The management of pediatric obesity
The management of pediatric obesity must be tailored to the patient’s needs and should involve a combination of dietary intervention, structured exercise program, stress reduction, and restful sleep.
Bariatric surgery is an option reserved for patients whose obesity has advanced beyond the point where the above mentioned interventions are likely to result in a meaningful benefit or for the patients who have already developed comorbidities associated with obesity. Thus, the aggressiveness of obesity management should be matched with the severity of the patient’s disease and its associated comorbidities.
Bariatric surgery is offered to a well selected group of patients, primarily focusing on prevention of early mortality and resolution of comorbidities associated with obesity. The ideal candidates for evaluation in Adolescent Bariatric Surgery Program at Boston Children’s hospital, per best practice updates (Pratt et al, Obesity, 2009), are the patients with BMI >40 or BMI >35 with significant comorbidities including:
- type 2 diabetes
- obstructive sleep apnea
- severe steatohepatitis
- idiopathic intracranial hypertension
In order to be considered for bariatric surgery the patient must meet these exclusion criteria:
- reach Tanner stage IV or V
- complete at least 95 percent of estimated growth
- able to accept dietary and physical changes following surgery
In addition, they must demonstrate psychological readiness with evidence of mature decision making and appropriate social support as evidenced by:
- ability to demonstrate and willingness to adhere to pre and post nutritional guidelines and medical care
- ability to demonstrate a developmentally appropriate understanding of weight loss surgery (WLS), realistic expectations about WLS, commitment to post-operative care and nutrition, and risks and benefits of weight loss surgery
- have appropriate support from family with realistic expectations about weight loss surgery
- the presence of a behavioral health concern or some forms of disordered eating are not an exclusion criterion, but the patient must be in treatment and considered stable prior to proceeding toward surgery.
Referring a patient for bariatric surgery
We will determine whether bariatric surgery is appropriate for your patient on a case-by-case basis and screen each patient for the presence of obesity associated co-morbidities. Our team consisting of surgeons, pediatric gastroenterologists, a psychologist, a nurse practitioner, registered dietitians, a clinical social worker, and a clinical coordinator adheres to Clinical Practice Guidelines (Mechanick et al., Endocr Pract. 2013) to provide personalized and state-of-the-art care to our pre- and post-operative patients.