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Bariatric Surgery in Adolescence

  • Marc Michalsky
Chapter

Abstract

The increase in overall prevalence of childhood obesity in the U.S. and elsewhere appears to have continued to rise and as a result, has been cited as a major threat to the health and well-being of millions of affected individuals. Recent data estimate that approximately 17% of the US pediatric population is classified as being obese. Furthermore, it has been recently estimated that an additional 7% of the affected population in this country are further categorized as being “severely obese” (i.e., body mass index (BMI) ≥120% of the 95th percentile or BMI ≥35 kg/m2). Although there have been some indications of a “leveling off” of obesity prevalence within specific subgroups of general pediatric population, obese adolescents and in particular, severely obese adolescents (age 12–19 years) have continued to show a steady rise in prevalence since the 1980s. In addition to these alarming trends in the U.S. and other western countries, recent data also suggest that a correspondingly rapid increase in the rate childhood obesity has also been observed in the developing world. Furthermore, such trends represents unique challenges to governments and populations that have traditionally struggled with significant problems associated with ongoing undernutrition. In addition to a seemingly unabated rise in the prevalence of childhood obesity over the past several decades, an expanding body of corresponding literature highlighting the coexistence of many obesity-related comorbid disease states, including evidence of cardiovascular disease, dyslipidemia, impaired glucose metabolism, type 2 diabetes mellitus, hypertension, obstructive sleep apnea, polycystic ovarian disease, and fatty liver disease, has recently emerged. The establishment of various related comorbid conditions, previously thought to primarily exist only within the severely obese adult population, coupled with evidence demonstrating poor outcomes related nonsurgical therapeutic interventions (i.e., exercise and diet and behavioral modification regimens) and evidence that severely obese youth have an extraordinarily high risk of becoming severely obese adults, has resulted in an increased interest in the application of weight loss surgery (i.e., bariatric surgery) during the adolescent time period.

The current chapter will focus on data regarding the development of several key comorbid conditions encountered in the severely obese adolescent population and review the current clinical indications for the use of surgical weight loss procedures among teens, including best practice guidelines and longitudinal outcomes related to the most commonly performed bariatric procedures. In addition, the chapter will review the use of metabolic and bariatric surgery for pediatric patients with special considerations (i.e., the very young, individuals with syndromic or hypothalamic obesity, etc.). Lastly, the current consensus-driven guidelines for the development of a multidisciplinary care model designed to provide adolescent-specific treatment that is separate and distinct from the adult care as well as current challenges related to access to care for this underserved and vulnerable population will be presented.

Keywords

Obesity Bariatric Surgery Comorbid Adolescents 

References

  1. 1.
    Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013–2014. JAMA. 2016;315(21):2292–9.CrossRefGoogle Scholar
  2. 2.
    Skinner AC, Skelton JA. Prevalence and trends in obesity and severe obesity among children in the United States, 1999–2012. JAMA Pediatr. 2014;168(6):561–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Kimm SY, Obarzanek E. Childhood obesity: a new pandemic of the new millennium. Pediatrics. 2002;110(5):1003–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295(13):1549–55.CrossRefPubMedGoogle Scholar
  5. 5.
    Daniels SR, Kelly AS. Pediatric severe obesity: time to establish serious treatments for a serious disease. Child Obes. 2014;10(4):283–4.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lasserre AM, Chiolero A, Paccaud F, Bovet P. Worldwide trends in childhood obesity. Swiss Med Wkly. 2007;137(9–10):157–8.PubMedGoogle Scholar
  7. 7.
    Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006;1(1):11–25.CrossRefPubMedGoogle Scholar
  8. 8.
    de Onis M, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. 2010;92(5):1257–64.CrossRefPubMedGoogle Scholar
  9. 9.
    Brandt ML, Harmon CM, Helmrath MA, Inge TH, McKay SV, Michalsky MP. Morbid obesity in pediatric diabetes mellitus: surgical options and outcomes. Nat Rev Endocrinol. 2010;6(11):637–45.CrossRefPubMedGoogle Scholar
  10. 10.
    Inge TH, Miyano G, Bean J, et al. Reversal of type 2 diabetes mellitus and improvements in cardiovascular risk factors after surgical weight loss in adolescents. Pediatrics. 2009;123(1):214–22.CrossRefPubMedGoogle Scholar
  11. 11.
    Teeple EA, Teich S, Schuster DP, Michalsky MP. Early metabolic improvement following bariatric surgery in morbidly obese adolescents. Pediatr Blood Cancer. 2012;58(1):112–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Michalsky MP, Inge TH, Simmons M, et al. Cardiovascular risk factors in severely obese adolescents: the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr. 2015;169(5):438–44.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Michalsky MP, Raman SV, Teich S, Schuster DP, Bauer JA. Cardiovascular recovery following bariatric surgery in extremely obese adolescents: preliminary results using Cardiac Magnetic Resonance (CMR) imaging. J Pediatr Surg. 2013;48(1):170–7.CrossRefPubMedGoogle Scholar
  14. 14.
    O’Brien PE, Sawyer SM, Laurie C, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA. 2010;303(6):519–26.CrossRefPubMedGoogle Scholar
  15. 15.
    Treadwell JR, Sun F, Schoelles K. Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Ann Surg. 2008;248(5):763–76.CrossRefPubMedGoogle Scholar
  16. 16.
    Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr. 2007;150(1):12–17 e12.CrossRefPubMedGoogle Scholar
  17. 17.
    Kelleher DC, Merrill CT, Cottrell LT, Nadler EP, Burd RS. Recent national trends in the use of adolescent inpatient bariatric surgery: 2000 through 2009. Arch Pediatr Adolesc Med. 2012:1–7.Google Scholar
  18. 18.
    Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999;103(6 Pt 1):1175–82.CrossRefPubMedGoogle Scholar
  19. 19.
    Ippisch HM, Inge TH, Daniels SR, et al. Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol. 2008;51(14):1342–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Bout-Tabaku S, Michalsky MP, Jenkins TM, et al. Musculoskeletal pain, self-reported physical function, and quality of life in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort. JAMA Pediatr. 2015;169(6):552–9.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Ryder JR, Edwards NM, Gupta R, et al. Changes in functional mobility and musculoskeletal pain after bariatric surgery in teens with severe obesity: Teen-Longitudinal Assessment of Bariatric Surgery (LABS) study. JAMA Pediatr. 2016;170:871–7.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Cuspidi C, Rescaldani M, Tadic M, Sala C, Grassi G. Effects of bariatric surgery on cardiac structure and function: a systematic review and meta-analysis. Am J Hypertens. 2014;27(2):146–56.CrossRefPubMedGoogle Scholar
  23. 23.
    Inge TH, Zeller MH, Jenkins TM, et al. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr. 2014;168(1):47–53.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Olbers T, Gronowitz E, Werling M, et al. Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS). Int J Obes. 2012;36(11):1388–95.CrossRefGoogle Scholar
  25. 25.
    Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(2):113–23.CrossRefPubMedGoogle Scholar
  26. 26.
    Dixon JB, le Roux CW, Rubino F, Zimmet P. Bariatric surgery for type 2 diabetes. Lancet. 2012;379(9833):2300–11.CrossRefPubMedGoogle Scholar
  27. 27.
    Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Schauer PR, Mingrone G, Ikramuddin S, Wolfe B. Clinical outcomes of metabolic surgery: efficacy of glycemic control, weight loss, and remission of diabetes. Diabetes Care. 2016;39(6):902–11.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Purnell JQ, Selzer F, Wahed AS, et al. Type 2 diabetes remission rates after laparoscopic gastric bypass and gastric banding: results of the longitudinal assessment of bariatric surgery study. Diabetes Care. 2016;39(7):1101–7.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Pinhas-Hamiel O, Zeitler P. The global spread of type 2 diabetes mellitus in children and adolescents. J Pediatr. 2005;146(5):693–700.CrossRefPubMedGoogle Scholar
  31. 31.
    Xanthakos SA, Jenkins TM, Kleiner DE, et al. High prevalence of nonalcoholic fatty liver disease in adolescents undergoing bariatric surgery. Gastroenterology. 2015;149(3):623–34. e628CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics. 2006;118(4):1388–93.CrossRefPubMedGoogle Scholar
  33. 33.
    Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116(6):1413–9.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Xanthakos S, Miles L, Bucuvalas J, Daniels S, Garcia V, Inge T. Histologic spectrum of nonalcoholic fatty liver disease in morbidly obese adolescents. Clin Gastroenterol Hepatol. 2006;4(2):226–32.CrossRefPubMedGoogle Scholar
  35. 35.
    Mathurin P, Gonzalez F, Kerdraon O, et al. The evolution of severe steatosis after bariatric surgery is related to insulin resistance. Gastroenterology. 2006;130(6):1617–24.CrossRefPubMedGoogle Scholar
  36. 36.
    Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;135(1):48–58.CrossRefPubMedGoogle Scholar
  37. 37.
    Michalsky M, Reichard K, Inge T, et al. ASMBS pediatric committee best practice guidelines. Surg Obes Relat Dis (Official Journal of the American Society for Bariatric Surgery). 2012;8(1):1–7.CrossRefGoogle Scholar
  38. 38.
    Pratt JS, Lenders CM, Dionne EA, et al. Best practice updates for pediatric/adolescent weight loss surgery. Obesity (Silver Spring). 2009;17(5):901–10.CrossRefGoogle Scholar
  39. 39.
    Styne DM. Childhood and adolescent obesity. Prevalence and significance. Pediatr Clin N Am. 2001;48(4):823–54. viiCrossRefGoogle Scholar
  40. 40.
    Kalra M, Inge T. Effect of bariatric surgery on obstructive sleep apnoea in adolescents. Paediatr Respir Rev. 2006;7(4):260–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002;162(8):893–900.CrossRefPubMedGoogle Scholar
  42. 42.
    Kalra M, Inge T, Garcia V, et al. Obstructive sleep apnea in extremely overweight adolescents undergoing bariatric surgery. Obes Res. 2005;13(7):1175–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Guardiano SA, Scott JA, Ware JC, Schechner SA. The long-term results of gastric bypass on indexes of sleep apnea. Chest. 2003;124(4):1615–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Rasheid S, Banasiak M, Gallagher SF, et al. Gastric bypass is an effective treatment for obstructive sleep apnea in patients with clinically significant obesity. Obes Surg. 2003;13(1):58–61.CrossRefPubMedGoogle Scholar
  45. 45.
    Hamdallah IN, Shamseddeen HN, Getty JL, Smith W, Ali MR. Greater than expected prevalence of pseudotumor cerebri: a prospective study. Surg Obes Relat Dis (Official Journal of the American Society for Bariatric Surgery). 2013;9(1):77–82.CrossRefGoogle Scholar
  46. 46.
    Jamal MK, DeMaria EJ, Johnson JM, et al. Impact of major co-morbidities on mortality and complications after gastric bypass. Surg Obes Relat Dis (Official Journal of the American Society for Bariatric Surgery). 2005;1(6):511–6.CrossRefGoogle Scholar
  47. 47.
    Sugerman HJ, Felton WL 3rd, Sismanis A, Kellum JM, DeMaria EJ, Sugerman EL. Gastric surgery for pseudotumor cerebri associated with severe obesity. Ann Surg. 1999;229(5):634–40. discussion 640–2CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Sugerman HJ. Multiple benefits of bariatric surgery. Manag Care. 2005;14(10 Suppl):16–21.PubMedGoogle Scholar
  49. 49.
    Chandra V, Dutta S, Albanese CT, Shepard E, Farrales-Nguyen S, Morton J. Clinical resolution of severely symptomatic pseudotumor cerebri after gastric bypass in an adolescent. Surg Obes Relat Dis (Official Journal of the American Society for Bariatric Surgery). 2007;3(2):198–200.CrossRefGoogle Scholar
  50. 50.
    Tsiros MD, Coates AM, Howe PR, Grimshaw PN, Buckley JD. Obesity: the new childhood disability? Obes Rev (An Official Journal of the International Association for the Study of Obesity). 2011;12(1):26–36.CrossRefGoogle Scholar
  51. 51.
    Mendelson M, Michallet AS, Perrin C, Levy P, Wuyam B, Flore P. Exercise training improves breathing strategy and performance during the six-minute walk test in obese adolescents. Respir Physiol Neurobiol. 2014;200:18–24.CrossRefPubMedGoogle Scholar
  52. 52.
    Danielsson P, Kowalski J, Ekblom O, Marcus C. Response of severely obese children and adolescents to behavioral treatment. Arch Pediatr Adolesc Med. 2012;166(12):1103–8.CrossRefPubMedGoogle Scholar
  53. 53.
    Knop C, Singer V, Uysal Y, Schaefer A, Wolters B, Reinehr T. Extremely obese children respond better than extremely obese adolescents to lifestyle interventions. Pediatr Obes. 2015;10(1):7–14.CrossRefPubMedGoogle Scholar
  54. 54.
    Rofey DL, Zeller MH, Brode C, et al. A multisite view of psychosocial risks in patients presenting for bariatric surgery. Obesity (Silver Spring). 2015;23(6):1218–25.CrossRefGoogle Scholar
  55. 55.
    Thakkar RK, Michalsky MP. Update on bariatric surgery in adolescence. Curr Opin Pediatr. 2015;27(3):370–6.CrossRefPubMedGoogle Scholar
  56. 56.
    Zeller MH, Modi AC, Noll JG, Long JD, Inge TH. Psychosocial functioning improves following adolescent bariatric surgery. Obesity (Silver Spring). 2009;17(5):985–90.CrossRefGoogle Scholar
  57. 57.
    Kim RJ, Langer JM, Baker AW, Filter DE, Williams NN, Sarwer DB. Psychosocial status in adolescents undergoing bariatric surgery. Obes Surg. 2008;18(1):27–33.CrossRefPubMedGoogle Scholar
  58. 58.
    Messiah SE, Lopez-Mitnik G, Winegar D, et al. Changes in weight and co-morbidities among adolescents undergoing bariatric surgery: 1-year results from the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis (Official Journal of the American Society for Bariatric Surgery). 2013;9(4):503–13.CrossRefGoogle Scholar
  59. 59.
    Gastrointestinal surgery for severe obesity. Proceedings of a National Institutes of Health Consensus Development Conference. March 25–27, 1991, Bethesda, MD. Am J Clin Nutr 1992;55(2 Suppl):487S–619S.Google Scholar
  60. 60.
    Sjoholm K, Anveden A, Peltonen M, et al. Evaluation of current eligibility criteria for bariatric surgery: diabetes prevention and risk factor changes in the Swedish obese subjects (SOS) study. Diabetes Care. 2013;36(5):1335–40.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Inge TH, Jenkins TM, Zeller M, et al. Baseline BMI is a strong predictor of nadir BMI after adolescent gastric bypass. J Pediatr. 2010;156(1):103–108 e101.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Michalsky M, Kramer RE, Fullmer MA, et al. Developing criteria for pediatric/adolescent bariatric surgery programs. Pediatrics. 2011;128(Suppl 2):S65–70.CrossRefPubMedGoogle Scholar
  63. 63.
    Blackstone R, Dimick JB, Nguyen NT. Accreditation in metabolic and bariatric surgery: pro versus con. Surg Obes Relat Dis (Official Journal of the American Society for Bariatric Surgery). 2014;10(2):198–202.CrossRefGoogle Scholar
  64. 64.
    Baltasar A, Serra C, Bou R, Bengochea M, Andreo L. Sleeve gastrectomy in a 10-year-old child. Obes Surg. 2008;18(6):733–6.CrossRefPubMedGoogle Scholar
  65. 65.
    Dan D, Harnanan D, Seetahal S, Naraynsingh V, Teelucksingh S. Bariatric surgery in the management of childhood obesity: should there be an age limit? Obes Surg. 2010;20(1):114–7.CrossRefPubMedGoogle Scholar
  66. 66.
    Mohaidly MA, Suliman A, Malawi H. Laparoscopic sleeve gastrectomy for a two-and half year old morbidly obese child. Int J Surg Case Rep. 2013;4(11):1057–60.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Alqahtani A, Elahmedi M, Qahtani AR. Laparoscopic sleeve gastrectomy in children younger than 14 years: refuting the concerns. Ann Surg. 2016;263(2):312–9.CrossRefPubMedGoogle Scholar
  68. 68.
    Bingham NC, Rose SR, Inge TH. Bariatric surgery in hypothalamic obesity. Front Endocrinol (Lausanne). 2012;3:23.Google Scholar
  69. 69.
    Inge TH, Pfluger P, Zeller M, et al. Gastric bypass surgery for treatment of hypothalamic obesity after craniopharyngioma therapy. Nat Clin Pract Endocrinol Metab. 2007;3(8):606–9.CrossRefPubMedGoogle Scholar
  70. 70.
    Alqahtani AR, Elahmedi MO, Al Qahtani AR, Lee J, Butler MG. Laparoscopic sleeve gastrectomy in children and adolescents with Prader-Willi syndrome: a matched-control study. Surg Obes Relat Dis (Official Journal of the American Society for Bariatric Surgery). 2016;12(1):100–10.CrossRefGoogle Scholar
  71. 71.
    Daigle CR, Schauer PR, Heinberg LJ. Bariatric surgery in the cognitively impaired. Surg Obes Relat Dis (Official Journal of the American Society for Bariatric Surgery). 2015;11(3):711–4.CrossRefGoogle Scholar
  72. 72.
    Marceau P, Marceau S, Biron S, et al. Long-term experience with duodenal switch in adolescents. Obes Surg. 2010;20(12):1609–16.CrossRefPubMedGoogle Scholar
  73. 73.
    Zeller MH, Reiter-Purtill J, Ratcliff MB, Inge TH, Noll JG. Two-year trends in psychosocial functioning after adolescent Roux-en-Y gastric bypass. Surg Obes Relat Dis (Official Journal of the American Society for Bariatric Surgery). 2011;7(6):727–32.CrossRefGoogle Scholar
  74. 74.
    Sugerman HJ, Sugerman EL, DeMaria EJ, et al. Bariatric surgery for severely obese adolescents. J Gastrointest Surg (Official Journal of the Society for Surgery of the Alimentary Tract). 2003;7(1):102–7. discussion 107–8CrossRefGoogle Scholar
  75. 75.
    Boza C, Viscido G, Salinas J, Crovari F, Funke R, Perez G. Laparoscopic sleeve gastrectomy in obese adolescents: results in 51 patients. J Gastrointest Surg (Official Journal of the American Society for Bariatric Surgery). 2012;8(2):133–7. discussion 137–9Google Scholar
  76. 76.
    Alqahtani AR, Antonisamy B, Alamri H, Elahmedi M, Zimmerman VA. Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years. Ann Surg. 2012;256(2):266–73.CrossRefPubMedGoogle Scholar
  77. 77.
    Pepper VK, Rager TM, Diefenbach KA, Raval MV, Teich S, Michalsky MP. Robotic vs. laparoscopic sleeve gastrectomy in adolescents; reality or hype. Obes Surg. 2016;26:1912–7.CrossRefPubMedGoogle Scholar
  78. 78.
    Gortmaker SL, Wang YC, Long MW, et al. Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Aff. 2015;34(11):1932–9.CrossRefGoogle Scholar
  79. 79.
    Inge TH, Boyce TW, Lee M, et al. Access to care for adolescents seeking weight loss surgery. Obesity (Silver Spring). 2014;22(12):2593–7.Google Scholar
  80. 80.
    Woolford SJ, Clark SJ, Gebremariam A, Davis MM, Freed GL. To cut or not to cut: physicians’ perspectives on referring adolescents for bariatric surgery. Obes Surg. 2010;20(7):937–42.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Michalsky MP. Adolescent bariatric surgery in the United Kingdom; a call for continued study and open dialogue. Arch Dis Child. 2014;99(10):885–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryNationwide Children’s HospitalColumbusUSA

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