Bariatric surgery in children- is it right?

There has been a huge explosion of bariatric surgery as a weight loss technique in the US. I have operated on many such patients as a board certified plastic surgeon. Cosmetic surgery for patients who have lost large amounts of weight include removal of excess skin from the abdomen (abdominoplasty), thighs (thigh lift)  and arms (arm lift). Weight loss patients also may need to have breast lifts, with or without breast enlargement with implants.

chubby kids

Here is a previous blog about this topic. After the weight loss comes the surgery

Whereas bariatric surgery for adults has proven safe and effective, there is now a growing movement to perform weight loss surgery on children. In the US children as young as 14 are routinely patients for this type of surgery. In Saudi Arabia one bariatric surgeon has performed weight loss surgery on over 1500 children, the youngest being 3 years old!

Reasons for weight loss surgery

Being overweight causes significant medical problems for patients including:

  • Diabetes – over 50 %  of obese patients have Type 2 diabetes
  • Hypertension – and resulting heart disease
  • Sleep apnea – inability to sleep lying down causing breathing to stop
  • Joint pain – from carrying extra weight
  • Inability to exercise
  • Cosmetic appearance suffering

These same medical problems occur for children — in addition to social alienation due, for example, to lack of participation in sports and other activities.

Reasons not to have bariatric surgery

There are a number of possible complications to consider for patients who want to have weight loss surgery:

  • Infection- 2% rate
  • Leakage from intestines – 2% but with grave consequences
  • Bleeding – 10% rate
  • Malnutrition from malabsorption of nutrients

amongst many other risks of surgery.

In children though the severe weight loss that occurs may cause problems with brain development and sexual maturation. Both these activities require sufficient energy and good nutrition.

The surgeons who perform weight loss surgery in children, argue that they must use all techniques available to improve the health of these children. it is true that many of these obese children are sick and will have remarkably shorter lives. Some may even gain notoriety in one of the many TV shows about the morbidly obese.

Plastic surgeons will also need to be on board with this idea. Sooner or later a parent of a child who has lost a large amount of weight and now has that weight hanging down will come forward and ask for a tummy tuck on a 10 year old or a thigh lift. Is that to be accepted medical practice?

Obesity occurs in 14% of children in developed countries and 9% in developing countries. Places like Saudi Arabia, Qatar and the Gulf countries have much higher rates of obesity, possibly due to genetic factors. The whole world is actually getting fat and our children are getting fat faster and that is not healthy.

Changes in nutrition, eating cultures, activity and parental ability to say NO to chubby youngsters will all be more important in years to come.

Morad Tavallali, M.D., FACS