Taffy Makaya, Rebecca Poole and Kavitha Rozario
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members of the British Obesity and Metabolic Surgery Society and groups of
primary care practitioners based in London two thirds (66%) of professionals
believed that adolescents with a BMI >40 or BMI >35 and with significant co-
morbidities could be offered surgery. Parental psychological counselling was
felt to be one of the most important pre-requites. Other pre-requisites were 6 -
12 months of being involved in weight management programmes (58% stated
12 months as appropriate, and 24% regarding 6 months as sufficient. The
majority of healthcare professionals stated that surgery should only be offered
at an age over 16 years, while 17% of bariatric surgeons did not specify a
minimum age limit. More than 80% of the professionals surveyed considered
bariatric surgery in adolescents as acceptable [102]. Recent reports in the UK
media and newspapers also reflect the shift in support of bariatric surgery for
children and adolescents, a particular advocate being Dr Ashish Desai, a
paediatric surgeon specialising in childhood obesity at King's College Hospital
[103]. The argument for surgery is that having a surgical procedure is better
and cheaper than treating the chronic effects of complications of obesity such
as type 2 diabetes and high blood pressure- this is despite the typical cost for a
gastric band being about £7000, but up to £12 000 [104]. Some data shows
that morbidly obese people with T2DM who undergo bariatric surgery fully
recover the costs of surgery in 2-3 years [105]. This is in part due to a decrease
in need for obesity related medications. Obesity and associated illnesses such
as type 2 diabetes are estimated to cost the Health Service £5 billion a year.
However these conclusions about cost effectiveness should be interpreted with
caution as they are somewhat limited due to lack of long term data.
The 2014 UK NBSR was the first in-depth description of bariatric surgery
in patients under the age of 25 years old within the UK. For all those aged <25
years, the initial BMI ranged between 31-81 kg m^2 (average of 48.7 kg m^2 ).
There were 62 patients aged ≤18 years having bariatric surgery during the
three-years between 2011 and 2013 [97]. The youngest patient was aged 12,
with 17 patients aged 16 or less. Media coverage surrounding the fact that a
child as young as 12 had received bariatric surgery reflected the shock of
society that children that young were requiring surgical intervention to manage
obesity [104].
Those who speak strongly against bariatric surgery in children argue
several points. A particular concern is that parents/carers are making a very
complex decision on behalf of the young person – this is a particular concern if
non-reversible surgery is contemplated. The other major concern is the
psychological impact of the surgery on the young person. Food, and how we
consume food, has a major role in how we fit in with our peers and with