Weight loss surgery has traditionally been viewed as a procedure for adults with severe obesity who haven’t been able to lose weight or keep it off. Now, pediatricians are calling for it to be more accessible for children and teens with severe obesity too.
The American Academy of Pediatrics now recommends that metabolic and bariatric surgery should be considered a safe treatment option for children and teens with severe obesity – and should be covered by insurance for young people. The AAP made the recommendation in its first-ever policy statement on surgical treatments for children and teens with severe obesity, published in the medical journal Pediatrics on Sunday.
“This policy statement focuses more upon acceptance of – and access to – appropriate care than anything else,” said Dr. Kirk Reichard, surgical director of the Bariatric Surgery Program at Nemours/Alfred I. duPont Hospital for Children in Delaware, who was a co-author of the policy statement.
“Right now there’s a lot of variability in what’s paid for. There are certain plans that simply consider bariatric surgery under the age of 18 as experimental, which means they’re not going to be covered,” he said. “This policy statement specifically says that there’s no specific age guideline. Furthermore, we recognize that severe obesity in children disproportionally affects racial and ethnic minorities, and the economically disadvantaged, especially for girls.”
Becoming the person she wanted to be
Avery Feinstein, who underwent a gastrectomy last year when she was 18 to treat her severe obesity, called the new AAP recommendations “awesome” and said she hopes that more awareness is raised around adolescent bariatric surgery. Gastrectomy is a surgical procedure to remove part or all of the stomach.
“It changed my life and it’s cool that they’re going to try to help other people change their lives too at a young age,” Feinstein said.
“It’s helped me so much with who I am now,” she said. “If I did that in older age, I would miss my college years, living like how I am now and having the best time of my life.”
As a 19-year-old college sophomore at the University of Missouri, Feinstein now says she’s thriving. She joined a sorority, maintained her studies to become a psychiatrist, and continued to eat a healthy diet and stay active. Her favorite pastime is riding her horse, Rudy, whom she houses in a barn just 15 minutes away from campus.
Yet the journey to this point in Feinstein’s life wasn’t easy.
Feinstein struggled with her weight throughout childhood. She went to a weight-loss camp in middle school and tried strict diets, but neither helped her manage a healthy weight. During that time, Feinstein felt self-conscious and concerned about her health.
“I was trapped in how big I was,” she said.
At age 17, Feinstein and her mother visited a nutritionist at Ann & Robert H. Lurie Children’s Hospital of Chicago, and the nutritionist recommended Feinstein to the hospital’s adolescent bariatric surgery program.
Immediately, Feinstein knew that – with support from her mother and the help of the hospital staff – she wanted to undergo surgery to improve her health, especially before starting college in the fall.
“I had no clue that this could have been an option,” Feinstein said about the surgery.
“I knew that I was going to go off to college and this was the perfect time to turn my life around,” she said. “This was something that was going to help me become the person that I wanted to be, and not the person that I was.”
Obesity, which now affects 1 in 5 children and adolescents in the United States, can raise the risk for many health problems, including diabetes, heart disease, stroke, arthritis, breathing problems and certain cancers.
When Feinstein was admitted to the bariatric surgery program, she had a body mass index of 46 and had sleep apnea.
Body mass index, or BMI, is a person’s weight in kilograms divided by the square of their height in meters – and is used to screen for obesity. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex.
BMI is assessed when deciding whether surgery could be the best treatment approach for a person with severe obesity, said Dr. Ann O’Connor, a pediatric surgeon and director of the adolescent bariatric surgery program at Ann & Robert H. Lurie Children’s Hospital of Chicago. She performed Feinstein’s procedure.
“People who have a BMI over 40 – they normally would be people you would consider candidates for surgery,” O’Connor said. “If the BMI is 35 and higher, and they have other health problems like diabetes or hypertension or sleep apnea, then they might be candidates as well.”
The program’s protocol also requires that “teens must be 13 years or older and mature enough to understand the implications of surgery.”
‘This surgery is not just ‘here’s a fix’ ‘
The adolescent bariatric surgery program required Feinstein to complete a six-month diet and exercise plan before surgery, to encourage lifestyle changes that could continue after surgery – changes such as having salads for lunch instead of sandwiches. Feinstein was also required to stabilize her weight during that six-month period.
