Bariatric surgery in adolescents: Choose wisely

Issue: February 2013

QUEBEC CITY — Careful selection is imperative when identifying adolescents who are candidates for bariatric surgery, according to Laurent Biertho, MD, who presented on this topic at the Canadian Pediatric Endocrine Group 2013 Scientific Meeting.

Perspective from Jill Hamilton, MD

Adolescents who are selected for bariatric surgery have a BMI of 40 kg/m² or more or a BMI of 35 kg/m² and a comorbidity such as diabetes or hypertension, Biertho, who is clinical professor in the department of surgery at Laval University, Quebec City, said in an interview with Endocrine Today.

“Sometimes [bariatric surgery] is the only solution for these patients. It’s not our goal to do more bariatric surgery in adolescents; the goal should be prevention (of the need for bariatric surgery). The medical literature shows that if adolescents are obese, the vast majority will go on to become obese adults,” Biertho said.

Adolescents would only be considered as candidates for bariatric surgery after failed attempts at weight loss through lifestyle interventions such as diet and exercise. Before surgery, candidates would undergo a psychological assessment to ensure they understood that surgery is not just a “quick fix” solution for weight loss, Biertho said. The adolescent’s family would also be educated about the surgery.

After surgery, proper follow-up and vitamin supplementation are vital.

Adolescent candidates for bariatric surgery, unlike adult candidates, typically present with better health status. In terms of the type of intervention, whether it is gastric bypass, gastric banding or sleeve gastrectomy with or without duodenal switch, there is limited long-term data on the efficacy of the procedure in adolescents, he said.

For more information:

Biertho L. Obesity surgery in the adolescent. Presented at: Canadian Pediatric Endocrine Group 2013 Scientific Meeting; Jan. 24-26, 2013; Quebec City.

Disclosure: Biertho reports no relevant financial disclosures.

Perspective

Jill Hamilton, MD

Bariatric surgery is a very effective way to improve health on a long-term basis, but clinicians should proceed with caution in terms of choosing this intervention for adolescents. It has to be done at an expert center, and we have to select the optimal candidates who will comply with vitamin supplementation and ultimately benefit.

Jill Hamilton, MD

Pediatric endocrinologist at the Hospital for Sick Children in Toronto, and Associate Professor at the University of Toronto

Disclosures: Hamilton reports no relevant disclosures.