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Approved surgical options needed for severe pediatric obesity

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ORLANDO, Fla. — Approved interventions for severe pediatric obesity are not enough to combat the growing problem, which puts children and adolescents at risk for immediate and long-term comorbidities, according to data presented here.

Ilene Fennoy, MD, MPH, FAAP, FACE, medical director of the Center for Comprehensive Adolescent Bariatric Surgery at Columbia University Medical Center, said adolescents aged 12 to 19 years with severe obesity are at increased risk for remaining obese as adults, and already show signs of insulin resistance, hypertension, metabolic syndrome and nonalcoholic fatty liver disease.

Ilene Fennoy

Severe obesity affects 4% to 6% of children in the United States, and the prevalence is increasing, according to Fennoy.

“At the moment, we can see clearly that morbid obesity in adolescence has little chance of remission, and we need more people to understand that,” Fennoy said during a press conference. “It is associated with comorbidities, both in adolescence and progressing into adult life.”

Diet and exercise are only marginally effective in adolescents, said Fennoy, who also spoke at a “meet the experts” session to discuss the issue. For children who are severely obese — in the 120th percentile for BMI — studies show that levels for LDL, C-reactive protein and interleukin-6 all increase, and reversing the damage is difficult.

“These children are having all the manifestations of early cardiovascular disease in adolescence,” she said. “Even when you look at a child in the 85th to 90th percentile at age 13 years, you can expect, at age 27, that 47% of them will have a BMI greater than 30 kg/m². There is little or no chance that a 13-year-old who is obese ... is going to be normal weight by 27.”

Currently, the only approved pediatric interventions are lifestyle changes that incorporate diet and physical activity modifications, and one weight-loss agent — Xenical (orlistat, Hoffmann-La Roche)/Alli (orlistat, GlaxoSmithKline) — approved for children aged at least 12 years, Fennoy said. Bariatric surgery, which is not approved but sometimes performed during adolescence, seems to offer the best chance at success, according to Fennoy.

“Bariatric surgery is having a significant impact on weight loss and comorbidities in adults,” she said. “The documentation in pediatrics is less clear, but it is showing the same trends. Therefore, we need to be considering it as an appropriate intervention for the pediatric population, and we clearly need more experimentation with respect to pharmacotherapy.”

Fennoy said the latest studies are promising, but more studies showing long-term outcomes for bariatric surgery in adolescents are necessary.

“We don’t have anything for the adolescent who is 350 lb already that is going to get them any improvement, besides bariatric surgery,” Fennoy said. “The 5 kg to 10 kg they may lose from diet and exercise is really not significant for what they need to lose.” – by Regina Schaffer

Reference:

Fennoy I. Treatment of Severe Pediatric Obesity. Presented at: AACE Annual Scientific and Clinical Congress; May 25-29, 2016; Orlando, Fla.

Disclosure: Fennoy reports consulting for Novo Nordisk.