A few years back, obesity surgery in children was not indicated and the official Mexican and international standard advised this type of surgery only for adults over 18 years. Nowadays, due to poor results in the conservative measures for weight control, there are hundreds of children and teenagers in the United States and Europe being intervened with the three main techniques: adjustable band, gastric sleeve and gastric bypass.
The major public health problem that overweight children represent and especially the number of typical adult diseases (diabetes, hypertension, musculoskeletal disorders, sleep apnea, among others) we are already seeing in children and adolescents, has made the medical community to reconsider bariatric surgery as an option for these patients. In India, for instance, a gastric bypass was performed to a 4 year old, whose body max index (BMI) was 41, because he suffered from sleep apnea that caused him to stop breathing while asleep.
The Pediatric Committee of the American Society for Metabolic and Bariatric Surgery (ASMBS) has demonstrated the usefulness of obesity surgery to treat children with diseases associated with this condition. Surgery has mainly been instructed in children over 13 years.
The overweight child must be primarily evaluated by the pediatrician, who should be assisted by specialists in endocrinology, psychology, nutrition and physical therapy. The bariatric surgeon taking the case must be part of a pediatric obesity clinic and, yes, if after an extensive evaluation by pediatricians conservative treatment does not give the expected results, bariatric surgery should be an option.
A morbidly obese 13 year-old teenager that already presents associated diseases has not a promising quality of life for the years to come. It is clear that under these circumstances, the benefits of surgery far outweigh the risks, greatly improving their life expectancy and their quality of life for the subsequent adult life.
Bariatric surgery in children is still being researched and assessed, but it is a fact that hundreds of adolescents are being intervened around the globe with outstanding results. In Mexico, pediatricians are the experts in the field and are expected to take the leadership to form specialized children obesity clinics that will focus in treating this increasingly health issue, and consult with bariatric surgeons the candidacy of minors for these procedures. Both specialists should assess the case and decide honestly and in light of current knowledge what it is best for the patient.