Obesity is rapidly becoming a problem of epic proportions in the adolescent patient population. The implications of this profound health crisis are clearly recognized as serious and immediate, and long-term physical and psychological consequences are being identified. Childhood and adolescent obesity are now considered independent risk factors for adult morbidity and premature mortality.1,2
Resorting to bariatric surgery to address these issues in morbidly obese adolescents who have life-threatening comorbidities is a radical concept demanding increasing attention, particularly given the growing amount of data demonstrating positive outcomes after bariatric surgery in the adult population. Adolescence represents a period of significant growth and maturation both physically and emotionally, thus issues unique to this patient population exist, which must be addressed when considering bariatric surgery. This chapter focuses on aspects of bariatric surgery unique to the adolescent population, including the health consequences of obesity in this age group, the indications for bariatric surgery, preoperative and postoperative management, as well as a review of current outcomes.
In the United States, obesity has far surpassed malnutrition as the most pressing nutritional disorder.3 Children are the fastest growing segment of the population afflicted by this disorder. The proportion of children and adolescents who are obese tripled between 1980 and 2002.4,5 Recent prevalence studies in the United States estimate 17.1% of children and adolescents to be overweight.6 Clear ethnic and racial disparities are also noted with especially high rates of obesity in the Hispanic and African American communities.6–9 A recent study in a New York City elementary school reviewed over 3,000 students’ demographic data and demonstrated the prevalence of overweight in young children to be 43% (more than half of whom were obese) with significantly higher levels among Hispanic and Black children.10
This problem of obesity is not isolated to the United States, rising trends in overweight and obesity both in adults and children are apparent in both developed and developing countries worldwide.11–15 In China, for example, the prevalence of obesity in school children increased from 1.5% in the late eighties to 12.6% in 1997.16
Throughout childhood, dramatic changes in adiposity, height, and weight occur; thus, the exact definition of obesity in children and adolescents is subject to much debate. In general, it can be defined as an excess of body fat. Accurate assessment of body fat requires underwater weighing, dual energy x-ray absorptiometery, or bioelectric impedance, all of which are not practical for everyday use.17
Body mass index (BMI, kg/m2) is widely used as a surrogate measure of adiposity, particularly in the adult populations. An adult with a BMI ≥ 30 kg/m2 is considered obese.18 In children and adolescents who are still growing and have changing body shapes, BMI can be less accurate, particularly as it fails to ...