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Weight-loss surgery for kids: maybe as a last resort

May 6, 2010 |  3:19 pm

For the 17% of American kids who are considered obese, prevention -- the strategy everyone agrees is the best way to tackle the nation's health woes -- is no longer an option. What, then, to do to prevent a wave of obesity-related diseases down the line?

A new review article published in the British journal the Lancet acknowledges that despite all the hand-wringing -- and the fact that the breathtaking rise in obesity among kids has begun to stabilize -- we seem to know less than ever about what works best to prevent or reverse obesity in kids. Current recommendations for how much kids should reduce their caloric intake "might be too conservative," given research done in 2006, says a team lead by a researcher from the National Institutes of Health, Dr. Joan C. Han. The "sedentary lifestyles of children nowadays" have driven a need for new and better research on how much the "energy burned" end of the equation needs to change, Dr. Han's team wrote.

One thing the Lancet writers -- and U.S. physicians generally -- are not so keen on: bariatric surgery for kids. They call the risks of bariatric surgery for children "substantial" and point out that the long-term safety and effectiveness of such surgery "remain largely unknown." Accordingly, they said, it should be reserved for the most obese children, those with a BMI over 50 or for those with a BMI over 40 who already have weight-related complications such as high blood pressure, high cholesterol, fatty liver or diabetes.

"Even then," they wrote, bariatric surgery should be "considered with extreme caution."

According to a study published this week in the Journal of Obesity Surgery, they are preaching, for the most part, to the choir on this point. In a national survey of family physicians and pediatricians, 48% said they would not ever refer an obese adolescent for bariatric surgery. Few physicians responded that children younger than 15 should be referred to a specialist to consider weight-loss surgery. And the physicians were slightly more likely to recommend surgery earlier to an extremely obese girl than to a boy.

A group of four hospitals led by Cincinnati Children's Hospital Medical Center has been studying the circumstances under which bariatric surgery works best for children. Among their findings: that bariatric surgery significantly improved abnormalities in heart function.

--Melissa Healy