Surgery for Childhood and Adolescent Obesity

Many forms of dietary and drug treatment have been proposed to treat childhood obesity but none have been shown to provide anything other than short-term weight loss. As with adults, the only successful long-term treatment for obesity is weight loss surgery. 

Which surgical procedure? 

Whilst many different operations have been proposed for obesity in younger children, in our view the only procedure which should be considered is the gastric band. The main reason for this is safety:  the gastric band is a remarkably safe procedure – much more so than any other surgical treatment.   

Although advocated by some for use in adolescents, procedures such as Roux-en-Y gastric bypass (RYGBP) or sleeve gastrectomy (SG) should NOT be used in adolescents (those under 20-years of age) for the following reasons:

• Firstly, RYGBP and SG have an effect on a range of gut hormones, including ghrelin. No one yet knows what the long-term effects of this might be in younger people, particularly with regard to growth and emotional development.

• Secondly, unlike the gastric band, both RYGBP and SG may be associated with significant vitamin and mineral deficiencies, which could lead to anaemia, bone disease and damage to the nervous system. The frequency and severity of these complications and their long-term effects has never been studied in children.

• Both RYGBP and SG are highly invasive procedures as they involve dividing or removing stomach tissue and bowel.  Because of this they have a propensity to leak or bleed, which may result in serious complications. The SG cannot be reversed and the RYGBP is very difficult to reverse. In contrast, the gastric band does not involve cutting stomach or bowel and is an entirely reversible procedure.
  

Is the gastric band effective in children?

A number of studies have looked at the efficacy and safety of the gastric band in children. Probably the best to date was a well conducted trial involving 50 adolescents aged 14-18 years. Study subjects were divided into two groups of 25; one treated using diet and lifestyle measures only, whilst the subjects in the second group all underwent gastric banding. Results showed that 21 (84%) of the gastric banding group achieved more than 50% of their excess weight, compared with only 3 (12%) in the lifestyle group. Subjects undergoing surgery had major improvements in their health and quality of life and had no surgical complications. The benefits remained over the 2 years of follow-up.

Is my child eligible for a gastric band procedure?

Your child may be a candidate for gastric banding if he/she fulfills all of the following criteria...

• Is aged 14-years or over - To undergo a surgical weight loss procedure, to attend for regular band adjustments and to comply with specific dietary and lifestyle requirements, requires a certain level of physical and emotional maturity. In our experience children under the age of 14 are unlikely to have achieved this.

• Is classified as seriously obese - The definition of obesity in adolescence is complex.

• Is suffering adverse consequences due to their obesity. These may be physical, psychological or social (or more usually a mixture of all three).

• Has failed to lose weight with non-surgical treatments - It is important that non-surgical treatments, including diet and physical activity have been entirely exhausted.

• Has no underlying medical cause for his/her obesity - In a small minority of cases of teenage obesity there may be an underlying medical or endocrine (hormonal) cause.  In rare cases it may be due to genetic disorders (e.g. Prader Willi Syndrome). In all cases it is essential that conditions should be excluded before a surgical intervention is contemplated.

• Is not at undue risk from a general anaesthetic/surgery - Obviously, there must be no underlying medical problem which could make having a general anaesthetic or surgery hazardous. In practice, it is extremely rare to have to refuse surgery for a medical reason. In any event, a thorough medical examination is performed on two occasions by two independent experts as part of the standard pre-operative assessment.

• Understands the consent process - Teenagers aged 14-16 are not able to give independent consent to a procedure and need parental consent. Those aged 16-18 are able to consent, though we strongly recommend that parents are closely involved in the consent process. It is essential that the young person is contemplating surgery because they want it, not because they are being coerced by parental or outside pressure. In practice this may not be easy to achieve, but given that the examination and assessment is performed by highly experienced physicians – involving parents and teenagers – it is usually possible to gain good insight into the origins or motive to proceed to surgery. Evidence from experienced centres suggest this is not a major issue in practice.

• Has successfully completed the pre-operative assessment programme - All teenagers who wish to go ahead with gastric band surgery will need to complete our surgical pre-operative assessment programme.