weight-loss
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The worldwide prevalence of childhood obesity has increased by 47% between 1980 and 2013.[1] Obesity, a condition where body mass index (BMI) is greater than or equal to 30, is increasingly seen in adolescents and can also affect their adulthood.[2] These BMI cutoff numbers vary based on ethnicity and race. Obesity can result in emotional and behavioural problems.[3] The condition can be attributed mainly to changes in diet, physical inactivity, sedentary lifestyle and other genetic changes.[4] About 2%-6% out of 17% of obese children are categorized as extremely obese.[5]

People with obesity are at a greater risk of developing the following health conditions:[5]

  • Cardiovascular diseases
  • Impairment of glucose metabolism
  • Sleep disorder
  • Raised intracranial pressure
  • Liver disease
  • Psychological problems

Weight loss can be achieved through proper lifestyle modifications and/or medications. If a person is severely obese, has other associated health conditions and has failed at other methods of losing weight, bariatric surgery can be considered.[2]

Bariatric surgery is a surgical procedure that helps in weight loss by making changes to stomach or small intestine.[2] It ensures sustainable weight loss and improved quality of life.[5]

Who can undergo bariatric surgery?

The eligibility criteria required for adolescents undergoing surgery includes the following:[5]

  • Attainment of skeletal maturity
  • Commitment by a person as well as the family to understand the care necessary pre- and post-surgery
  • The ability to take mature decisions alone
  • Demonstrable family support
  • Understanding the risks and benefits of surgery

A multidisciplinary team required for bariatric surgery includes a bariatric surgeon, paediatric specialist, dietician and a mental health specialist. Long-term follow-up after surgery is recommended to ensure better service and safety.[1]

How can surgery affect the quality of life?

Obesity in children can result in low self-esteem, discrimination and depression, which may continue in adulthood. Recent findings show that such issues may result in reduced academic performance in adolescents.[4]

Anger, anxiety, depression and violent behaviour were decreased, and an overall improvement in self-esteem, mood and self-concept were seen after surgery.[1] Health-related quality of life (HRQOL) is a patient’s perspective on their day-to-day activities due to health issues. HRQOL helps doctors to identify patient’s wellness and those in need of support, referral, or recommendation. Youth with obesity have low HRQOL as compared to others with a medical condition of increased risk.[6] A study by Zeller reports significant improvement in HRQOL measures and depressive symptoms in the first year after surgery.[5]

Thus, it can be concluded that a dramatic rise in HRQOL was seen post-surgery in an early follow-up. More data on the long-term effects of surgical therapy are needed for further study of surgical therapy for obesity in adolescents.[7]

References:

  1. Durkin N, Desai AP. What is the evidence for paediatric/adolescent bariatric surgery? Curr Obes Rep. 2017 Sep;6(3):278-285. doi: 10.1007/s13679-017-0277-4.
  2. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts for bariatric surgery [Internet]. [cited 2020 Jan 14]. Available from: https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery/definition-facts.
  3. World Health Organization. Adolescent obesity and related behaviours: trends and inequalities in the WHO European region, 2002–2014 [Internet]. [cited 2020 Jan 14]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0019/339211/WHO_ObesityReport_2017_v3.pdf.
  4. Beamish AJ, Johansson SE, Olbers T. Bariatric surgery in adolescents: what do we know so far? Scand J Surg. 2015 Mar;104(1):24-32. doi: 10.1177/1457496914553150.
  5. Thakkar RK, Michalsky MP. Update on bariatric surgery in adolescence. Curr Opin Pediatr. 2015 Jun,27(3):370-6. doi: 10.1097/MOP.0000000000000223.
  6. Zeller MH, Inge TH, Modi AC, Jenkins TM, Michalsky MP, Helmrath M, et al. Severe obesity and comorbid condition impact on the weight-related quality of life of the adolescent patient. J Pediatr. 2015 Mar;166(3):651-9.e4. doi: 10.1016/j.jpeds.2014.11.022.
  7. Loux TJ, Haricharan RN, Clements RH, Kolotkin RL, Bledsoe SE, Haynes B, et al. Health-related quality of life before and after bariatric surgery in adolescents. J Pediatr Surg. 2008 Jul;43(7):1275-9. doi: 10.1016/j.jpedsurg.2008.02.078.

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