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Bariatric Surgery for the Adolescence
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BARIATRIC SURGERY FOR THE ADOLESCENCE
Dr Sunita Goel
Consultant Anesthesiologist
Mumbai
 
Obesity is reaching epidemic proportions in the pediatric and adolescent populations. The prevalence of adolescent obesity has tripled over the last 3 decades, and the consequences of pediatric and adolescent obesity are becoming clearer. Aside from the fact that obese adolescents have a substantial risk of becoming obese adults, they also have an increased risk of co-morbidities commonly associated with adult-onset obesity including hypertension, hyperlipidemia and glucose intolerance. Additionally, obese children and adolescents experience significant psychosocial consequences. There is little evidence that dietary or pharmacologic treatments will effectively reverse morbid obesity in adolescence. Because of this epidemic, adolescents are increasingly seeking bariatric surgery as a realistic and effective treatment for their morbid obesity

Patient Evaluation:

Body mass index BMI (weight in kilograms divided by the height in meter squared) is a useful screening tool for assessing and tracking the degree of obesity among adolescence. Medical evaluation should include investigations into causes of obesity that may be amenable to treatment and identification of any obesity related health complications.

The most important ethical issues when considering an adolescent for a bariatric procedure are whether the patients health is being compromised by severe obesity, whether the patient has failed more conservative options to meet that health need and whether the patient has decisional capacity.


Criteria for bariatric surgery:

  • Has failed > 6 months of available, organized attempts at weight management.

  • Has attained or nearly attained physiologic maturity.

  • Severely obese BMI>40kg/m2 with severe obesity related co-morbidities or BMI>50kg/m2 with less severe co-morbidities.

  • Avoid pregnancy for atleast 1-year post surgery.

  • Capable and willing to adhere to nutritional guidelines.

  • Informed consent to surgical treatment.

  • Decisional capacity.

  • Supportive family environment

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