Do surgical interventions to treat obesity in children and adolescents have long- versus short-term advantages and are they cost-effective?

Abstract

The prevalence of childhood and adolescent obesity in the WHO European Region has risen in recent decades. Obesity in this population is linked to increased risk factors for cardiovascular diseases, type 2 diabetes, sleep apnoea and psychological distress. While bariatric surgery is seen as an effective intervention under clear conditions for obese adults, the indications for medical and surgical treatment of overweight and obese children are still not well defined. Moreover, children and adolescents have distinctive metabolic, developmental and psychological needs, which must be carefully considered to avoid the inappropriate use of weight-loss surgery. This review looks at the effectiveness and cost–effectiveness of surgical interventions for overweight and obese children and adolescents, and finds that the majority of relevant studies are methodologically limited and long-term data remain largely unavailable. Some evidence suggests that bariatric surgery in severely obese adolescents can result in significant weight loss, and improvement in co-morbidities and quality of life. A conservative approach to child and adolescent bariatric surgery is warranted until further long-term prospective studies on the subject are conducted, so there remains an urgent need to develop alternatives to surgery, such as lifestyle programmes that are even modestly effective.