Obesity affects nearly 20% of children between the ages of 2 and 19, making it a common childhood condition. Meanwhile, a new research letter published in JAMA Pediatrics found that rates of severe obesity in kids have jumped from 5.6% in 2015 to 6.5% in 2019 — and bariatric surgeries have climbed, too.
Metabolic and bariatric surgeries — which are surgical procedures used to help a patient lose weight — rose by nearly 20% in kids aged 10 to 19 between 2020 and 2021, the letter found. The overall numbers aren't massive — nearly 2,500 children had bariatric surgery during the two-year period — but they weren't insignificant, either.
The letter's researchers clearly stated that bariatric surgery is a "safe and effective treatment," noting that the American Academy of Pediatrics (AAP) supports its use in children with severe obesity who meet certain criteria. But why are more children having bariatric surgery, and what are the risks involved? Doctors explain.
Why is bariatric surgery on the rise in children?
A lot may have to do with the AAP endorsing the practice, lead author of the paper Sarah E. Messiah, a professor of epidemiology and director of the The University of Texas School of Public Health at the University of Texas Health Science Center at Houston, tells Yahoo Life. "For the first time in 2019 the American Academy of Pediatrics issued a statement endorsing increased access to bariatric surgery for adolescents who were medically qualified," she says. "This may have helped relax some of the stigma around surgery for adolescents in the pediatrics community."
Messiah also notes that these surgeries are seen as safe. "Many studies published over the past decade have shown that surgery is one of the only safe and effective treatment options for severe obesity in youth with low complication rates," she says.
There also seems to be an increased interest in treating severe obesity sooner, rather than waiting until a child is an adult to have surgery, Dr. Fatima Cody Stanford, instructor of medicine and pediatrics at Harvard Medical School and obesity medicine physician at Massachusetts General Hospital, tells Yahoo Life. "It's a treatment modality that has shown to have a huge impact on a lot of different things, including life expectancy and the ability to do something as simple as getting into school and graduate school," she says. "Individuals with excess weight are often discriminated against, particularly as young people."
Data show that bariatric surgery can help with health issues other than obesity, Dr. Christine Finck, surgeon in chief at Connecticut Children’s Medical Center, tells Yahoo Life. She points to a 2022 study published in the Journal of American College of Surgeons that found "significant sustained reductions" in weight and other conditions like asthma and diabetes, and low rates of long-term complications, a decade or more after teens had bariatric surgery. "These findings have important implications for adolescents who may be considering surgery for weight reduction and overall health improvements that extend into adulthood," she says.
Overall, experts say they aren't shocked that bariatric surgery is on the rise in kids. "It's not surprising to me because obesity is on the rise throughout the population," Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, Calif., tells Yahoo Life. "One of the effective treatments is surgery."
When is bariatric surgery considered for a child?
Not every child with obesity qualifies for bariatric surgery. The AAP says that, in general, bariatric surgery is recommended for children who meet the following criteria:
They have a body-mass index (BMI) of 35 or greater, with additional health complications of obesity OR
They have a BMI of 40 or greater, even if they don't have other health complications
There is no specific age requirement for surgery, but the most data available is for kids aged 13 and up, the AAP says.
There are typically more qualifications that need to be met, and they can vary by doctor and their practice. In Finck's practice, a child is evaluated by a pediatrician to see what could be behind the weight gain, as well as whether the child has additional conditions, like type 2 diabetes. "In addition, the adolescent must be evaluated by nutrition, psychology and physical therapy," she says. Children have to show that they can make some changes, like limiting sugary beverages and exercising. "After three to six months in the program, compliance and readiness for surgery is assessed by the multidisciplinary team," Finck says. "Attendance at support group is required prior to surgery and as a program, we follow the adolescents for a minimum of five years post-operatively. We have a transition of care plan in place also, to help with transition to an adult practice when the time is right."
What risks are involved?
There are different types of bariatric surgery and each comes with unique risks. However, Ali says that risks largely revolve around having surgery. "All surgery comes with risks," he says. Bariatric surgery in particular comes with a risk of infection, bleeding and a need for re-operation, Finck says.
"Most common long-term complications are nutritional deficiencies," Messiah says. "Other complications include post-operative development of dumping syndrome [a group of symptoms, including diarrhea, nausea and feeling light-headed or tired after a meal, that are caused by the stomach emptying quickly], developing kidney stones and not losing the desired amount of weight or weight regain." Because of this, Messiah says it's "critical" that kids understand the importance of supplementing for their overall health.
How to talk to kids responsibly about bariatric surgery
Talking to kids about bariatric surgery can feel complicated, but Stanford says it's often the children who want to have the surgery. "The parents have to buy into it more than the kids," she says. "The children more often will be more interested in surgery than the parents."
She recommends making sure that children understand that this is a tool for their health, but not a cure. "I see a lot of people who think this will be a cure, but it is a lifelong commitment," she says.
Messiah says that this should be a "family-supportive decision," noting that a child with severe obesity can't be treated in a vacuum, especially when they're still dependent on their parents for food and even physical activity. "Parents can emphasize that they love and support their adolescent unconditionally, regardless of their weight as a first step in this journey," she says. "Parents can learn about the pros and cons of the surgery [and] the necessary medical, psychological and other clearances that are necessary to have the surgery so that they can engage in informed conversations with their child."
Messiah stresses that "every child and family situation is unique," so it's important to adapt to your family's unique circumstances. "Open communication, empathy and professional guidance — including medical and mental health professionals — can help navigate this sensitive topic while prioritizing overall health and well-being," she says. "Do not be afraid to engage in conversations with the bariatric team — they are there to support the entire family."
Wellness, parenting, body image and more: Get to know the who behind the hoo with Yahoo Life's newsletter. Sign up here.