American Academy of Pediatrics Releases First Policy Statement on Metabolic, Bariatric Surgery

October 28, 2019

(COLUMBUS, Ohio) – Recent data report the prevalence of severe obesity in youth has nearly doubled since 1999 and affects about 4.5 million children in the United States. The American Academy of Pediatrics (AAP) has released its first policy statement for the multidisciplinary care of metabolic or bariatric surgery for pediatric patients with severe obesity.

The statement, published in Pediatrics, provides recommendations for practitioners and policy makers, and accompanies a technical report which provides additional details and supporting evidence.

Data sources for the policy statement includes recent reporting from the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study, the largest ongoing observational cohort of youth undergoing metabolic and bariatric surgery to date. Teen-LABS is a multi-center clinical study funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health (NIH) that is examining the safety and health effects of surgical weight loss procedures in the pediatric population.

“This important policy statement is a significant step forward in the treatment of severe obesity in this underserved pediatric population,” said Marc P. Michalsky, MD, FACS, FAAP, FASMBS, surgical director of the Center for Healthy Weight and Nutrition at Nationwide Children’s and co-author of the policy statement. “Recent studies have linked severe obesity to increased cardiometabolic risk factors, which are alleviated following weight loss surgery. In addition, recent investigations have demonstrated higher rates of remission of hypertension and type 2 diabetes among children and adolescents undergoing bariatric surgery when compared to older patients; supporting the argument that early intervention makes sense.”

According to the policy statement, AAP recommendations for pediatricians include:

  • Recognize that severe obesity places children and adolescents at higher risk for liver disease, type 2 diabetes, dyslipidemias (abnormal amount of lipids in the blood), sleep apnea, orthopedic complications and mental health conditions
  • Seek out high-quality multidisciplinary centers experienced in assessing risks and benefits of various treatments for pediatric patients with severe obesity, including bariatric surgery. Identify patients who meet criteria for surgery and provide timely referrals to comprehensive pediatric-focused metabolic and bariatric surgery programs
  • Coordinate pre- and postoperative care, and monitor patients postoperatively specifically for micronutrient deficiencies, risk-taking behavior and mental health concern
  • Understand the efficacy, risks, benefits and long-term health implications of metabolic and bariatric surgery procedures so that pediatricians may effectively advocate for increased access to treatment for pediatric patients and help guide families in their decision making with regard to treatmen
  • Advocate for an increase in the number of and access to multidisciplinary pediatric-focused metabolic and bariatric surgery centers, ensuring equal access for all patients who meet treatment criteria

AAP recommendations for government, health, and academic medical centers include:

  • Use best-practice guidelines outlined in the policy statement to support safe and effective multidisciplinary pediatric-focused metabolic and bariatric surgery programs
  • Consider best practice guidelines, including the avoidance of unsubstantiated lower age limits, in context with potential health care benefits and individualized patient-centered care
  • Increase in the number of and access to multidisciplinary pediatric-focused metabolic and bariatric surgery centers, ensuring equal access for all patients who meet treatment criteria

AAP recommendations for public and private insurers include:

  • Provide payment for multidisciplinary preoperative care to ensure appropriate selection of surgical candidates
  • Provide payment for bariatric surgery from evaluation through follow-up and ongoing care for patients who meet standard criteria as described in the policy statement
  • Reduce barriers to metabolic and bariatric surgery (including limited access, inadequate payment, unsubstantiated exclusion criteria and delays in approval) for patients who meet standard criteria

“I applaud the AAP for coming out in support of these treatment options for severe obesity in children and adolescents,” said Thomas H. Inge, MD, PhD, associate surgeon-in-chief at Children’s Hospital Colorado in Aurora, Colorado, and chair of the Teen-LABS study consortium. “Severe obesity in youth disproportionately affects pediatric patients, and surgical intervention has emerged as safe and effective treatment for children and adolescents affected by severe obesity.”

Best practices outlined in the policy statement include multidisciplinary care that involves pediatric experts in obesity, adolescent medicine, mental health, nutrition and exercise science, in addition to surgeons; pediatric-oriented care to address the unique developmental, physiological and emotional needs of children and adolescents throughout the treatment process; and consideration of a patient’s values and their preference with regard to the type of bariatric surgical procedure.