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Is there a place for bariatric surgery in treating childhood obesity?
  1. J P H Shield1,
  2. E Crowne2,
  3. J Morgan3
  1. 1
    University of Bristol and Bristol Royal Hospital for Children, Bristol, UK
  2. 2
    Bristol Royal Hospital for Children, Bristol, UK
  3. 3
    Department of Surgery, Southmead Hospital, Westbury on Trym, Bristol, UK
  1. Dr Julian P H Shield, Reader in Diabetes and Metabolic Endocrinology, University of Bristol & Bristol Royal Hospital for Children, Upper Maudlin St, Bristol, BS2 8AE, UK; j.p.h.shield{at}bristol.ac.uk

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Current NICE guidelines for surgery in adults and children Basic: adults and children

  • In a BMI of 40 kg/m2 or more or between 35 kg/m2 and 40 kg/m2 and other significant disease (for example, type 2 diabetes or high blood pressure) that could be improved by weight lost.

    All appropriate non-surgical measures have been tried but have failed to achieve or maintain adequate, clinically beneficial weight loss for at least 6 months.

    The person has been receiving or will receive intensive management in a specialist obesity service.

    The person is generally fit for anaesthesia and surgery.

    The person commits to the need for long-term follow-up.

Children

  • Bariatric surgery may be considered for young people only in exceptional circumstances and if they have achieved or nearly achieved physiological maturity. The person commits to the need for long-term follow-up.

    Surgery for obesity should be undertaken only by a multidisciplinary team that can provide paediatric expertise in:

    Pre-operative assessment, including a risk-benefit analysis that includes preventing complications of obesity and specialist assessment for eating disorder(s).

    Information on the different procedures, including potential weight loss and associated risks.

    Regular post-operative assessment, including specialist dietetic and surgical follow-up.

    Management of co-morbidities.

    Psychological support before and after surgery.

    Information on or access to plastic surgery (such as apronectomy) where appropriate.

    Access to suitable equipment, including scales, theatre tables, Zimmer frames, commodes, hoists, bed frames, pressure-relieving mattresses and seating suitable for patients undergoing bariatric surgery and staff trained to use them.

    All young people should have had a comprehensive psychological, educational, family and social assessment before undergoing bariatric surgery.

The media has long been fascinated by the implications and newsworthiness of the current epidemic of childhood obesity in this country. The media response to the publication of the National Institute for Health and Clinical Excellence guidelines1 on obesity seemed to concentrate principally on the report’s directions regarding …

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