Stigma, lack of information and costs limit access to surgery for adolescents

Adolescents with severe obesity may not pursue metabolic bariatric surgery for weight loss due to lack of information, difficulties with access to care, and because of social stigma, according to a study led by a University of Colorado School of Medicine researchers. The study, ‘Barriers to Metabolic Bariatric Surgery in Adolescents: Results of a Qualitative Study’, published in SOARD, identified a general lack of information about the surgery, social stigma and issues with costs as primary factors limiting access.

Credit@ Obesity Act Coalition

Dr Eric G Campbell, professor of medicine at the CU School of Medicine and director of research at the University of Colorado Center for Bioethics and Humanities, and his co-authors interviewed 14 young adults between the ages of 19 years and 25 years who underwent metabolic bariatric surgery in the past five years. The goal of the study was to better understand issues that prevented these young adults from undergoing the surgery while they were adolescents.


“Reduced access to metabolic bariatric surgery for adolescents with severe obesity removes care that could dramatically improve their quality of life and reduce mortality,” said Campbell. “Previous studies have shown that metabolic bariatric surgery is the most effective treatment for adolescents with severe obesity, so health care providers should make sure they are knowledgeable about this care option and recommend it in appropriate cases.”


In the study, the young people who were interviewed described their experiences with health care providers. In some cases, their physicians did not discuss the possibility of metabolic bariatric surgery.


“It was never offered to me under the age of 18,” one interviewee said. “I never would have known it was an option for me.”


Others described resistance to consideration of the surgery. Another study participant said: “A lot of people have the mindset that bariatric surgery is an easy way out. I don’t know, I just think there’s a stigma behind it.” Another said their insurance declined to cover the costs of the care.

While the number of people interviewed for the study was small, an estimate of the number of youth in the US with severe obesity is 4.5 million. Providing care to help those youths have healthier lives is critical because obesity in adolescence is strongly predictive of obesity in adulthood. The article cites another study that finds 77% of obese children ages 9-11 will remain obese as adults.

“Metabolic bariatric surgery is one part of the reasonable standard of care for adolescents with severe obesity and it is both unprofessional and unethical for health care providers to withhold this information from an adolescent who is a potential candidate,” added Campbell.

All but two of the authors on this study were affiliated with the University of Colorado School of Medicine at the time of the research. One of the authors, Dr Thomas Inge, now surgeon-in-chief at Ann & Robert H. Lurie Children's Hospital of Chicago and professor of surgery and pediatrics at Northwestern University Feinberg School of Medicine, commented: “As our work shows, adolescents with severe obesity face many significant barriers to accessing metabolic bariatric surgery. It is essential that we as physicians actively address these barriers to a safe and effective treatment for the disease of severe obesity, which robs so many youth of their health, well-being, and years of life.”