Bariatric Surgery in Kids With Obesity Becoming More Common

More youths with obesity have undergone metabolic and bariatric surgery since a 2019 American Academy of Pediatrics (AAP) policy statement highlighted the need for increased access to this surgery for pediatric patients, a retrospective analysis showed.

Completion rates for metabolic and bariatric surgery among youths increased from before the AAP statement release through 2021, overall and for each ethnic subgroup (P for trend <0.001), reported Sarah E. Messiah, PhD, of the University of Texas Health Science Center at Houston School of Public Health in Dallas, and colleagues.

In addition, more youths and adults completed surgery in 2021 than in 2020, resulting in 18.85% and 24.36% year-to-year increases in metabolic and bariatric surgery rates, respectively, they noted in a research letter published in JAMA Pediatrics.

Also in 2021, completion of these surgeries increased from 182 to 258 procedures in Black youths, from 179 to 273 procedures in Hispanic youths, and from 459 to 518 procedures among white youths (P for trend <0.001 for all).

Messiah and team noted that the AAP 2019 policy statement urging for increased adolescent access to metabolic surgery if appropriate according to clinical practice guidelines likely played a big role in this uptick in surgery-seeking behavior.

“The AAP has highlighted the need to educate pediatricians about the benefits of MBS [metabolic and bariatric surgery] for qualified patients,” Messiah’s group wrote. “Historically, MBS has been underused in youths due to barriers, including low referral rates, limited access, and poor insurance coverage.”

The “results of the present study suggest cautious optimism regarding the decreasing barriers to MBS for those U.S. youth in need,” they added.

These increases preceded the AAP’s more recent guidance that took an even stronger stance against childhood obesity, moving away from the notion of “watchful waiting” and instead advocating for “immediate, intensive obesity treatment to each patient” as soon as they receive a diagnosis.

“Behavioral lifestyle interventions alone do not result in long-term, clinically important weight loss among youth with severe obesity,” Messiah and colleagues pointed out, underscoring the need for safe and effective treatments as rates of severe obesity — defined as a body mass ≥120% of the 95th percentile adjusted for age and sex or an index >35 — continue to rise among kids.

Notably, in the past decade, childhood obesity rates increased from 17.7% to 21.5%, according to data from the National Health and Nutrition Examination Survey (NHANES). As a result, the CDC expanded BMI-for-age growth charts in late 2022 to accommodate the steadily rising obesity rates in youths.

For this study, Messiah’s group pulled data from 2015 to 2021 from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program for youths ages 10 to 19, as well as adults (ages 19 and up).

Their analysis included 1,346,468 participants with a mean age of 44.9 years; 81.1% were female, 16.9% were Black, 9.7% were Hispanic, and 57.4% were white.

Messiah and team noted that data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program may not be representative of all surgery practices in the U.S., which was a limitation to their study.