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Bariatric Surgery As a Last Resort for Extreme Childhood Obesity

Jun 26, 2017 10:59AM ● Published by Digital Media Director

At her heaviest, a 14-year-old patient at Children’s Hospital & Medical Center weighed 362 pounds, had a body mass index greater than 52, and suffered from a host of health issues related to her weight. Her family tried diet, exercise plans, and medication over the years, but the girl continued to gain weight.

As fast as she was growing, she could have soon had a heart attack or stroke, so pediatric surgeon Robert A. Cusick, MD, of Children’s Specialty Physicians, an associate professor of Pediatric Surgery at UNMC College of Medicine, performed a gastric sleeve resection on the girl at Children’s alongside the bariatric surgery team from Nebraska Medicine. The laparoscopic procedure employs a stapling device to remove about 85 percent of a patient’s stomach, leaving it in the shape of a sleeve or tube, decreasing food consumption by triggering an earlier satiety.

Children’s launched its bariatric surgery program in 2013. As of June 2017, 12 children had undergone either a gastric sleeve resection or a gastric bypass. It is not a first-line response to treating adolescent obesity at Children’s – but it is a viable last resort.

“If these kids can achieve great success without surgery, we’d love that. But when they don’t achieve that success, we want to be able to offer bariatric surgery,” Dr. Cusick says.

Candidates for bariatric surgery at Children’s must have a BMI of at least 40 or a BMI of 35 with another significant comorbidity, such as diabetes, obstructive sleep apnea, lipid disorders, pulmonary hypertension or fatty liver disease.

To ensure that all other avenues to better health have been exhausted, the pathway to bariatric surgery begins in HEROES (Healthy Eating with Resources, Options and Everyday Strategies), Children’s bariatric weight management program for children and adolescents. The multidisciplinary program combines medical management; required nutrition, behavior and fitness classes; behavioral health therapy and consultations with medical specialists.

Prior to surgery, patients must undergo a minimum of six months of medically-managed weight loss supervised by the HEROES team, exercise and nutrition classes, psychological testing and clinic follow-up to manage any comorbidities. “It’s a lot of behavioral modification we’re teaching and reinforcing,” says nurse practitioner Carly Frost, MSN, FNP-BC.

Dr. Cusick acknowledges the concept of performing the procedure on adolescents is not without controversy. “There are people who say you shouldn’t be doing this on children – ‘Can’t they just change their lifestyles?’ The problem is that once you get to these very high BMIs, surgery may be the only durable solution.”

“The reality is these kids are in our community; they’re getting bullied; and we need to figure out a way to make their lives better,” he says. “We’re trying to get them to lose a significant amount of weight so, with the help of the HEROES program, they can resume a healthier lifestyle.”

That has been the case for the then 14-year-old on whom Dr. Cusick performed bariatric surgery. She is now in high school, down 120 pounds, plays sports, and was able to stop taking many of the medications that used to help keep her alive. Doctors have since traced her weight gain to a genetic anomaly that triggered a rare overgrowth syndrome.

Dr. Cusick calls his work with young bariatric surgery patients “one of the most rewarding things I’ve done as a pediatric surgeon because you see these significant transformations in these kids. We’ve tried all the medical things and seen them fail. To finally have that success – it changes their whole outlook on life. Their whole persona is changed.”

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