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Health disparities in childhood obesity and access to bariatric surgery

Wed, 10/28/2020 - 11:50
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Although adolescents with obesity are choosing bariatric surgery as a way to lose a significant amount of weight, many of those with severe obesity, especially Hispanic and Black adolescents, are not being offered that treatment option. There findings were reported in a retrospective study, ‘Disparity Between United States Adolescent Class II and III Obesity Trends and Bariatric Surgery Utilization, 2015-2018’, published in Annals of Surgery by researchers at The University of Texas Health Science Center at Houston (UTHealth).

Nearly 19% of children and adolescents in the US have obesity. For many of these children the condition will continue into adulthood. Furthermore, childhood obesity can be linked to mortality and morbidity in adulthood, making it one of the leading causes of death in the US Ethnic minority groups have the highest rates of severe obesity in the country.

"It's no surprise that childhood obesity has been a challenge in this country from both a public health and clinical standpoint for decades," said Dr Sarah Messiah, lead author of the study and professor of epidemiology, human genetics, and environmental sciences at UTHealth School of Public Health in Dallas. "What is most alarming is that over the past five to ten years, we have seen an increase in those who have severe obesity. This group of patients is growing at three times the pace of adolescents with obesity."

Paediatricians often suggest lifestyle modifications such as changes in diet to reduce calorie intake and increased physical activity. However, dietary and behavioural changes alone have not been proven to be successful in treating children and adolescents with severe obesity.

Messiah and other researchers suggest in the paper that bariatric surgery, in combination with lifestyle changes, could be the best option for treating severely obese adolescents.

"The American Academy of Pediatrics supports the use of bariatric surgery in adolescents because evidence shows that it works and is safe. Pharmaceutical treatment options are very limited and have mixed results, and unfortunately for those who are already severely obese, lifestyle changes won't be enough," Messiah said.

By obtaining data from the American Society for Metabolic and Bariatric Surgery, researchers found that although obese adolescents are turning to weight loss surgery as a way to lose a significant amount of weight, many of those who are severely obese, especially Hispanic and Black adolescents, are not being offered that treatment option.

The 2015–2018 National Health and Nutrition Examination Survey (NHANES) cross-sectional data (n=19,225) generated US severe obesity prevalence estimates. The 2015–2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) longitudinal (30 day) cohort data was used to compare adolescent and adult (n=760,076) post-operative outcomes and to calculate utilisation rates.

The outcomes showed that the mean age of the analytical MBSAQIP sample was 17.9 (1.15) years in youth (n=3,846) and 45.1 (11.5) in adults (n=744,776), majority female (77.4%, 80.7%, respectively) and non-Hispanic white (68.5%, 59.4%, respectively). The overall 2015–2018 bariatric surgery utilisation rate for youth was 1.81 per 1,000 and 5.56 per 1,000 for adults (p<0.001). Adult patients had slightly higher percentage (4.2%) of hospital readmissions vs youth (3.4%, p=0.01) but there were no differences for other post- bariatric surgery complication. From 2015–2018 the US prevalence of youth severe obesity increased in Hispanics and non-Hispanic blacks (p-trend <0.001), but non-Hispanic whites had higher rates of bariatric utilisation (45.8%) vs to Hispanics (22.7%) and non-Hispanic blacks 14.2% (p=0.006).

"There is a big disconnect between those who are getting the surgery and those who need it. Research has shown that this is a safe and effective way to help these children get their life on track, but the issue is bariatric surgery is not being utilized to treat obesity among ethnic minority groups," explained Messiah. "More paediatricians need to refer these patients to surgeons if they are a good candidate to help get their patients on a healthier path.”

Despite potential risks, Messiah said adolescents face diabetes, heart disease, asthma, high blood pressure, and psychological issues including anxiety, depression, and low self-esteem that studies have found are associated with severe obesity in youth. Most recently, studies have shown that both adult and paediatric patients with obesity are at a high risk of severe illness or death if they were to contract COVID-19.

"Research shows that readmission into hospitals post-surgery due to any complications is low. Out of surgeries performed between 2017 and 2018, only 3.4% of youth patients were readmitted to the hospital," she said. "The bottom line is, most adolescents will not lose the weight on their own, and utilising bariatric surgery is a safe and effective way to help treat this problem before it is too late," Messiah said. "We need to start intervening earlier so that they can enter adulthood healthier."