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Adolescents

Half of physicians would not recommend surgery to adolescents

Nearly one-half of physicians would not ever refer an obese adolescent for bariatric surgery

According to research published in Obesity Surgery, half of primary care physicians say they would not recommend bariatric surgery to a patient under the age of 18, even though studies suggest that severely obese adolescents may benefit from the procedure.


Childhood obesity has increased dramatically over the last few decades and adolescents are more likely to suffer from T2DM, hypertension, non-alcoholic steotohepatitis, sleep apnea, choleolithiasis and premature death as adults. As the prevalence and severity of obesity among adolescents has increased, so has the number seeking bariatric surgery. Little is known about the opinions and referral behaviours of primary care physicians regarding bariatric surgery among adolescents.

As a result, Dr Susan Woolford, Medical Director of the Pediatric Comprehensive Weight Management Center at the University of Michigan, and colleagues, assessed primary care physicians’ opinions regarding referral of obese adolescents for bariatric surgery. 


Minimum age at which physicians would make a referral for bariatric surgery was 18 years

In spring of 2007, a two-page survey was fielded to a national random sample of physicians (375 paediatricians and 375 family physicians). The survey explored physicians’ opinions about: (1) whether they would ever refer an adolescent for bariatric surgery, (2) the minimum age at which bariatric surgery should be considered, and (3) prerequisites to bariatric surgery. Chi-square tests were used to examine associations in responses. 


Results


The response rate was 67%. Nearly one-half of physicians (48%) would not ever refer an obese adolescent for bariatric surgery. The most frequently endorsed minimum age at which physicians would make a referral for bariatric surgery was 18 years (46%). Almost all respondents endorsed the need for participation in a monitored weight management programme prior to bariatric surgery (99%).

However, the recommended duration of treatment varied from three months to over five years, with almost half recommending 12 months of monitored treatment prior to surgery. 


For adolescents, participating in these programmes could be helpful by providing time to make a stable decision regarding surgery and to adopt healthy habits that will improve their post-operative course, but the delay in surgery could also lead to further weight gain.


Some severely obese adolescents may desire and potentially benefit from bariatric surgery, but referral for the procedure may depend heavily on the attitudes of their primary care physicians. The authors suggest further studies should explore primary care physicians' knowledge regarding the risks and benefits of bariatric surgery for adolescents and the basis upon which they make referral decisions regarding bariatric surgery for their obese patients.


“We still have a lot to learn about the long term effects of bariatric surgery among adolescents,” said Woolford. “But recent studies suggest that it can be helpful to improve the health outcomes of severely obese adolescents.”


Physicians who support the possibility of bariatric surgery for adolescents may do so because studies have indicated that obesity in adolescents has long-term health effects even if patients eventually lose weight, the authors write. 


“Primary care physicians should be prepared to discuss this treatment option with families as they are on the front line of obesity treatment,” she concluded. “Their attitudes regarding bariatric surgery may affect whether or not an adolescent pursues the procedure.”

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