Childhood Obesity in the United Kingdom 115Evaluation of an adolescent bariatric surgery programme. The objectives of
study E are to ‘investigate the acceptability, safety and short-term outcomes of
adolescent bariatric surgery in the UK and to investigate predictors (BMI,
psychological, surgical, patient-centred measures) of outcome’. The study
aims to recruit 40 sequential patients aged 13-17 who undergo bariatric
surgery at UCLH, with assessment at surgery, 1, 3 6 and 12 months post-
surgery. The Decision making study has been an additional project, linked to
Study E, looking at the decision making process within the adolescent bariatric
teams in 3 different hospitals in England as well as how adolescents and their
family decide upon bariatric surgery.
There has been a call to consolidate services for bariatric surgery in
children, with the establishment of ‘quaternary services’ and specialist
commissioning where these centres would have official designation and direct
funding from the government (NHS England) to perform this surgery (Tier 4).
This would facilitate referral pathways, information sharing, research and data
collection. Providers, surgeons, premises, on site services and obesity surgery
throughput should meet the minimum IFSO Guidelines for Safety, Quality,
and Excellence in bariatric surgery. There is currently a consultation taking
place for service set-up [136].
CONCLUSION
There is clear evidence of the effectiveness of bariatric surgery as a
management option for obesity in adults. There is limited long-term data on
outcomes and complication in the paediatric group – with a limitation in RCTs
and limited data beyond 3 years. Currently the UK is lagging behind the US in
terms of numbers of surgical interventions and trials. There is however an
initiative to centralise bariatric surgery services in the UK and this should lead
to more straight-forward referral pathways and more robust studies and
information gathering. This should in turn help build public and physician
confidence in adopting bariatric surgery as a viable and realistic treatment
option in managing childhood obesity.