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), thigh (thigh lift) and arms (arm lift). Weight loss patients also need to have breast lifts with or without breast enlargement with implants.
Here is a previous blog about this topic. https://www.tavmd.com/2010/11/02/after-weight-loss-comes-the-surgery-arm-lift/
Whereas bariatric surgery for adults has proven safe and effective now there is 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 specially due 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 mal-absorption 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 in children occurs in 14% in developed countries and 9% in underdeveloped countries. Places like Saudi Arabia , Qatar and the gulf countries have rates of obesity much higher probably due to genetic factors also. The whole world is actually getting fat and our children are getting fat faster than is healthy for them.
Changes in nutrition, eating cultures, activity and parental ability to say NO to chubby youngsters will all be more important in years to come.