How Many Kids Would Be Good Candidates for Bariatric Surgery?

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WL Shapiro et al. Pediatrics 2024: e2023063916. Prevalence of Adolescents Meeting Criteria for Metabolic and Bariatric Surgery (link includes a ~4 minute video abstract)

Methods: This retrospective cohort study analyzed electronic health record data of 603,051 adolescents aged 13 to 17 years between January 1, 2018, and December 31, 2021

Key findings:

  • 4.4% (1 in 23) of all adolescents met the eligibility criteria for bariatric surgery.
  • 22.2% had obesity (12.9% class 1, 5.4% class 2, and 3.9% class 3).
  • The most frequently diagnosed comorbid conditions were gastroesophageal reflux disease (3.2%), hypertension (0.5%), and nonalcoholic fatty liver disease (0.5%). 
  • The authors estimate that ~1 million U.S. adolescents meet criteria for bariatric surgery though only ~1700 receive this treatment yearly
  • The study strongly demonstrates that the comorbid conditions associated with obesity are underdiagnosed. In some cases this is because the screening is not done; yet, in other cases, despite screening, comorbid conditions go undiagnosed. For example, the prevalence of hypertension based on having at least 3 elevated BP measurements was 10 times higher than the prevalence based on the diagnosis being made (ICD 10) codes

My take: A lot of kids meet criteria for bariatric surgery but few undergo this surgery. If effective anti-obesity medications become more widely adopted (affordable), this may be a preferable option to surgery, especially in the pediatric age group. Surgery could be deferred to those who did not respond. Also, immediate implications of the study are that we need to be more diligent about looking for associated health problems (eg. OSA, HTN, T2DM, MASLD).

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