Adolescent Bariatric Surgery

Abstract

The prevalence of severe obesity among children and adolescents continues to increase and poses a serious healthcare challenge both in the United States and worldwide. With 17 % of the US pediatric and adolescent population being categorized as obese (BMI >95th percentile) and up to 4 % as extremely obese (BMI >99th percentile), the medical community is facing a concurrent increase in the number and severity of numerous obesity-related comorbid illnesses (i.e., hypertension, insulin resistance, type 2 diabetes mellitus, obstructive sleep apnea, polycystic ovary disease, dyslipidemia, fatty liver disease, etc.) that were previously believed to only affect the adult population. In response to disappointing outcomes related to nonsurgical weight-loss treatment strategies as well as mounting evidence demonstrating a high association between the development of juvenile-onset childhood obesity and persistent severe obesity into adulthood, there has been a recent rise in the use of bariatric surgical intervention in an effort to obtain durable weight loss and abrogate the potential long-term physiological burden of chronic obesity. In this chapter, we will review recent data regarding the development and progression of several commonly encountered obesity-related comorbid illnesses in the pediatric population, which serve as an important foundation in support of the argument for adolescent surgical weight reduction (i.e., “early intervention”). In addition, this chapter will review the current evidence-based recommendations regarding use of specific bariatric procedures, including discussion of longitudinal outcomes and associated complications as well as a brief review of the current recommendations for the multidisciplinary care of the adolescent bariatric patient.