By Teddi Fine
Like adults, severely overweight children and teens are at heightened risk for a host of physical and emotional problems, including cardiovascular disease (e.g., high cholesterol and blood pressure) and diabetes, as well as poor self-esteem and depression. Also like adults, growing numbers of young people and their parents are turning to weight-loss surgery as a potential solution.
Unlike adults, though, the kids might not be physically or emotionally ready for such measures, worries Assistant Professor Shawna Mudd, DNP, CNP-AC, PNP-BC, who adds a concern that guidelines regarding adolescent weight-loss surgery are not consistent or necessarily followed regularly or with precision.
Some 17 percent of children and adolescents (ages 2 to 19)—or 12.5 million—are obese, increasing the likelihood that they will become adults with even more serious weight problems. “Current Guidelines for Weight Loss Surgery in Adolescents: A Review of the Literature,” which Mudd conducted with a colleague, highlights the significant variance in current guidelines, particularly when it comes to age, body mass index, and co-occurring health problems. Factors like surgical setting and follow-up care also remain the subject of ongoing debate in the research and within professional organizations.
Critically, Mudd’s inquiry did find one area in which experts concur. Weight-loss surgery, whether gastric bypass or gastric banding, is a serious undertaking that should be considered only when an adolescent has achieved close to full physical and emotional maturity. Younger teens and children could be at risk for significant malabsorption that could affect growth and development. They also may lack the emotional maturity needed for success. That’s because weight-reduction surgery is just a one part of a larger process. Preparation for surgery and what comes afterward—like learning a new way of eating and living—can be overwhelming for a younger patient who may not be willing and able to make the lifelong commitment necessary to ensure the surgery’s success.
Mudd suggests that more research be conducted to assess the degree to which adolescents can make informed decisions and comply with post-surgery lifestyle changes. In the meantime, she says, “It’s important that nurse practitioners and other primary care providers be aware of the pluses and minuses of current obesity surgery guidelines for children and youth when assisting families with appropriate decision making and counseling.”