Baptist Health Bariatric Surgery Program Aligned with New Childhood Obesity Treatment Guidelines

More than 15 years ago, when the American Academy of Pediatrics (AAP) first addressed obesity, the condition was not recognized by the medical community as a disease. And, according to a Baptist Health bariatric surgery specialist, children who suffered from obesity had few treatment options, most of which focused on counseling about diet, nutrition and exercise.

Earlier this year, however, the AAP updated its guidelines, stressing that there is more evidence than ever that early and intensive treatment of obesity in children and adolescents is safe and effective. “There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” the AAP said in a statement.

Anthony Gonzalez, M.D., medical director of bariatric surgery at South Miami Hospital

“It was long overdue,” says Anthony Gonzalez, M.D., medical director of bariatric surgery at South Miami Hospital, of the new guidelines. “Obesity is a disease now recognized by the American Medical Association (AMA) as a medical condition that causes a multitude of medical problems that can lead to early death.”

The AAP stresses that intensive behavioral and lifestyle changes should continue to be the initial approach taken to combat childhood obesity. But, for the first time, the AAP is setting age-based recommendations for providing anti-obesity medications, and possibly surgery, for some patients.

Adolescents, ages 12 years and older, should be evaluated for medications as “an adjunct to health behavior and lifestyle treatment,” the AAP said. Teens, ages 13 and older, with severe obesity (BMI equal to 120 percent of the 95th percentile for age and sex) “should be evaluated for metabolic and bariatric surgery,” the AAP adds.

An epidemic of childhood obesity

Dr. Gonzalez says the new guidelines are especially important in light of an ongoing childhood obesity epidemic in the United States. A modeling study supported by the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health provided an ominous warning: the obesity epidemic is expected to fuel a seven-fold increase in type 2 diabetes among people under age 20 by the year 2060.

According to the most recent update from the CDC on children and adolescents aged 2-19 years, the prevalence of childhood obesity was at about 20 percent, and affected about 15 million children and adolescents.

But those statistics were from before the COVID-19 pandemic began in early 2020 and most indicators point to an increase in childhood obesity since the pandemic. Obesity prevalence was even higher among minorities: 26 percent among Hispanic children and 25 percent among non-Hispanic Black children, the CDC states. 

Dealing with obesity early on

Dr. Gonzalez says that obesity is a serious disease that affects the patient’s physical, mental, emotional and social health. “Obesity begins at a young age and needs to be treated earlier to achieve the best outcomes,” he says, adding that South Miami Hospital’s bariatric program has been treating childhood obesity for more than 15 years.

“Historically, obesity in children has been ignored and has not been aggressively treated in an organized fashion,” Dr. Gonzalez says. “There has not really been any good treatment other than a pediatrician telling the child’s parents, ‘You’ve got to stop feeding your child so much, give them better food choices and make sure they’re getting physical activity every day.’”

Children can develop obesity-related health issues just like adults do, Dr. Gonzalez says. These include high blood pressure, hyperlipidemia, obstructive sleep apnea, liver damage, fatty liver and other conditions. Left untreated, these can pose serious health risks in adulthood, says Dr. Gonzalez, as long-term obesity can lead to cardiovascular disease, heart attack, stroke and an increased risk of cancer.

“The AAP’s new recommendations encourage physicians to treat the medical problems obese children have – the high blood pressure, the high lipids, the sleep apnea,” Dr. Gonzalez says. “That means they should be measuring your child’s BMI, as well as checking for and treating diabetes, high blood pressure and sleep apnea. If the level of obesity is severe, the entire family really needs to get involved and take proactive steps together to resolve it.”

Successful outcomes with surgery

Surgical options for obese patients at South Miami Hospital’s bariatric surgery center focus on procedures such as a sleeve gastrectomy, which removes 60 to 70 percent of the stomach, or a gastric bypass, which alters the way the stomach and intestine absorb and digest food. Both procedures have the effect of reducing your hunger and appetite and helping you feel full faster and with fewer calories, says Dr. Gonzalez.

“A sleeve gastrectomy can be very effective for many patients, and there is an 80 to 90 percent chance they’ll be able to maintain that weight loss for the rest of their life, while a gastric bypass has a success rate of 90 to 95 percent,” says Dr. Gonzalez. “But no operation is foolproof,” he cautions. “A change in behavior is key to successful outcomes.”

Adolescents fare better than adults and have better outcomes with bariatric surgery, Dr. Gonzalez says. “They have few if any comorbidities, fewer complications with surgery and a better chance at having successful outcomes – not just with their initial weight loss but also with their long-term weight loss maintenance. Plus, dealing with obesity early on prevents long-term medical problems and will lead to a better life and a more active lifestyle for these adolescents and young adults.”

Striving for long-term success

Patients in Dr. Gonzalez’s program are followed for a minimum of five years, he says. “After five years, hopefully they’ve figured it out and are going to be successful long term.” If the patient’s BMI goes below 30 during their first or second year, that’s considered a short-term successful outcome, Dr. Gonzalez adds. “With a BMI below 30, they’re not going to have any obesity-related health risks.”

There are no requirements for patients in the program to continue after five years, says Dr. Gonzalez. “We still communicate with them extensively and strongly encourage them to come back, but at that point it’s up to them.”

Dr. Gonzalez emphasizes that South Miami Hospital’s bariatric surgery program strives for long-term success with their patients.

“We provide a multi-disciplinary, comprehensive, long-term program for weight loss that involves not just surgeons such as myself but also an entire support team of nutritionists, mental health counselors, exercise physiologists and others whose only goal is to help our patients be successful for a long period of time,” he says. “In addition, South Miami Hospital has a support group for bariatric patients, which our patients find very helpful.”