OBESITY presents really alarming figures in adolescence, due to the high prevalence (20% of children are obese), the worrying increase in recent years (it has increased by 50% since the 1980s), and the large number of associated diseases that causes – comorbidities. The adolescent with obesity will present a risk of cardiovascular mortality between 3 to 5 times greater than 50 years; Type 2 diabetes in adolescence consumes beta cells in the pancreas (those that produce insulin) 4 times faster than in adults, and causes kidney, retinal and nerve damage much earlier than in adults ( 5 years after its start); and one third of obese adolescents have Sleep Apnea Syndrome – OSAS; among other more alarming data, such as increased risk of cancer (colon, breast, ovary, etc.) in young adulthood.
For these very worrying reasons, BARIATRIC AND METABOLIC SURGERY is contemplated in adolescents, to provide adequate health and prevent all these comorbidities in youth and adulthood, in addition to improving the quality of life.
OBESITY in the ADOLESCENT is defined as:
- OVERWEIGHT:> 85th BMI percentile for sex and age
- OBESITY GRADE I:> 95th BMI percentile for sex and age
- OBESITY GRADE II:> 120% of the 95th percentile BMI for sex and age. BMI> 35
- GRADE III OR MORBID OBESITY:> 140% of the 95th BMI percentile for sex and age. BMI> 40
BMI is the BODY MASS INDEX, the result of dividing the weight in kilos between the square of the height in meters.
According to the WHO World Health Organization, adolescence is the age between 10 and 19 years.
The INDICATIONS for BARIATRIC AND METABOLIC SURGERY in the ADOLESCENT (American Society for Metabolic and Bariatric Surgery, ASMBS) are:
- BMI ≥35 or> 120% of the 95th percentile with some associated higher COMORBIDITY as DIABETES TYPE 2, HEPATIC ESTEATOSIS (fatty liver), Obstructive Sleep Apnea Syndrome-OSAS, Intracranial hypertension, arthropathy of adolescence due to overweight (tibia vara or coxa vara), Gastroesophageal Reflux Disease, Polycystic Ovary, Arterial Hypertension-HTA and / or DL-Dislipemia (cholesterol or elevated triglycerides).
- BMI ≥40 or> 140% of the 95th percentile without having associated comorbidities yet.
There must be a MULTIDISCIPLINARY TEAM that includes
- Bariatric Surgeon EXPERT
- Pediatrician Specialist Adolescent Endocrinology.
- Child-Teen Nutritionist
- Psychologist specialized in Adolescent Mental Health Food
- Guarantee a follow-up of at least 2 years.
The CONTRAINDICATIONS for this surgery are:
- That the cause of obesity is medically treatable.
- Drug or alcohol addiction in the last year.
- Impossibility of therapeutic adherence due to mental or psychosocial causes.
- Pregnancy present or planned in the following year.
BENEFITS OF BARIATRIC AND METABOLIC SURGERY IN ADOLESCENCE
Studies conducted with more than 162,000 patients support these results (Chang et al., Obes Surg, 2014).
- LONG-TERM WEIGHT LOSS AND MAINTENANCE: Both vertical and tubular gastrectomy and laparoscopic gastric bypass achieve greater weight loss and long-term maintenance of the same in adolescents than in adults.
- EFFECTIVENESS-RESOLUTION OF COMORBIDITIES in 90% of patients: 92% of DIABETES TYPE 2, 75% of HT, 76% of DL, 96% of adolescents with OSAS, or 92% of steatohepatitis due to the liver fatty.
- SAFETY OF SURGERY: LOW MORBIDITY (8% minor complications) AND ZERO MORTALITY (30-day mortality risk of 0.08%, similar to a laparoscopic cholescystectomy – gallbladder surgery).
Compared with adults, BARIATRIC SURGERY in ADOLESCENTS achieves greater weight loss, more lasting over time, with fewer complications, and with a higher rate of comorbidity resolution, that is, a better metabolic response.
RECOMMENDED SURGICAL TECHNIQUES
- VERTICAL LAPAROSCOPIC GASTRECTOMY. It is the most recommended technique, since it achieves a weight loss similar to bypass, less reoperation and less risk, better absorption of iron and other nutrients, and a resolution almost similar to the bypass of associated comorbidities.
- GASTRIC BYPASS. It is a good technique both bariatric (weight reduction) and metabolic (resolution of comorbidities), although in adolescence its indications to Severe Gastroesophageal Reflux Disease are very limited.
As a result of the coordination of the Obesity Unit of the Hospital Quironsalud of Valencia, led by Dr. Sala -expert bariatric and metabolic surgeon-, and the Pediatrics Unit headed by Dr. Gonzalo Pin -expert pediatrician and specialist in pathology of the sleep-, and to give solution and answer to the serious problem of the OBESITY in the ADOLESCENCE, arises the FIRST UNIT SPECIALIZED IN OBESITY AND BARIATRIC-METABOLIC SURGERY OF THE ADOLESCENT of the Private Health.
UNIT OF OBESITY AND BARIATRIC-METABOLIC SURGERY OF THE ADOLESCENT OF THE QUIRONSALUD HOSPITAL OF VALENCIA.
Our MULTIDISCIPLINARY team of specialists covers ALL facets of obesity in childhood and adolescence, both dietetic and nutritional as well as psychological, social, endocrinological and medical in general, physical activity, and surgical, of course; to give an effective response to the challenge of childhood obesity and adolescence in all its grades, as well as to solve the serious associated diseases, improving the quality of life of the ADOLESCENT.