Is bariatric surgery an option in obese adolescents?

Gastrointestinal surgeons should think very carefully before they make the decision to offer bariatric surgery to obese adolescents, an Australian expert warns. Associate Professor Wendy Brown from Monash University told a session at the AGW annual conference that she could only give a big “maybe” to answer the question of whether or not obese adolescents should be treated with bariatric surgery. On the one hand, she said, obesity and morbid obesity is a significant problem among Australian teenagers. The same co-morbidities affect obese adolescents as affect obese adults, and nearly all obese teenagers will remain obese as they grow up and will potentially experience reductions in their life expectancy. They often also suffer severe social stigmatisation because of their obesity, she said. Furthermore, traditional multidisciplinary, family based approaches, if they work, tend to succeed in maintaining weight levels rather than reducing them. On the other hand, she said, there is little data on the long-term mortality and morbidity of adolescents who have undergone bariatric surgery. This is particularly worrying for teenagers who will then have to live with the effects of their surgery. The trials that do exist tend to be small, case control or retrospective studies, but even those report some worrying adverse mortality and morbidity outcomes. “I think that if teenagers are going to be offered bariatric surgery, it needs to be a very well considered decision,” Professor Brown said. “The teenagers themselves need to know the implications of the surgery itself and its lifelong consequences… and the family should be supportive but should not be pushing them [to undergo it],” she said. She added that surgeons who perform such surgery should be sure that they are adequately prepared to perform it well, and to offer a lifetime of follow-up. They should also only consider procedures that are potentially reversible....