When is adolescent bariatric surgery necessary?

Abdalla Zarroug, M.D: Hello my name is Abdullah Zurich. I’m a pediatric surgeon at the Mayo Clinic in Rochester, Minnesota and today we’re going to be talking about adolescent bariatric surgery. We’ve had a program for adolescent weight loss for quite some time; It’s actually a mature program. The pediatric surgical aspects of it along with the bariatric surgery have been in place for over five years but the weight loss program really goes back to when Dr. Seema Kumar started this even before that. Children undergo different behavior modification programs without surgery and that’s their goal — the goal is to be able to lose weight without any intervention that is surgical or invasive.

When the adolescent fails behavioral modification, when it’s medically indicated, then we can go on to talk about bariatric interventions or surgical interventions that we perform. Really we have a multidisciplinary program here. We have pediatric dietitians. We have pediatric surgeons. We have bariatric surgeons. The individual who heads the program is Dr. Seema Kumar. She’s a pediatric endocrinologist and she’s been doing this for some time. This is actually her research focus and her clinical focus and with her leading the program what we’ve done is had a team of specialized pediatric providers and we performed the full or we provide the full gamut of pediatric services so that the child or the adolescent, even if they need bariatric surgery or most of the time they actually need other interventions for medical comorbidities, we have the full gamut here at Mayo Clinic to provide those medical services.

Specifically for bariatric surgery, really the benefits are only for those or at least the procedure is only for those that meet criteria. Well, what are the criteria? Well, they need to be above the 95th or 99th percentile for weight and age. What does that mean? Roughly speaking, their BMI needs to be over 40. We don’t use the adult criteria of over 35. You really use over 40 with a medical core morbidity that is related to their obesity. So things like diabetes or sleep apnea or liver cirrhosis oftentimes those medical comorbidities can be life-threatening or they can have a quality of life effect on the adolescent and with the procedure we can help change that. And it really is helping. It’s not just the only thing that we’re going to do.

So what’s the process? The process is that they meet with the pediatric endocrinologist, they meet with the dietician, they meet with the multidisciplinary team including a behavioral specialist. It could be a psychologist. It could be a psychiatrist. It could be both depending on what the needs of the adolescent are. And they also meet with myself in pediatric surgery and an adult bariatric surgeon.

From the surgical aspect we’ve decided that we’re going to see the patients — both the adult
bariatric surgeon who performs these types of procedures every single day and a pediatric surgeon so that we can have an adolescent or a pediatric aspect to it. And so we see these patients in advance what in deciding whether they’re going to be a fit or good candidate for the procedure.

We often see them at an integral time perhaps at three months or four months to make sure that things are going well. We check in with the pediatric endocrinologist. We check with the dietitian. We check in with the psychologists to make sure that the adolescent is still in an appropriate candidate and that we’re going to go ahead with the procedure in about three months.

Most of the time it takes about a six months process of behavioral modification and at least not weight gain but hopefully weight loss and making sure that they’re medically fit for the procedure that they’ll still benefit. They do that most of the time they can do that here at Mayo. Every now and then we have people who don’t live within this vicinity so they can get some of that elsewhere but for the most part we like to do that it at Mayo because again the program is mature. It’s over five years that we’ve been doing this.

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