Pediatric Bariatric Surgery Debate

An important element of long-term health and weight loss success is the development of an integrated multidisciplinary education program. Such a program must be aimed at teaching both parents and patients about the anatomic and physiologic features of the proposed surgery and the lifelong need for strict adherence to nutritional guidelines and daily physical activity and offering behavioral strategies to meet these needs. Attendance at adolescent bariatric support group meetings before and after surgery can also be quite helpful (Inge et al.,

“Bariatrics is the branch of medicine that focuses on the causes, prevention, and treatment of obesity” (“Medical Dictionary,” 2015). Bariatric surgery is a specific discourse community connecting individuals through mutual interests, shared knowledge, and expertise of treating obese populations. The field of bariatric surgery is a discourse community with several purposes. It encourages innovative surgical and nonsurgical solutions in obesity care. It formulates hypotheses and develops and conducts experimental designs to test the hypotheses’ reliability and validity. Furthermore, it aims to stimulate discussion about its findings.

Obesity has been a major health issue in the community for the past three decades, and has recently become a spreading concern for children (Black & Hager, 2013). Childhood obesity leads to many health and financial burdens in the future, and has become a public health priority. According to the Centers for Disease Control and Prevention (CDC) (2016), childhood obesity has doubled in children and quadrupled in adolescents in the past 30 years. Black and Hager (2013) state that pediatric obesity is a major public health problem that effects a child’s mental and physical health. Having childhood obesity also increases the risk of developing adult obesity and many other chronic illnesses. Childhood obesity will be further explored in the following sections and will include: background, current surveillance methods, epidemiology analysis, screening and diagnosis, and the plan of action.

Child obesity is a serious public health issue in the United States and its increase has reached epidemic level. The prevalence of obesity among children has dramatically increased from 1970 to 2010 (Saydah, Bullard, Cheng, Ali, Gregg, Geiss, & Impertore, 2014). This issue should no longer be ignored because its consequences can affect all of us in different ways. Usually, when we see an obese child, we only think about his/her body appearance and we ignored all the health issues that can cause. Child obesity is a preventable disease that can lead many health complications if it is not treated.

However, pre-operative, operative, and post-operative guidelines are quiet variable and not well understood. National Institute for Health and Care Excellence (NICE) established “guidelines for the clinical management of obesity in both adults and children to provide a general appraisal of the evidence, with broad suggestions for care pathways” (Black, White, Viner, & Simmons, 2013). More substantive guidelines on “how to manage pediatric-adolescent bariatric surgery populations, advice concerning, which complications and co-morbidities to measure, and encouraging longer-term follow-up would benefit both patients and clinicians” (Black, White, Viner, & Simmons,

Bariatric Surgery is surgery on the stomach of a person to help with serious signs of obesity. With this surgery there are many type of procedures that all causes you to loss weight but there are man type of ways to do so. Bariatric surgery also known as a type of weight loss surgery it is optional for people who have a bmi also known as body mass index only if greater than 40 you are considered obese. Your BMI is based on your height and weight. It's one way to see if you're at a normal healthy weight for yourself. Your BMI for being Underweight is less than 18.5. Your BMI at an Healthy weight is 18.5 to 24.9.Your BMI for overweight is 25 to 29.9. Finally Your BMI for obesity would be 30 or higher. Surgery is also an option for human beings with a body mass index between 35 and 40 who have health problems like type 2 diabetes or heart disease.There are two main types of bariatric surgery which are restrictive surgeries and malabsorptive surgeries.

The literature review was organized in a pattern that explained the difficulties one has after receiving bariatric surgery. The investigator incorporates previous studies completed that were relevant to this study. There was no apparent gap in the data that was presented. The investigator uses secondary sources and does not utilize any primary sources in displaying background data. Despite the rich data that the literature review contained, it was poorly organized and could have used the help of headings to better understand the investigator s ideas. The literature review was combined in with the introduction which made it difficult to read. Despite the confusion, the rationale for framing the research question was very clear and directly followed the literature review.

In the United States, child and adolescent obesity has become a significant epidemiological issue. There are over 12 million children

They studied <30-day and 30-day to 2-year mortality in 85,048 subjects who were treated with bariatric surgery from 478 treatment groups in 361 reports published from January 1, 1990 to April 30, 2006. The researchers divided the mortalities by dividing them in different categories that include mortality relating to technique (open and laparoscopic BPD-DS, open and laparoscopic gastric bypass, open and laparoscopic gastroplasty, laparoscopic gastric banding and reoperations or revisions); mortality relating to procedure type (malabsorptive, malabsorptive/restrictive, restrictive), mortality with respect to publication year, mortality with respect to design and mortality with respect to subgroups like females versus males, superobese and elderly. The researchers concluded that low mortality rates are associated with the surgery. In particular, total mortality at less than 30 days and 30 days to two years was 0.28% and 0.35% respectively. This is significantly lower than rates of mortality associated with other operative procedures. In particular, the in-hospital mortality rates after operations in the hospitals of the United States are 5.4% for paediatric heart surgery, 8.3% for pancreatectomy, 0.3% for hip replacement, 10.7% for craniotomy, 3.5% for coronary artery bypass grafting and 3.9% for aortic

Obesity has a profound impact on the health and development of children and adolescents. There are immediate and long term health risks, such as, asthma, sleep apnea, orthopedic complications, acid reflux, cardiovascular disease and insulin resistant type 2 diabetes. Severely obese adolescents can suffer serious morbidity. In fact, there are few organs systems that obesity does not affect. Of equal concern, are the teasing, discrimination, and bullying of obese adolescents (Must, 2011). While treatments such as behavioral and lifestyle modifications may work for the majority of children affected by obesity and help them increase their health, there are adolescents affected by severe obesity that require more aggressive treatment such as bariatric surgery (Aaron S. Kelly, Sarah E. Barlow, Goutham Rao, Thomas H. Inge, Laura L. Hayman, Julia Steinberger, Elaine M. Urbina, Linda J Ewing, and Stephen R. Daniels 2013).

As most patients should know, a bariatric surgery is a procedure conducted by a bariatric surgeon or medical licensed professional. The primary factor of a bariatric surgery is to aid in weight reduction; therefore, this surgery is mainly issued to patients who are morbidly obese. This type of surgery can also be reserved for patients that are not responding well to their diet or have been decreasing in their physical activities. It should be well noted that there are four types of bariatric surgeries, each of them serving a different purpose for the needs of the patient.

Whitlock et al. (2008) conducted a systematic review to determine which interventions effectively reported positive outcomes for overweight and obese children and adolescents, including behavioural, pharmacological, and surgical treatment interventions. For the purpose of this report, only behavioural interventions will be considered. These trials compared outcomes of behavioural weight management interventions to control conditions, with outcomes reported at least 6 months after the start of the intervention. Most patients ' BMI prior to interventions was greater than the 95th percentile, and even more worrying, in some instances adults ' criteria for Class I obesity was met.

There are numerous postoperative concerns after bariatric surgery in adolescence. To avoid nutritional complications, patients must adhere to guidelines regarding diet and vitamin/mineral supplementation. Gastric bypass essentially results in surgically enforced, very low-calorie, low-carbohydrate dietary intake, thus requiring attention to adequate (0.5 g/kg) daily protein intake. Micronutrients, including calcium, vitamin B12, folate, multivitamins, thiamine, and iron (for menstruating female subjects), must be supplemented after gastric bypass (Inge et al., 2005).

     Obesity is climbing the charts as being a major killer of our population. This paper informs the reader on how bariatric surgery treats the severely obese. Focus is given on who should

Weight loss surgery shouldn’t be enter into lightly. Understanding that this is not only a lifestyle change but a life change that a person needs to live by to maintain a healthy lifestyle. We are living in a society were a sharp increase in the number of patients who travel vast distances across the state or international borders for bariatric surgery. Currently, there are no specific guidelines or recommendations in place regarding global bariatric healthcare. However, unique risks and challenges are associated with bariatric surgery exist that must be thought about. Additionally, follow-up and long-term need for revisional procedures in some patients must also be considered. Given that in not cases preoperative evaluation and patient education