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08-02-2017 | Adolescents | Book chapter | Article

16. Assessing and Selecting Patients for Bariatric Surgery

Author: Thomas H. Inge

Publisher: Springer Berlin Heidelberg



The use of bariatric procedures in general appears to be steeply increasing in pediatric age groups over recent years, suggesting a need for appropriate assessment criteria prior to surgery and for prospectively and rigorously collected adolescent outcome data. As of yet, the scientific evidence base is not sufficiently robust to allow a precise discrimination of which procedures are optimal for adolescents. Indeed, experts have broadly characterized the quality of evidence for effectiveness and safety of adolescent bariatric surgery as fair to poor for all procedures that have been reported. Despite limitations in the evidence base, clinicians are faced with a need to manage myriad health problems in adolescents with extreme obesity and more recently, higher quality prospectively collected data have emerged documenting efficacy and safety of adolescent bariatric procedures. Recommendations for assessment and selection of adolescent patients that are thoughtfully derived from our knowledge of obesity and bariatric surgery provide useful tools for those faced with sometimes difficult treatment decisions.
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):12–7 e12.
Thompson DR, Obarzanek E, Franko DL, Barton BA, Morrison J, Biro FM, et al. Childhood overweight and cardiovascular disease risk factors: the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2007;150(1):18–25. CrossRefPubMedPubMedCentral
Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA. 2010;303(3):242–9. CrossRefPubMed
Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337(13):869–73. CrossRefPubMed
Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922–1935. N Engl J Med. 1992;327(19):1350–5. CrossRefPubMed
Sinaiko AR, Donahue RP, Jacobs DR Jr, Prineas RJ. Relation of weight and rate of increase in weight during childhood and adolescence to body size, blood pressure, fasting insulin, and lipids in young adults. The Minneapolis Children’s Blood Pressure Study. Circulation. 1999;99(11):1471–6.
Vanhala M, Vanhala P, Kumpusalo E, Halonen P, Takala J. Relation between obesity from childhood to adulthood and the metabolic syndrome: population based study. BMJ. 1998;317(7154):319. CrossRefPubMedPubMedCentral
Inge TH. Bariatric surgery for morbidly obese adolescents: is there a rationale for early intervention? Growth Horm IGF Res. 2006;16 Suppl A:S15–9.
Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation. 2005;111(15):1999–2012. CrossRefPubMed
Garcia VF, DeMaria EJ. Adolescent bariatric surgery: treatment delayed, treatment denied, a crisis invited. Obes Surg. 2006;16(1):1–4. CrossRefPubMed
Skelton JA, Cook SR, Auinger P, Klein JD, Barlow SE. Prevalence and trends of severe obesity among US children and adolescents. Acad Pediatr. 2009;9(5):322–9. CrossRefPubMedPubMedCentral
Must A, Strauss RS. Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord. 1999;23(Suppl 2):S2–11. CrossRefPubMed
Pinhas-Hamiel O, Dolan LM, Daniels SR, Standiford D, Khoury PR, Zeitler P. Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr. 1996;128(5 Pt 1):608–15. CrossRefPubMed
Becque MD, Katch VL, Rocchini AP, Marks CR, Moorehead C. Coronary risk incidence of obese adolescents: reduction by exercise plus diet intervention. Pediatrics. 1988;81(5):605–12. PubMed
Kohler MJ, Thormaehlen S, Kennedy JD, Pamula Y, van den Heuvel CJ, Lushington K, et al. Differences in the association between obesity and obstructive sleep apnea among children and adolescents. J Clin Sleep Med. 2009;5(6):506–11. PubMedPubMedCentral
Urbina EM, Kimball TR, McCoy CE, Khoury PR, Daniels SR, Dolan LM. Youth with obesity and obesity-related type 2 diabetes mellitus demonstrate abnormalities in carotid structure and function. Circulation. 2009;119(22):2913–9. CrossRefPubMedPubMedCentral
Barlow SE, Dietz WH. Obesity evaluation and treatment: expert committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics. 1998;102(3):E29. CrossRefPubMed
Pfeifer SM, Kives S. Polycystic ovary syndrome in the adolescent. Obstet Gynecol Clin North Am. 2009;36(1):129–52. CrossRefPubMed
Berenson GS, Srnivasan SR. Cardiovascular risk factors in youth with implications for aging: the Bogalusa Heart Study. Neurobiol Aging. 2005;26(3):303–7. CrossRefPubMed
Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289(2):187–93. CrossRefPubMed
Zeller MH, Modi AC. Predictors of health-related quality of life in obese youth. Obesity (Silver Spring). 2006;14(1):122–30. CrossRef
Lawson ML, Kirk S, Mitchell T, Chen MK, Loux TJ, Daniels SR, et al. One-year outcomes of Roux-en-Y gastric bypass for morbidly obese adolescents: a multicenter study from the Pediatric Bariatric Study Group. J Pediatr Surg. 2006;41(1):137–43; discussion 137–43.
Kalarchian MA, Levine MD, Arslanian SA, Ewing LJ, Houck PR, Cheng Y, et al. Family-based treatment of severe pediatric obesity: randomized, controlled trial. Pediatrics. 2009;124(4):1060–8. CrossRefPubMedPubMedCentral
Levine MD, Ringham RM, Kalarchian MA, Wisniewski L, Marcus MD. Is family-based behavioral weight control appropriate for severe pediatric obesity? Int J Eat Disord. 2001;30(3):318–28. CrossRefPubMed
Gogakos A, Tzotzas TC, Krassas GE. Recent concepts of pharmacotherapy and bariatric surgery for childhood obesity: an overview. Pediatr Endocrinol Rev. 2009;7(2):83–94.
Wald AB, Uli NK. Pharmacotherapy in pediatric obesity: current agents and future directions. Rev Endocr Metab Disord. 2009;10(3):205–14. CrossRefPubMed
Wake M, Canterford L, Patton GC, Hesketh K, Hardy P, Williams J, et al. Comorbidities of overweight/obesity experienced in adolescence: longitudinal study. Arch Dis Child. 2009;95(3):162–8. CrossRefPubMed
Inge TH, Zeller MH, Lawson ML, Daniels SR. A critical appraisal of evidence supporting a bariatric surgical approach to weight management for adolescents. J Pediatr. 2005;147(1):10–9. CrossRefPubMed
Ratcliff MB, Reiter-Purtill J, Inge TH, Zeller MH. Changes in depressive symptoms among adolescent bariatric candidates from preoperative psychological evaluation to immediately before surgery. Surg Obes Relat Dis. 2011;7(1):50–4. CrossRefPubMed
Inge TH, Garcia V, Daniels S, Langford L, Kirk S, Roehrig H, et al. A multidisciplinary approach to the adolescent bariatric surgical patient. J Pediatr Surg. 2004;39(3):442–7; discussion 446–7.
Tsai WS, Inge TH, Burd RS. Bariatric surgery in adolescents: recent national trends in use and in-hospital outcome. Arch Pediatr Adolesc Med. 2007;161(3):217–21. CrossRefPubMed
Treadwell JR, Sun F, Bruening W, Reston J, Noble M, Schoelles K, et al. Bariatric surgery in pediatric patients. In: 2007. http://​www.​hta.​hca.​wa.​gov/​documents/​bariatric_​pediatric.​pdf. Accessed 21 Feb 2011.
Treadwell JR, Sun F, Schoelles K. Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Ann Surg. 2008;248(5):763–76. CrossRefPubMed
Jen HC, Rickard DG, Shew SB, Maggard MA, Slusser WM, Dutson EP, et al. Trends and outcomes of adolescent bariatric surgery in California, 2005–2007. Pediatrics. 2010;126(4):e746–53. CrossRefPubMed
O’Brien PE, Sawyer SM, Laurie C, Brown WA, Skinner S, Veit F, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA. 2010;303(6):519–36. CrossRefPubMed
Aikenhead A, Knai C, Lobstein T. Effectiveness and cost-effectiveness of paediatric bariatric surgery: a systematic review. Clinical Obesity. 2011:1–14.
Inge TH, Jenkins TM, Zeller M, Dolan L, Daniels SR, Garcia VF, et al. Baseline BMI is a strong predictor of nadir BMI after adolescent gastric bypass. J Pediatr. 2010;156(1):103–8 e101.
Varela JE, Hinojosa MW, Nguyen NT. Perioperative outcomes of bariatric surgery in adolescents compared with adults at academic medical centers. Surg Obes Relat Dis. 2007;3(5):537–40; discussion 541–32.
Inge TH, Krebs NF, Garcia VF, Skelton JA, Guice KS, Strauss RS, et al. Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics. 2004;114(1):217–23. CrossRefPubMed
Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis. 2008;4(5 Suppl):S109–84. CrossRefPubMed
Apovian CM, Cummings S, Anderson W, Borud L, Boyer K, Day K, et al. Best practice updates for multidisciplinary care in weight loss surgery. Obesity (Silver Spring). 2009;17(5):871–9. CrossRef
Inge TH, Lawson L. Treatment considerations for severe adolescent obesity. Surg Obes Relat Dis. 2005;1(2):133–9. CrossRefPubMed
Apovian CM, Baker C, Ludwig DS, Hoppin AG, Hsu G, Lenders C, et al. Best practice guidelines in pediatric/adolescent weight loss surgery. Obes Res. 2005;13(2):274–82. CrossRefPubMed
Pratt JS, Lenders CM, Dionne EA, Hoppin AG, Hsu GL, Inge TH, et al. Best practice updates for pediatric/adolescent weight loss surgery. Obesity (Silver Spring). 2009;17(5):901–10. CrossRef
Lenders CM, Wright JA, Apovian CM, Hess DT, Shukla RR, Adams WG, et al. Weight loss surgery eligibility according to various BMI criteria among adolescents. Obesity (Silver Spring). 2009;17(1):150–5. CrossRef
Hillman JB, Miller RJ, Inge TH. Menstrual concerns and intrauterine contraception among adolescent bariatric surgery patients. J Womens Health (Larchmt). 2011;20(4):533–8. CrossRef
Roehrig HR, Xanthakos SA, Sweeney J, Zeller MH, Inge TH. Pregnancy after gastric bypass surgery in adolescents. Obes Surg. 2007;17(7):873–7. CrossRefPubMed
Inge TH, Zeller M, Harmon C, Helmrath M, Bean J, Modi A, et al. Teen-longitudinal assessment of bariatric surgery: methodological features of the first prospective multicenter study of adolescent bariatric surgery. J Pediatr Surg. 2007;42(11):1969–71. CrossRefPubMedPubMedCentral