Bariatric Surgery in Children, Research Paper Example

Introduction

Obesity is the most deadly epidemic of the present day and it is rapidly spreading on a global scale. Many individuals believe this epidemic is a self-inflicted problem and is nothing but the sheer lack of a person’s willpower to control what he or she consumes. However, during the period from 1980 to 2002, the prevalence of obesity doubled in adults ages 20 years and over (Garrett & McNolty, 2010). Even more frightening is the fact that this problem actually tripled in the age group of individuals ages 6 to 19 years old—the children of our society (Garrett & McNolty, 2010).

The problem of childhood obesity is primary in the healthcare community and is associated with neurological, endocrine, cardiovascular, pulmonary, musculoskeletal, and gastrointestinal problems (van Geelen, Bolt, & van Summeren, 2010). If this is not enough, it also causes psychological problems such as lower self-esteem, anxiety, depression, other generalized social disorders. This article attempts to expound on the subject of childhood obesity, the bariatric option used to help control this problem, and the ethics involved in the use of this option in younger individuals.

Childhood Obesity and Bariatric Surgery

Obesity is generically defined in adults as having a body mass index of greater than 30 in adults or being in the 95^th percentile for a child’s age group (Inge, Helmrath, Vierra, & Ikramuddin, 2008). There are, during the present time, more children in the obese category than children who suffer from cancer, cystic fibrosis, HIV, and juvenile diabetes combined (Inge, Xanthakos, & Zeller, Bariatric surgery for pediatric extreme obesity: Now or later?, 2007). This puts an extreme hardship on children and adolescents because of the fact that obesity in addition to other problems will place them at risk for future medical conditions much earlier in life than if they were healthy and not overweight. It will almost certainly lead to an earlier death as well (Inge, Xanthakos, & Zeller, Bariatric surgery for pediatric extreme obesity: Now or later?, 2007).

Until now, behavioral weight management was the advocated method of weight loss for these levels of extreme obesity and the results were fair at best. There have been reports of a BMI reduction of 3% for individuals who have undergone behavioral weight management during the childhood or adolescent stage and rarely have the individuals been successful at keeping the weight off (Inge, Xanthakos, & Zeller, Bariatric surgery for pediatric extreme obesity: Now or later?, 2007). Presently, however, bariatric surgery is thought of as an effective treatment option for children and adolescents who have levels of extreme obesity that are life-threatening and could lead to very early mortality if not counterattacked.

Experts believe that reasons for this insurgence in the obesity epidemic are due to a decrease in physical activity because of the modern technical age, increased use of the television, more video gaming, increased use of the computer, and general eating patterns. There are also going to be genetic and biological factors that affect weight gain, but these are not going to cause the magnitude of obesity that we are witnessing at present (Hyman, Kooi, & Ficklen, 2008). The treatment of obesity in children and adolescents is a problem for health care professionals and is not successful a large amount of the time. This is because many physicians do not want to perform bariatric surgery on a child or adolescent due to risks involved, yet they know with diet modification only there is a chance that the weight will come back tenfold and the child will eventually need bariatric surgery eventually (Hyman, Kooi, & Ficklen, 2008).

The term bariatric surgery is used for surgical procedures that are performed for the indication of removing excess weight and promoting weight loss. This surgery is risky, but has been shown to significantly improve the quality of life and length of life in individuals who have the surgery and alter their diet and exercise routines to remain healthy afterward (Hyman, Kooi, & Ficklen, 2008).

Problems Caused by Childhood Obesity

Health Issues

There are several health issues caused by childhood obesity and the consumption of food, in general, is first on the list. The preparation of food in the present day plays a large factor in how the family eats. Cheaper foods are more readily available and these foods are often not the healthiest foods available. The portion sizes are larger and labels on the food containers often mislead consumers, especially children, to believing they are consuming something healthy when they are actually eating food that is not nourishing to the body (Garrett & McNolty, 2010). Add this to the change in the lifestyle of children and adolescents as states previously and it is not wonder why obesity has become a problem of epic proportions in our society today.

In addition to the health problems already discussed, there are also more specific problems such as metabolic disorders, sleep apnea, and psychosocial impairments that children and adolescents are now facing who have not ever had to face in years previous because of the increase in obesity (Inge, Xanthakos, & Zeller, Bariatric surgery for pediatric extreme obesity: Now or later?, 2007). A potentially life-threatening problem for adolescents is nonalcoholic fatty liver disease, a problem now mostly found in older obese adults, which leads to cirrhosis of the liver and an early death. This has no cure and the only treatment option is a liver transplant which is highly implausible due to comorbidities affecting individuals who normally suffer from the disease. If children or adolescents begin to contract this disease during their early years, they will have a fatty liver before they are adults and their life spans will be significantly decreased when this can be prevented through weight loss (Inge, Helmrath, Vierra, & Ikramuddin, 2008).

Mental Issues

Just as there are health issues facing obese children and adolescents, there are psychological issues as well. Research has indicated that obese youth have had significant impairments in the daily routines of their lives in terms of their psychosocial behavior (Inge, Xanthakos, & Zeller, Bariatric surgery for pediatric extreme obesity: Now or later?, 2007). An association has been correlated between symptoms of depression and adolescent obesity. Also, the overweight adolescent population has reported increased patterns of binge eating compared to non-overweight adolescents in various group studies. It can be surmised that adolescents, especially females, have an increased level of self-esteem issues, low self-worth, distorted self-image issues, and general anxiety issues that are parallel to their obesity and the fact they have been unsuccessful at keeping the weight off, especially if they have been overweight since childhood (Inge, Xanthakos, & Zeller, Bariatric surgery for pediatric extreme obesity: Now or later?, 2007).

Bariatric Surgery in Children

Criteria

There are criteria needed in order for patients to be considered for bariatric surgery, especially children and adolescents. The criteria for children and adolescents is more stringent and the following criteria was recently adopted by Australia and New Zealand as part of their bariatric obesity management plan:  a minimum age of 15 years unless there are exceptional circumstances, at which an age of 14 years would suffice; attainment of stage 4 or 5 of the Tanner stage of pubertal development; final or near final stage of adult height; severe obesity; presence of an associated comorbidity such as diabetes, hypertension, etc.; history of other weight management interventions and failure of those interventions; motivation and support from the family; adolescent consent to the surgery (Baur & Fitzgerald, 2010).

As for the consent part of the criteria, this would have to be verified via a licensed counselor or psychiatrist to ensure that the adolescent understands the implications of the procedure and risks involved. Parental consent is also necessary and complete instruction of the treatment options, outcomes, and management is also required before surgery may be performed (Baur & Fitzgerald, 2010).

Types and Success of Procedures

During the 1970s to 1980s the first bariatric procedures for adolescents were reported. The jejunoileal bypass was performed on 20 adolescent patients and there was a 34-36% weight reduction in these patients. Other quality of life improvements were also reported. However, many of the patients required a reversal procedure due to the complication of malnourishment from the surgery and is no longer used as a treatment option (Inge, Xanthakos, & Zeller, Bariatric surgery for pediatric extreme obesity: Now or later?, 2007).

The most used form of bariatric surgery is the Y gastric bypass, which is a gastric pouch created at the gastroesophageal junction to create a ‘small stomach’ to hold a smaller portion of food. The procedure is still mildly malabsorptive because there are not enough nutrients absorbed in the stomach and other nutritional supplements must be taken indefinitely, but the surgery has been the most successful of all bariatric surgeries performed on adults and children/adolescents since the 1980s and is still in use today (Inge, Xanthakos, & Zeller, Bariatric surgery for pediatric extreme obesity: Now or later?, 2007).

Complications of Surgery

Health Issues

In recent years, there have been documented cases of physical complications from bariatric surgeries. Some of the complications observed have been wound infections at the surgical site, pulmonary embolism, stomal stenosis, and ulcers. There have also been bowel obstructions and incisional hernias observed. This by no means tells us that bariatric surgery should not be performed; however, it does indicate the surgery is risky, just as is any surgery and should be identified as such before a patient makes the decision to have the procedure (Inge, Helmrath, Vierra, & Ikramuddin, 2008).Also, patients will have vitamin deficiencies after bariatric surgery due to the fact they are unable to absorb the nutrients needed because the stomach is no longer part of the digestive tract. Because of this, they are required to take supplemental vitamin therapy indefinitely. This is especially a concern for children and adolescents because their bodies are still growing and vitamin deficiencies could cause a problem with this. It is vital that they follow the supplemental regimen as indicated by the physician (Hyman, Kooi, & Ficklen, 2008; Inge, Helmrath, Vierra, & Ikramuddin, 2008).

Mental Issues

It is crucial that children and adolescents have an adequate support system of parents and other caregivers who will help them while having the surgery and afterward during recovery because this is something that is so much more than physical (Sarr, 2010). Children do not fully understand the implications of a surgery of this magnitude. Many of these children have psychosocial issues already and if the obesity is not reversed after the surgery, the problems will only exponentiate rather than go away. It is important that emotional support is given and help is offered so that the children and adolescents will have the ability and time to exercise, eat correctly, take the supplemental therapy, and make the correct nutritional choices in order to succeed in their quality of life from a mental standpoint (Sarr, 2010).

Ethics of Bariatric Surgery in Children

As we are well aware, many of the children who consider bariatric surgery already suffer from comorbidities and there is a chance for benefits to occur from surgery (Garrett & McNolty, 2010). With that being said, we should not jump into any surgical intervention without considering all of the consequences that are evident, both physical and mental. Also, we must understand that bariatric surgery is not a fool proof method and does not offer a one hundred percent success rate. It is only ethical for a child or adolescent to have bariatric surgery, in this author’s opinion, when all other options have been exhausted and the child or adolescent will most likely suffer a mortality because of the obesity if another intervention is not offered.

Conclusion

For adolescents and children who are affected by obesity, it is evident that there must be a drastic change implemented. There is a need for emotional support from the entire family and the child or adolescent should not have to suffer through this alone. Treatment options are available and bariatric surgery is one of those options. However, it is only through significant and thorough discussions that a drastic decision should be decided because this will inadvertently affect the child or adolescent for the rest of his or her life (Baur & Fitzgerald, 2010).

References

Baur, L., & Fitzgerald, D. (2010). Recommendations for bariatric surgery in adolescents in Australia and New Zealand. Journal of Pediatrics and Child Health, 46, 210-212.

Garrett, J., & McNolty, L. (2010). Bariatric surgery and the social character of the obesity epidemic. The American Journal of Bioethics, 10(12), 20-22.

Hyman, B., Kooi, K., & Ficklen, D. (2008, August). Bariatric surgery in adolescents. Journal of School Health, 78(8), 452-454.

Inge, T., Helmrath, M., Vierra, M., & Ikramuddin, S. (2008). Challenges of adolescent bariatric surgery: Tips for managing the extremely obese teen. Journal of Laproendoscopic and Advanced Surgical Techniques, 18(1), 157-169.

Inge, T., Xanthakos, S., & Zeller, M. (2007). Bariatric surgery for pediatric extreme obesity: Now or later? International Journal of Obesity, 31, 1-14.

Sarr, M. (2010). The problem of obesity: How are we going to address it? The American Journal of Bioethics, 10(12), 12-32.

van Geelen, S., Bolt, L., & van Summeren, M. (2010). Moral aspects of bariatric surgery for obese children and adolescents: The urgent need for empirical-ethical research. American Journal of Bioethics, 10(12), 30-32.