About 9% of teens have severe obesity, which translates to about 5 million youths,
according to the National Health and Nutrition Examination Survey. Yet only about
1,500 to 2,000 undergo bariatric surgery each year.
“Many people would agree that bariatric surgery is a generally underutilized option,”
said Mark P. Michalsky, M.D., FAAP, a member of the AAP Section on Surgery.
Dr. Michalsky plans to discuss the natural course of severe obesity if left untreated
and make the case for surgery during a session titled “Adolescent Bariatric Surgery:
When, Why, and How (F4018)” from 8:30-9:15 a.m. Tuesday, Nov. 6, in room W311EF of
the convention center.
Many children and adolescents with obesity suffer from co-morbid diseases such as
fatty liver, obstructive sleep apnea, hypertension, type 2 diabetes, and degenerative
musculoskeletal and joint complications, said Dr. Michalsky, professor of clinical
surgery and pediatrics at Nationwide Children's Hospital, Columbus, Ohio.
“Strikingly, many of these patients are dealing not just with one or two (co-morbidities)
but are dealing with multiple — three, four, five — what would otherwise be considered
independently significant co-morbid conditions,” he said.
Often, these conditions get worse over time, and the long-term consequences become
irreversible at some point.
“One of the strongest arguments for doing bariatric surgery in the adolescent population
is that we believe there is a strong window of opportunity to not only improve but
perhaps in some cases completely reverse many of these co-morbid conditions,” Dr.
Adolescents with severe obesity face not only physical ailments but also social problems.
“Anecdotally, many of the patients that I and my colleagues around the country come
into contact with are dealing with a number of social issues, and a significant proportion
of these teenagers are often homeschooled because of social anxiety and bullying,”
Dr. Michalsky said.
During the session, he plans to review data on outcomes of adolescent bariatric surgery,
including several large, multi-institutional trials that he is involved in.
“The take-home message of my presentation is that these operations are safe and tremendously
effective,” Dr. Michalsky said, “and as pediatricians … we need to start considering
the use of this type of treatment paradigm more readily than we’ve done in the past.”