Should Children Have Gastric Bypass Surgery?

We know childhood obesity is a problem. But do we know the answer? Or more importantly, what the answer isn't.

First Lady Michelle Obama has an exercise program for kids. So does the National Football League, and other organizations. But some children are opting for a more direct route to weight loss -- bariatric, or “gastric bypass,” surgery.

While a growing number of adults are undergoing this procedure, it remains controversial for children. A new poll by C.S. Mott Children’s Hospital shows most parents believe it should not be available to children under 18.

Just as cases of childhood obesity have skyrocketed in number over the last 40 years, so has children’s risk for obesity-related illness such as diabetes, high blood pressure, liver disease and other illnesses. Research shows a multitude of issues that contribute to the problem, but no single solution is clear.

Physicians tend to agree. They say that despite its benefits, bariatric surgery carries potential risks, which are not fully defined for adolescent patients. There is no standard age at which bariatric surgery is presented as an option for severely obese adolescents.

Minority parents more receptive

Overall, fewer than one-third of parents thought bariatric surgery should be an option for adolescents younger than 18. Black and Hispanic parents were more likely than white parents to consider bariatric surgery for younger adolescents.

In contrast, 13 percent of parents felt bariatric surgery should not be an option at any age – including one in five African-American parents. Among all groups, the most common viewpoint was that bariatric surgery should be delayed until the adolescent is 18 or older.

“Further research is required to explore why low-income and non-white parents were more accepting of bariatric surgery for adolescents, but it might be because these populations are disproportionately affected by obesity and are more familiar with the challenges faced by the severely obese,” said Susan J. Woolford, M.D., M.P.H., medical director of the Pediatric Comprehensive Weight Management Center at the University of Michigan Health System.

Longer pre-surgery weight loss period

The poll also showed that for parents who believe bariatric surgery should be reserved for those over 18, most also prefer that adolescents participate in a weight loss program for at least one year before considering bariatric surgery – six months longer than the minimum time generally required by doctors.

“Pediatric guidelines say bariatric surgery should be performed on adolescents only after at least six months of participation in an intensive weight-loss program," Woolford said.

The waiting period patients and their parents have the opportunity to implement lifestyle changes that are important for success after surgery.

“But parents in this study suggest a longer period,” said Woolford, who is also a clinical assistant professor with the Child Health Evaluation and Research unit in the Division of General Pediatrics.

Guidelines include adopting a low-fat, low-calorie diet, and implementing a regular exercise routine. Continuing these behaviors and taking regular supplemental vitamins and proteins following surgery are required to avoid serious complications.