i at r i c

ar e ry
S urg

Dr.Anu Sandhya
 Introduction
 Obesity in children and teens is a serious health problem. About 1 in 6
children in the U.S. are obese.
 A child who is overweight or obese is more likely to be overweight or
obese as an adult.
 Children with obesity have health problems that used to be seen only
in adults. A child who is overweight or obese is also more likely to have
problems such as:
 Low self-esteem
 Poor grades in school
 Depression
 prevalance
The number of overweight or obese infants and young children (aged
0 to 5 years) increased from 32 million globally in 1990 to 42 million.

The vast majority of overweight or obese children live in developing

countries, where the rate of increase has been more than 30% higher
than that of developed countries.

Researchers studied in UAE 1,440 children and teenagers aged 6 to

19 and found 14.2 per cent were overweight and a further 19.8 per
cent were obese.
Causes of Obesity in children

Dietary habits
Lack of exercise
Lack of sleep
Socio-economic situation
Genetic prevalence
Is Weight-loss Surgery Right for Your
Child?
The body mass index (BMI) measures below are used by many doctors to decide who can be
helped the most by weight-loss surgery. The general guidelines are:
 A BMI of 35 or higher
 And a serious health condition related to obesity, such as:
 Diabetes (high blood sugar)
 Moderate or severe sleep apnea

A BMI of 40 or higher and a less serious health condition related to obesity, such as:
 High blood pressure
 High cholesterol
 Mild sleep apnea
 Depression
factors to be considered before a child or
teenager has weight-loss surgery
No weight loss while on a diet and exercise program for at least 6
months, while under the care of a physician.
The teenager should be finished growing (usually 13-years-old or
older for girls and 15-years-old or older for boys).
Parents and the teen must understand and be willing to follow the
many lifestyle changes that are necessary after surgery.
The teen has not used any illegal substances (alcohol or drugs)
during the 12 months before surgery
 Obesity Care Team
Child psychologists and psychiatrists
Physical therapists
Dietitians
Anesthesiologists
Otolaryngologists (ear, nose and throat specialist)
Staff nurses
Cardiologist
Endocrinologist
Pulmonologist
 Classification
Overweight Obesity Group I Obesity Group II Morbid Obesity Super Morbid
BMI 25-29.9 BMI 25-29 BMI 30-34.9 BMI 35-39.9 Obesity
BMI > 45
+ Comorbidities + Comorbidities + Comorbidities
Or BMI 30-34.9 Or BMI 35-39.9 Or BMI 40-44.5
 Study

Results: One
• Objective: To hundred
evaluate sixteen children
the effect younger than
of laparoscopic 14
sleeve
gastrectomy
years (mean(LSG)± SD,on11.2
growth in children
± 2.5 younger than
years) underwent LSG.14
years in a matched
Compared with control
the 1:1 study.
matched group of nonsurgical
• Conclusions: This study challenges existing concerns regarding the safety and
weight of Surgery.
• Annals management,
2016 these children experienced
efficacy of bariatric surgery in prepubertal children. LSG is evidently safe and
significantly higher growth, gaining 0.9 mm more per
effective in this age group, •resulting
Methods: indata of young
significant nonsyndromic
weight children
loss, improved (age ≤14
growth,
month who
years) on average.
underwentorCompared
LSG. withwere
Patients 158age,
adolescents
sex, and
and resolution of comorbidities without mortality significant morbidity.
(age, 17.3
height ± matched
z-score 2.0 years) who
with underwent
those LSG in
on nonsurgical our
weight
management, and their results
institution, children youngerwerethan
compared with those
14 years had ofa
older adolescents
significantly (ageprevalence
lower > 14 years) of who underwent (P
comorbidities LSG.<
Generalized
0.001) but estimating equation analysis
similar resolution was=done
rates (P to assess
0.72–0.99).
growth.
There was no significant difference in the rate of
complications (P = 0.77), and no mortality or
significant morbidity was observed in any of the groups
Reference:
• Marcdante KJ, Kliegman RM. Obesity. In: Marcdante KJ, Kliegman RM,
eds. Nelson Essentials of Pediatrics. 7th ed. Philadelphia, PA: Elsevier
Saunders; 2015:chap 29.
• Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for
the perioperative nutritional, metabolic, and nonsurgical support of the
bariatric surgery patient -- 2013 update: cosponsored by American
Association of Clinical Endocrinologists, The Obesity Society, and
American Society for Metabolic and Bariatric Surgery. Endocr Pract.
PMID: 23529351 www.ncbi.nlm.nih.gov/pubmed/23529351.

• Child weight data factsheet; Public Health England (Oct 2015)

• weight loss is associated with improvement of comorbid diseases in
75-100% patients