BARIATRIC SURGERY: ARE ADOLESCENTS CANDIDATES ?

The obesity figures in the adult population worldwide are unsettling, but not only. 17% of American adolescents suffer from overweight, and 4% are obese, from which unfortunately 80% will remain so later on.
Ever since bariatric surgery exists there has been a debate over the opportunity to operate on obese adolescents. A majority of physicians deem that adolescents have no proper maturity to accept the downsides of a surgical procedure such as gastric reduction (as established through an adjustable banding), but a strong minority think one should respond to the distress of a 150 kg teenager who is uncomfortable at school, suffers from peer pressure and has a limited professional future. So far there is a worldwide consensus that such patients should not be operated in the first place, owing to the possibility of diet programs as a starter, involving multiple health care professionals, possibly within dedicated institutions; in case of patent failure, the option of bariatric surgery after 18 years remains, provided the family can support the following efforts along with nutritionists and psychologists.
In some countries like France, reimbursement is not authorized for such indications so far.
However, some seasoned surgical teams have presented data on adolescents. In the United States, surgeons in Minneapolis and Pittsburg have operated on more than 20 children aged from 13 to 17. All had a massive obesity with an excess-weight above 60 kg. The results of surgery have been satisfactory. A positive point: the peri-operative support is well established in the US for these patients; a negative point: the most important operation in the US is the gastro-jejunal bypass ('gold standard' operation), which is definitively a very efficient procedure, achieving the best long-term weight-loss, but also a heavier operation than adjustable gastric banding. It is thus questionnable to choose it for every patient.
A well documented Australian study has been also recently published: 17 young patients from 14 to 19 have been operated on with a laparoscopic adjustable gastric banding and had good results*. Let us conclude that it is highly recommanded that this type of surgery remains strictly under scrutiny, and be not largely available for adolescents unless dedicated teams can provide the necessary cares for them.
 
* Dolan K et col. Laparoscopic gastric banding in morbidly obese adolescents. Obesity Surgery, 2003, 13, 101-104.