Childhood Obesity in the United Kingdom 99combination of different modes of management, including weight loss
intervention programmes and in some cases surgery. Ultimately, the
development of different drugs for use in obesity should help deliver the goal
of personalised, effective treatment, with a patient’s management plan being
tailored to their own unique disease aetiology.
SURGICAL MANAGEMENT
Introduction
With the recognised limited outcomes in managing childhood obesity with
community based weight programmes and drug therapy recent thoughts have
now turned to bariatric surgery. Bariatric surgery is an established and well-
recognised therapeutic option for obesity in adults, with encouraging results
showing a sustained and significant weight loss, as well as a reduction in
obesity-related co-morbidities [94]. This review discusses bariatric surgery in
children with a review of the international literature available, and
incorporates data from the UK.
Background
Recognised forms of bariatric surgery include gastric bypass, gastric band,
gastric sleeve [95]. Gastric bypass surgery (Figure 2) is typically done
laparoscopically and is sometimes called laparoscopic Roux-en-Y gastric
bypass (LRYBP). It is often considered the gold-standard of bariatric surgery
and it represents a permanent change in the anatomy of the upper
gastrointestinal tract. Laparoscopic gastric band (LGB) surgery involves
placing an inflatable band around the upper part of the stomach, thereby
creating a small stomach pouch above the band, with the remainder of the
stomach below the band (Figure 3). Laparoscopic sleeve gastrectomy (LSG)
surgery is a non-reversible single step operation in which 80% of the stomach
is removed (Figure 4).