Elsevier

Surgery for Obesity and Related Diseases

Volume 5, Issue 1, January–February 2009, Pages 88-93
Surgery for Obesity and Related Diseases

Original article
Perspectives on pediatric bariatric surgery: identifying barriers to referral

Presented in part at the American Society of Metabolic and Bariatric Surgery 25th Annual Meeting, June 15–20, 2008, Washington DC
https://doi.org/10.1016/j.soard.2008.08.023Get rights and content

Abstract

Background

Pediatric obesity is a growing problem affecting the health of our youth. We sought to identify the barriers to pediatric bariatric referral at a tertiary referral center.

Methods

We performed a survey of pediatricians and family practitioners at a single institution to assess their perspectives on pediatric obesity.

Results

A total of 61 physicians completed the survey (response rate 46%). All believed pediatric obesity is a major problem, and 82.0% noted an increase in the incidence during a mean period of 15 years (range 3–25). Of the 61 physicians, 88.5% used nonoperative weight loss techniques, with only 1.8% reporting satisfactory results. However, 42.6% had referred a patient (adult or pediatric) for a bariatric procedure, of whom 84.6% were satisfied with the operative outcomes. Despite the high satisfaction with bariatric procedures, 88.5% would be unlikely or would never refer a child for a bariatric procedure, and 44.3% would be somewhat or very likely to refer an adolescent.

Conclusion

Physicians caring for children recognize the growing problem of childhood and adolescent obesity. Despite the poor outcomes with nonoperative methods and the high satisfaction with the outcomes of bariatric procedures, physicians are still reluctant to refer children and adolescents for surgical weight loss procedures.

Section snippets

Methods

With institutional review board approval, a survey was distributed to all physicians at Mayo Clinic Rochester who had clinical contact with children, including general pediatricians, pediatric specialists, family practitioners, and pediatric psychiatrists. The survey used a Likert scale to assess their perspectives on childhood (age <13 y) and adolescent (age 13–18 y) obesity in 3 different areas: (1) the severity of the problem, (2) physician-specific practices and outcomes in treating

Prevalence of overweight, obesity, and weight-related co-morbidities

All 61 respondents believed strongly that childhood and adolescent obesity is a serious health problem, and 50 recognized an increase in the incidence during a mean period of 15 years (range 3–25). Of the 61 physicians, 35 reported that <20% of children they saw were overweight (BMI <95th percentile but ≥85th percentile for same age and gender), and another 26 reported that 20–50% of children were overweight (Fig. 1a). In contrast, 46 reported that nearly 20–50% of adolescents were overweight

Discussion

Physicians directly involved in the care of pediatric patients are aware of the growing obesity epidemic among children and adolescents. They clearly recognize the very serious complications of obesity and the importance of sustainable excess weight loss to prevent disease progression and even achieve resolution of weight-related co-morbidities. Most of the physicians participating in the present study had implemented nonoperative weight loss measures in their practice. However, despite the

Conclusion

Physicians caring for children are aware of the growing epidemic of childhood and adolescent overweight/obesity. The current nonoperative options for weight loss are failing, but many providers still have a reluctance to refer patients for a bariatric evaluation. Efforts are needed to evaluate and document the short- and long-term safety and efficacy of bariatric procedures for appropriately selected pediatric patients, as well as the utility of a thorough evaluation in multidisciplinary,

Disclosures

The authors claim no commercial associations that might be a conflict of interest in relation to this article.

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