Adolescent Obesity and Bariatric Surgery

Morbid obesity in the United States has reached epidemic proportions. Families, physicians, and the government are finally hearing the message that obesity is an issue of health and not of appearance. Treating this epidemic requires a multidisciplinary approach and a commitment on the part of legislators, health care executives, and medical professionals. Prevention is critical, and all efforts should be made to support increasing safe physical activity for children and adolescents. Children and families also should be educated about appropriate food choices and portion sizes in schools and by their physicians. Decisions about foods in the schools and at home should be driven by education and not by advertising or other outside forces. The treatment of morbid obesity in adolescence first and foremost should be based on aggressive behavioral and dietary modification. With only a small daily increase in caloric expenditure and a relatively small decrease in caloric intake, many adolescents can achieve and maintain weight loss. This goal requires constant encouragement and surveillance on the part of a "coach," whether that be family, a commercial weight loss program, or a physician. For adolescents with severe morbid obesity who have failed attempts at weight loss, the options are medical therapy or bariatric surgery. Medical therapy is occasionally effective in some patients and should be considered. Bariatric surgery is currently the most effective method of weight loss for morbid obesity. Current indications for bariatric surgery in adolescence are more conservative than for adults, because the long-term consequences of this surgery in growing children are not known. The unique psychological and physical issues of adolescence add another layer of complexity to the management of these patients. For that reason, morbidly obese teenagers are best treated in centers with special expertise in the care of adolescents. Because the long-term outcomes of bariatric surgery in adolescents are not known, it is ethically and clinically important that these patients be enrolled, whenever possible, in long-term prospective outcome studies.