The American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee has released an updated version of their evidence-based guidelines initially published in 2012. The updated guidelines reflect the significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents.
The guidelines are published in the journal Surgery for Obesity and Related Disease.
- There are no data showing that preoperative attempts at diet and exercise correlate with success after MBS. Compliance with a multidisciplinary pre-operative program may improve outcomes after MBS, but prior attempts at weight loss should be removed as a barrier to surgery.
- Vertical sleeve gastrectomy (VSG) has become the most used and most recommended operation in adolescents, but with more extensive long-term data available for Roux-en-Y gastric bypass (RYGB), the use of either RYGB or VSG in adolescents is recommended.
- Certain co-morbidities should be considered, such as the psychosocial burden of obesity, orthopedic diseases specific to children, type 2 diabetes, gastroesophageal reflux, and cardiac risk factors. These comorbidities may be an indication for MBS at a younger age and should be considered in children with a lower obesity percentile.
- The most up-to-date definitions of childhood obesity are body mass index (BMI) cutoffs of 35 kg/m2 or 120% of the 95th percentile with a co-morbidity, or BMI 440 kg/m2 or 140% of the 95th percentile without a co-morbidity, whichever is lower. Early surgical intervention when the BMI is <45 kg/m2 may allow adolescents to reach a normal weight and avoid lifelong medication therapy and end-organ damage from comorbidities.
- Unstable family environments, eating disorders, mental illness, and prior trauma should not be considered contraindications for MBS.
- Prophylactic vitamin B1 for the first 6 months after MBS is recommended, along with education of patients and primary care providers on the signs and symptoms of common deficiencies. Vitamin B deficiencies should also be screened for and treated.
For further information log on to https://doi.org/10.1016/j.soard.2018.03.019
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