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Metabolic And Bariatric Surgery as the Definitive Solution to Combat Obesity Among US Youth

In the US pediatric population, severe obesity is the subcategory of obesity that is developing the quickest (body mass ≥ 120% of the 95th percentile adjusted for age and sex or an index >35 [measured as weight in kilograms divided by height in meters squared]).

From 5.6% in 2015 to 6.5% in 2018, this population’s rate of extreme obesity increased. Cardiometabolic comorbidities, liver and renal disease, and a lower quality of life are all linked to pediatric obesity, and these connections persist into adulthood. 

For young people with severe obesity, behavioral lifestyle therapies alone do not provide long-term, clinically significant weight loss. A reliable and safe procedure is metabolic and bariatric surgery (MBS), and this study was published in Jama Pediatrics.

A 2019 American Academy of Paediatrics (AAP) policy statement addressed increased teenage access to MBS when medically necessary. Recent clinical practice guidelines from the AAP have endorsed this position. Before and after the 2019 AAP statement, we looked at trends in MBS usage among adults and US kids aged 10 to 19 years. 

The American Society of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Programme (MBSAQIP) data from the combined 2015–2021 participant use files were used. According to the University of Texas Health Science Centre Committee for Human Subjects Protection, this cohort study was exempt from review and informed consent because it was a retrospective examination of available, anonymized data sets. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), reporting guidelines were followed for this study. 

A Cochran-Armitage trend test compared MBS use in 2015–2019 vs. 2020–2021 (years before and following the 2019 AAP statement release) in adolescents and adults (aged >19 years), as well as by racial and ethnic groups (self-reported Black, Hispanic, White, and other [American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander], multiracial, or unknown or not reported). 

The majority of racial and ethnic groups in the US as well as youngsters, have increasing access to and use of MBS. MBS use among youths notably rose in the first two years of the COVID-19 pandemic in 2020–2021, compared to 2015–2019. 

Adult MBS rates, on the other hand, fell in 2020. The AAP has emphasized the need to inform pediatricians about the advantages of MBS for eligible patients. MBS has historically been underutilized in juveniles due to obstacles such as low referral rates, restricted access, and inadequate insurance coverage.

In a recent study, our research team found that patients aged 15 to 21 who underwent MBS maintained their weight, had comorbidity reductions, and experienced few long-term complications. The MBSAQIP data may differ from all MBS practices in the US, posing a study limitation. However, the present study’s findings point to cautious optimism over lowering barriers to MBS for needy US kids. 

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