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Bariatric Surgery in Adolescence

  • Marc Michalsky
Chapter
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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 
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© 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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