Adolescent Bariatric Surgery

How we define and treat adolescent obesity

Pediatric and adolescent obesity are increasingly prevalent, with Georgia having the highest rate of pediatric obesity in the nation. Twenty-six percent of Georgia's high-school students, 33 percent of the state's middle school students and 31 percent of children who have ambulatory surgery at Children's Healthcare of Atlanta at Egleston Hospital are overweight or at risk of becoming overweight. The Adolescent Bariatric Surgery Program at Emory offers two surgical methods to address this widespread health problem.

Why Treat Adolescent Obesity?
How is Obesity Defined?
Who Should be Referred for Bariatric Surgery?
What Bariatric Operations are Available for Adolescents?
Contact Details

Childhood and adolescent obesity have significant social and psychological impact on the patient, such as exclusion and ridicule by peers. In addition to having a lower health-related quality of life (QOL) than healthy children and adolescents, the QOL of severely obese children and adolescents is similar to those diagnosed with cancer. Major health issues include diabetes, hypertension, pseudo tumor cerebri, arthropothies/orthopedic issues and obstructive sleep apnea. Ultimately, the obese child has a 70-80% risk of becoming an obese adult.

Before being evaluated by a surgeon as a candidate for weight reduction surgery, prospective patients must meet the required body mass index (BMI), a number mathematically calculated using inches and pounds or meters and kilograms to show body weight adjusted for height. Children are defined as obese if their BMI is greater than the 95th percentile and are considered overweight and at risk for obesity when their BMI is greater than or equal to the 85th and less than the 95th percentile. Please visit the CDC website to access an online BMI web calculator as well as tables of calculated BMI values for selected heights and weights for individuals two to 20 years of age.

There are no clearly defined indications for bariatric surgery in children. However, adolescent recommendations do exist and are based upon the adult criteria established by the National Institutes of Health: a BMI of 40 or more, which is approximately 100 pounds overweight for men and 80 pounds for women, or a BMI between 35 and 39.9 paired with a serious obesity-related health problem such as type 2 diabetes, heart disease or severe sleep apnea. It is also important that the patient understands the procedure and the lifestyle changes that it demands.

Consideration for bariatric surgery is generally warranted only when adolescents have experienced failure of six months of organized weight loss attempts and have met certain anthropometric, medical and psychologic criteria. Adolescent candidates for bariatric surgery should be severely obese (defined by the World Health Organization as a BMI greater than or equal to 40), need to have attained a majority of skeletal maturity (commonly greater than or equal to 13 years of age for girls and greater than or equal to 15 years of age for boys) and should have co-morbidities related to obesity that might be remedied with durable weight loss. Patients with a BMI greater than 50 with minor co-morbidities may also be considered.

Physicians are encouraged to refer patients that fit these criteria to the Adolescent Bariatric Surgery Program at Emory, whereupon a pre-operative work-up will be initiated if program physicians conclude that the patient is an appropriate candidate for bariatric surgery. Please be advised that this process can take six months or more.

The two most common bariatric procedures for adolescents in the U.S. are the Roux-en-Y gastric bypass and the adjustable gastric band. While both operations have advantages and disadvantages, they are both effective for weight loss and are typically performed laparoscopically.

• Roux-en-Y gastric bypass (RYGB):
  Restrictive and malabsorbtive, RYGB combines the creation of a small gastric pouch with the bypass of a portion of the small bowel. RYGB has been in use longer than AGB and has shown more long term results. Potential complications specific to RYGB include anastamotic leakage, internal hernia, wound problems and weight regain.
  
  
• Adjustable gastric band (AGB):
  This procedure involves the placement of a silastic band around the cardia of the stomach that is adjustable through a subcutaneous port, leaving a small pouch. While weight loss isn't as rapid as that of RYGB, AGB is reversible and is a much simpler operation, with the average length of stay for most patients being one-two-days. Unfortunately, the AGB device has yet to be approved by the FDA for use in patients under 18. However, the Emory program is one of several centers that is using the LapBand (Inamed Health, Santa Barbara, CA) AGB off-label and/or investigationally in adolescent patients.

Referrals to the Adolescent Bariatric Surgery Program can be made by calling 404.982.9938. The program operates in conjunction with the Emory Bariatric Center.

return to top