Improving Access to Child and Adolescent Weight Loss Surgery: A Review of Updated National and International Practice Guidelines

Abstract

The rise of childhood obesity is a growing concern due to its negative impact on health. Metabolic bariatric surgery (MBS) has gained popularity as an effective and adequate intervention for children and adolescent patients living with severe obesity. Nonetheless, access to MBS for this population is still limited. The objective of this paper is to conduct a comprehensive review of the latest national and international practice guidelines and improve access to MBS for children and adolescents. The paper focuses on the recommendations from the 2023 American Academy of Pediatrics (AAP) and 2022 guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Recently updated guidelines from the ASMBS and IFSO aim to improve access to MBS for children and adolescents and recommend patient selection, preoperative evaluation, and postoperative care. While lifestyle changes, medication, and behavioral therapy are commonly prescribed, they often fail to achieve permanent weight loss and its maintenance. Weight-loss surgeries like sleeve gastrectomy (SG) and gastric bypass (RYGB) show promising results in managing severe obesity in adolescents. SG has become the preferred method for treating severe obesity in adolescents, surpassing RYGB. Weight stigma is also explored in this review, revealing its negative effects on individuals who are overweight and underweight. Furthermore, telehealth is identified as an increasingly valuable tool for managing pediatric obesity, as it can improve access to care, particularly for those in remote areas where physicians trained to treat childhood obesity and the shortage of bariatric surgeons experienced in treating younger adolescents and pediatricians with advanced training are major obstacles.

Keywords: adolescent obesity; bariatric surgery; body mass index (bmi); child nutrition; gastric bypass surgery.

Figure 1. A Multidisciplinary Approach to Bariatric Surgery in the Pediatric and Adolescent Population.

Adapted from the American Society for Metabolic and Bariatric Surgery (ASMBS) Public Education Committee and the ASMBS Pediatric Committee [10].

Figure 2. The Comorbidities Associated with Obesity Among Children and Adolescents.

Adapted from the American Society for Metabolic and Bariatric Surgery (ASMBS) Public Education Committee and the ASMBS Pediatric Committee [10].