Obesity and Bariatric Surgery
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For many people the term “obesity” conjures up an image of a heavy person to whom judgmental modifiers are applied. Fat babies are overfed. Fat children eat too much and don’t exercise. Overweight teenagers are lazy and live on junk food. Obese adults live on supersized portions, sweets and television. Obesity, like loud noise and bad odors, can be offensive.
While food choices and activity levels play significant roles in the development of obesity, the propensity for an individual to develop obesity is closely connected to a complex network of interactions that include genetic factors, organ microenvironments, endocrine activity and caloric expenditure. Obesity is no longer considered merely a result of bad choices but rather a disease for which there are genetic predispositions, techniques for prevention and management and also long term consequences.
For pediatric surgeons, obesity has become a factor in practice. Surgical treatment of severe obesity in pediatric and adolescent patients has become more acceptable as pioneering groups such as the TeenLABS consortium in the United States and others in Europe, the Middle East and Australia have demonstrated the safety and efficacy of adult weight loss operations performed in children and adolescents. While few pediatric surgeons perform weight loss procedures in their practices, the increasing number of patients who undergo these operations and procedures increases the likelihood that one will encounter a patient who has undergone weight loss surgery.
More often, however, the pediatric surgeon is called upon to evaluate and treat the child or adolescent with obesity whose surgical problem is not related to a weight loss procedure (e.g., cholecystitis, trauma, malignancy). It is useful for surgeons facing a young patient with obesity to be aware of the issues associated with the condition and how they might impact care and treatment decisions.