Severely obese children who are unable to slim down should be eligible for weight loss surgery, a new study suggests.
The gastric sleeve procedure is safe and effective long-term, said a research team that followed participants as young as 5 for a decade.
"Lack of long-term data and some pediatricians' fears that bariatric [weight loss] surgery might affect children's linear growth has led to worldwide resistance to performing weight loss procedures for children below 14 or 15 years of age," said principal study author Dr. Aayed Alqahtani. He is a professor of bariatric and minimally invasive surgery at King Saud University in Saudi Arabia.
"Our findings present clear evidence that should remove hesitance to perform bariatric surgical treatment in children and young adolescents who could benefit from the operation," Alqahtani said in a news release from the American College of Surgeons. "We have a proven solution for severe obesity and its comorbidities [related diseases]," he added.
The operation involves dividing and removing a part of the stomach, including the part that has the so-called hunger hormone, which stimulates appetite. The remaining stapled portions create a "sleeve" that makes the stomach banana-sized. Patients then eat less food and can lose weight.
The study included 2,500 Saudi Arabians aged 5 to 21 with severe obesity (120% of the 95th percentile on U.S. Centers for Disease Control and Prevention growth charts). The study patients had tried to lose weight on six-month programs that included diet and behavioral counseling. About one-third were younger than 15.
The participants had their procedures between 2008 and 2021. Prior to surgery, about 10% had type 2 diabetes or abnormal blood fats and about 15% had high blood pressure. Obesity can raise the risk of these conditions, and also contribute to fatty liver disease, sleep apnea and depression.
In the United States, about 19% of youths are obese, the study authors noted.
Alqahtani's team found no differences in weight loss or height trajectory for the younger kids, aged 5 to 14, than for older pediatric patients who had the operation.
Patients lost an average of 30% of their total weight and had widespread reversal of type 2 diabetes and key heart disease risk factors, with no procedure-related deaths or major complications, Alqahtani said.
The study authors suggested that there should be no lower age cutoff for the procedure.
The patients continued to have good results seven to 10 years after their operations, according to the study, including resolved type 2 diabetes in more than 70% of patients. Blood fat levels and blood pressure were normal in more than half of those who had these problems, and patients maintained an average 71% loss of excess weight.
The study findings were published online Sept. 23 in the Journal of the American College of Surgeons.
The findings were consistent with the most recent guidelines from the American Academy of Pediatrics and the American Society for Metabolic and Bariatric Surgery, which do not advise waiting until a child reaches maturity if the operation is recommended.
"If you surgically intervene early, you can cure children's obesity-related diseases early and improve their quality of life, and if you wait longer, their diseases might become irreversible," Alqahtani said.
The U.S. Centers for Disease Control and Prevention has more on childhood obesity.
SOURCE: American College of Surgeons, news release, Sept. 23, 2021