office includes lifestyle modification and behavioral-psychological support and is critically important for the amelioration of obesity and prevention of associated comorbidities.

Pilot Evaluation of a Multidisciplinary Strategy for Laparoscopic Sleeve Gastrectomy in Adolescents and Young Adults with Obesity and Intellectual Disabilities

TLDR
The development of a pilot program for the evaluation and treatment of children with ID referred for MBS is described, and the feasibility of such an approach to promote weight loss and possible improvement in obesity-related medical comorbidities in this population is demonstrated.

Bariatric Surgery in Adolescents

TLDR
Effective management of obese adolescents requires early referral, a multidisciplinary team approach, and early identification of potential surgical candidates.

Racial Disparities in Obesity Treatment Among Children and Adolescents

TLDR
The reviewed studies show the role of race on disease treatment and increased research efforts, especially in pharmacotherapy and metabolic and bariatric surgery (MBS), will help combat obesity in pediatric communities of color.

Surgery for the treatment of obesity in children and adolescents.

TLDR
Laroscopic gastric banding led to greater body weight loss compared to a multi-component lifestyle program in one small study with 50 participants, and a high risk of bias was identified.
...

References

SHOWING 1-10 OF 65 REFERENCES

Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches A Scientific Statement From the American Heart Association

TLDR
This scientific statement is to provide justification for and recommend a standardized definition of severe obesity in children and adolescents, and raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks, and challenges and shortcomings of currently available treatment options.

Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity

TLDR
Roux-en-Y gastric bypass and vertical sleeve gastrectomy are the most commonly performed metabolic and bariatric procedures in the United States and have been shown to result in sustained short, mid, and long-term weight loss, with associated resolution of multiple obesity-related comorbid diseases.

ASMBS pediatric metabolic and bariatric surgery guidelines, 2018.

  • J. PrattA. Browne J. Zitsman
  • Medicine
    Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
  • 2018

Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement

TLDR
It is concluded with moderate certainty that screening for obesity in children and adolescents 6 years and older is of moderate net benefit and clinicians should offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status.

Cardiovascular Risk Factors After Adolescent Bariatric Surgery

TLDR
In adolescents undergoing bariatric surgery, girls, those with greater weight loss, and younger individuals had greater improvements in multiple CVD-RFs, while older participants at time of surgery were less likely to resolve dyslipidemia and girls were more likely than boys to demonstrate improvements in EBP.

Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Obese Adolescents

TLDR
Compared with medical therapy, surgical treatment of severely obese adolescents with type 2 diabetes was associated with better glycemic control, reduced weight, and improvement of other comorbidities, which support the need for a well-designed, prospective controlled study to define the role of surgery for adolescents withtype 2 diabetes.

Comparative effectiveness of bariatric procedures among adolescents: the PCORnet bariatric study✩

  • T. IngeR. Coley M. Michalsky
  • Medicine
    Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
  • 2018

Sex, Race, and Consideration of Bariatric Surgery Among Primary Care Patients with Moderate to Severe Obesity

TLDR
African Americans and men were less likely to have considered bariatric surgery and were lesslikely to have been recommended surgery by their doctors, and differences in how obesity affects QOL appear to account for some of these variations.

Weight loss after bariatric surgery in obese adolescents: a systematic review and meta-analysis.

Developing Criteria for Pediatric/Adolescent Bariatric Surgery Programs

TLDR
This work has examined and compiled the current expert recommendations for guidelines and criteria that are needed to deliver safe and effective bariatric surgical care to adolescents.
...