Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Bariatric surgery viable for teens with cognitive disabilities
Key clinical point: Bariatric weight-loss surgery could be a safe, effective intervention for teens with intellectual/developmental disability and obesity.
Major finding: Total weight loss did not differ between teens with or without intellectual/developmental disability for up to 2 years post surgery.
Study details: The findings are based on comparisons of 63 adolescents (17 with cognitive or developmental disabilities) who underwent bariatric surgery during 2010-2017.
Disclosures: The research did not use external funding, and the authors reported no disclosures.
Citation:
Hornack SE. Pediatrics. 2019 Apr 15. doi: 10.1542/peds.2018-2908.
Despite increasing evidence to support the safety and effectiveness of bariatric surgery in confronting the challenge of increasing obesity rates among adolescents, access to care remains limited for many such teens.
Prominent examples include a significant disparity in insurance authorization for bariatric surgical care when comparing pediatric patients to their adult counterparts, low rates of referral from primary caregivers, and general uncertainty regarding potential exclusionary criteria.
The researchers should be commended for exploring bariatric surgery outcomes in an understudied population. However, both the likely importance of social supports to the participants’ success and, especially, the need to approach the issue of informed thoughtfully, perhaps with additional institutional guidance are crucial to success.
Although literature addressing ethical concerns specifically associated with bariatric surgery for children with intellectual or developmental disability is limited, previous attempts to offer a logical clinical framework highlight the importance of using a case-by-case approach predicated on the need to establish a well-defined risk/benefit ratio.
As an important part of efforts to tackle such challenges, bariatric surgical care providers should strongly consider the routine use of available resources (i.e., institutional ethics committees) to assist in complex medical decision making.”
These comments are adapted from an accompanying editorial by Marc P. Michalsky, MD, of the Ohio State University and Nationwide Children’s Hospital, both in Columbus (Pediatrics. 15 April 2019; doi: 10.1542/peds.2018-4112). He reported having no disclosures.