Overweight
and obesity in children and adolescents have increased worldwide in recent
years. Depending on the definition, for example, 10-20% of all schoolchildren
and adolescents in Germany are overweight, making increased body weight the
most frequent nutrition-related health disorder in these age groups.
The health
risks of obesity in adulthood are scientifically well documented and have
already been presented here. The development of obesity in childhood has an
additional negative impact on health. Obessive children and adolescents are
often stigmatised, which has a problematic effect on psychosocial development
and can lead to the development of eating disorders.
In obese
children and adolescents, the risk of dying from a disease caused by overweight
increases by 6-7% every 2 years. The treatment of childhood obesity must
therefore be as early and effective as possible. Although the conservative
treatment of obesity in children and adolescents leads to good short-term
results, the long-term results are often disappointing, as they are in adults.
The aim of bariatric interventions in childhood and adolescence is to improve
quality of life, health and life expectancy through the expected weight
reduction or control of further weight gain.
Surgical
procedures in childhood are still controversially discussed. The
"International Pediatric Endosurgery Group" (IPEG) recommends that
bariatric surgery should be considered for adolescents with a BMI >40 kg/m²
or a BMI >35 kg/m² with severe secondary diseases, if the patients are
almost fully grown and conservative therapy methods are exhausted.
The
indication for a bariatric intervention in childhood and adolescence must
always be given individually and as a team with the family. The treatment team
should have appropriate experience in the treatment of obesity in young
patients and should consist of a paediatrician, an internist, a nutritionist, a
paediatrician/youth psychiatrist, a social worker, a psychologist and a surgeon
with several years of experience in bariatric surgery. Counselling and surgery
should only be carried out in a centre with special experience in bariatric
surgery. In addition, an age-appropriate environment is required in the clinic:
pediatric anaesthesia, intensive care unit for children and adolescents, etc.
Close follow-up care must also be guaranteed.
Bilbiography
sources:
Alqahtani AR, Antonisamy B, Alamri H, et al. (2012) Laparoscopic sleeve
gastrectomy in 108 obese children and adolescents aged 5 to 21 years. Ann Surg
256: 266–273.
Al-Qahtani
AR. (2007) Laparoscopic adjustable gastric banding in adolescent: safety and
efficacy. J Pediatr Surg 42: 894–897.
Fatima J,
Houghton SG (2006) Bariatric Surgery at the Extremes of Age. J Gastrointest
Surg 10: 1392–1396.
Givan F.
Paulus, et al. (2015) Bariatric Surgery in Morbidly Obese Adolescents: a
Systematic Review and Metaanalysis. Obes Surg 25: 860–878.
International
Pediatric Endosurgery G (2009) IPEG guidelines for surgical treatment of
extremely obese adolescents. J Laparoendosc Adv Surg Tech A 19: (Suppl 1)
Oude
Luttikhuis H, Baur L, Jansen H, et al. (2009) Interventions for treating
obesity in children. Cochrane Database Syst Rev (online) (1): CD001872.
Treadwell
JR, Sun F, Schoelles K (2008) Systematic review and metaanalysis of bariatric
surgery for pediatric obesity. Ann Surg 248: 763–776.
