Battling Childhood Obesity with Bariatric Surgery
With childhood obesity becoming an ever-present epidemic, the issue of patient qualification for bariatric surgery needs to be revisited. Recent data shows that nearly 17 percent of US youth between the ages of 6 and 19 are considered overweight. Overweight youth are more likely to develop serious health problems, such as Type-2 Diabetes and heart disease.
Last fall, the National Institute of Health launched a five-year study to assess the benefits and risks of bariatric surgery in teens. The study, known as the Teen-LABS protocol, mirrors that of the adults LABS study, an observational study that evaluates the benefits and risks of bariatric surgery, and its impacts on the health and well-being of extremely obese adults. The Teen-LABS study will also collect information on the preoperative and 2-year postoperative status of participants, including measures of body composition, cardiovascular risk factors, sleep apnea episodes, diabetes indicators, depressive symptoms, quality of life, eating habits and nutrional status.
The benefits of bariatric surgery outweigh the risks. The procedure can reduce the amount of calories and nutrients the body absorbs by reducing the stomach size. About 75 percent of patients are expected to lose 75-80 percent of their excessive body weight. Over 70 percent of patients with hypertension will be off medications. Over 90 percent of patients with Type-2 non-insulin dependent diabetes will be also be off medications. The surgery can result in complete resolution of sleep apnea, asthma, joint pain, arthritis, reflux, fatigue and shortness of breath. Although these benefits outweigh the risks, not all obese patients qualify for bariatric surgery. Major risks include bleeding, infections, gallstone, gastritis, pulmonary embolism, peritonitis, stomal stenosis and vitamin deficiencies.
According to NIH guidelines, in order to qualify for bariatric surgery, patients must:
- Suffer from morbid obesity. Patients with morbid obesity have a Body Mass Index (BMI) of 40 or above.
- Have made a significant effort at weight loss by participating in supervised weight loss programs over a long period of time and failed to have achieved significant weight loss.
- Have a co-morbid condition related to obesity and be willing to take part in a presurgery weight-loss effort to improve the success of surgery Examples of co-morbid conditions include Type-2 diabetes, sleep apnea, asthma, hypertension, high cholesterol, metabolic syndrome or infertility.
- Be able to make necessary lifestyle adjustments to sustain the level of weight loss necessary to address medical conditions.
Four types of bariatric surgery exist. Roux-en-y gastric bypass surgery (RGB) works by restricting food intake and by decreasing the absorption of food. Food intake is limited by a small pouch, similar in size to the adjustable gastric band. The absorption of food is reduced by excluding most of the stomach, duodenum and upper intestine from contact with food by routing food directly from the pouch into the small intestine.
Adjustable Gastric Band surgery (AGB) works primarily by decreasing food intake. Food intake is limited by placing a small bracelet-like band around the top of the stomach to produce a small pouch about the size of a thumb. The outlet size is controlled by a circular ballon inside the band that can be inflated or deflated with saline solution in order to meet the needs of the patient.
A Gastric Sleeve operation, a third type of bariatric surgery, restricts food intake but does not lead to decreased absorption of food. In the surgery, most of the stomach is removed which may result in decreased production of the hormone ghrelin which reduces hunger more than purely restrictive operations.
The most commonly practiced type of bariatric surgery is laparoscopic surgery. Laparoscopic surgery is performed through “open” approaches by making abdominal incisions in the traditional manner. Most bariatric surgery today is performed laparoscopically because it requires a smaller cut, creates less tissue damage, leads to earlier discharges from the hospital and has fewer complications. Evidence-based medicine shows that laparoscopic surgery incurs fewer risks like impairment of pulmonary function, decreased wound infections and incisional hernias. Major and minor complications and risks increase with the size of the patient, despite which surgery is performed.
Because bariatric surgeries are so expensive, ranging from $17,000 to over $30,000, careful consideration established through evidence-based medicine must be applied to individual cases. Most private insurance carriers require patients to submit a letter of medical necessity from his or her doctor. The letter should include the patient’s height and weight history and BMI; a detailed description of the patient’s obesity-related health conditions, including records of treatment; a list of current medications; a detailed description of how obesity affects the patient’s daily activities; a detailed history of past dieting efforts; and a history of exercise programs, including gym membership documentation. The option of surgical treatment should be offered to those patients who are morbidly obese, well informed, motivated and fully accept operative risks.
© 2008 AllMed Healthcare Management, Inc. 621 SW Alder Street, Suite 740 Portland, Oregon 97205 - All rights reserved.