Defining a Way Forward for Pediatric Weight-loss Surgery

By: Valerie Lauer
Friday, June 26, 2015

As the rate of obesity among young people continues to rise and medical professionals more fully comprehend the role pediatric obesity plays in patients’ well-being, more clinicians are turning to bariatric surgery to address the condition and its comorbidities.

Researchers in Saudi Arabia say that when pediatric weight-loss surgery is conducted following a newly developed clinical pathway, patients do not experience stunted growth and achieve a high degree of resolution of obesity-related comorbidities.

Solution Under Fire

From 2000 to 2009, the number of bariatric surgeries performed on U.S. patients ages 10–19 tripled; however, some observers fear that performing such procedures on young patients may interfere with growth and development. A study published in Pediatrics in April 2011 found that bariatric surgery results in significant loss of bone mass, while other studies highlight concerns about issues such as nutritional deficiencies and ineffective follow-through by young patients.

Researchers Aayed Alqahtani, MD, and Mohamed Elahmedi, MBBS, with King Saud University in Riyadh, Saudi Arabia, saw a structured clinical pathway as a means to address some of those concerns.

“Without published experience detailing a standardized set of guidelines together with the results expected with it, centers around the world would be sailing in uncharted waters,” Dr. Elahmedi says. “Standardizing practice allows for reproducible results and uniform outcomes.”

A Clearer Path

To test the clinical pathway they proposed, the researchers enrolled 659 patients in the project, 291 of whom underwent sleeve gastrectomy. The remainder followed a non-invasive weight management program.

“The key components of our pathway include rigorous selection criteria for bariatric surgery, detailed preoperative and postoperative care instructions, a standardized surgical technique, and a lifelong follow-up plan that anticipates the nutritional needs of the patients,” Dr. Alqahtani says.

Patients’ progress was closely monitored for four years, notes the study, published in Obesity Surgery. In the end, participants who underwent bariatric surgery had greater resolution of comorbidities — 90 percent, compared with less than 30 percent resolution among those in the weight management program — and grew an average of one millimeter more each month.

“It is our opinion that we should not deny children and adolescents a treatment that has been proven to resolve their obesity and its related complications based on concerns that are not backed by any evidence.”
— Aayed Alqahtani, MD

Also of note, the rate of complications among sleeve gastrectomy patients under this protocol was lower than average — 4.1 percent, compared with 11 percent typically seen among adult patients. Researchers attribute their results both to the effectiveness of early intervention and the clear roadmap of care they established.

“While short-term and intermediate-term results are very encouraging and indicate that no issues may be discovered in the long term, unforeseen complications cannot be ruled out,” Dr. Elahmedi says. “However, we believe that by inducing cure of obesity and associated diseases like diabetes, sleep apnea and hypertension, bariatric surgery should actually result in improved long-term outcomes in this young population.”