Sleeve gastrectomy may benefit obese adolescents with cognitive or developmental disability

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By Will Boggs MD

NEW YORK (Reuters Health) - Sleeve gastrectomy yields similar benefits for severely obese adolescents with and without cognitive impairment or developmental disability (CI/DD), researchers report.

"We think the findings of the study indicate that all treatment options for obesity should be available to people with CI/DD as they are to children and adolescents without these disabilities," Dr. Sarah E. Hornack and Dr. Eleanor R. Mackey from Children's National Health System and The George Washington University, Washington, DC told Reuters Health by email.

They added, "As with anyone, a decision whether to undergo surgery needs to be tailored to the individual needs and concerns, and this is no different for people with CI/DD than it is for anyone undergoing obesity treatment."

Obesity and severe obesity are more prevalent among youth with CI/DD, but treatments, including bariatric surgery, are understudied in this group.

Dr. Hornack, Dr. Mackey, and colleagues evaluated weight loss outcomes for 17 adolescents with CI/DD receiving laparoscopic sleeve gastrectomy and 46 other adolescents having the same operation. The average age at surgery in groups was roughly 18 years.

The average percentage of excess body mass index (BMI) loss overall was 37% at 3 months postsurgery, increased another 10% in the next 3 months, and slowed thereafter, reaching 57% at 12 months and remaining stable through 24 months postsurgery.

The presence of CI/DD had no significant effect on either the percentage of excess BMI loss at 3 months postsurgery or on its rate of change, the authors reported online April 15 in Pediatrics.

There was a nonsignificant trend for a higher rate of decrease in percentage of excess BMI loss among individuals with CI/DD.

IQ at baseline did not predict the percentage of excess BMI loss after sleeve gastrectomy.

"We are pleased that research is catching up to clinical care and demonstrating that bariatric surgery is an important treatment option for children and adolescents with severe obesity," Dr. Hornack and Dr. Mackey said. "It is the most effective current treatment and should be available for consideration for all families who might benefit."

"We hope that physicians won't act as gatekeepers in referrals for consultation for surgery for children and adolescents with CI/DD," they said. "We hope instead that providers will see that surgery can be a valuable treatment for severe obesity in youth with CI/DD and therefore provide families with a referral to consult with a surgical team to determine if surgery is a good treatment option for them. Expert surgical teams can provide consultation to families about risks and benefits, address concerns about ability to provide consent/assent, and ensure that the family is able to choose the treatment that is right for them."

Dr. Kanika A. Bowen-Jallow from University of Texas Medical Branch, Galveston, who recently reviewed adolescent bariatric surgery, told Reuters Health by email, "The most interesting outcome of this manuscript is dispelling the notion that children with CI/DD are not capable of achieving the same excellent weight loss outcomes with bariatric surgery as children without CI/DD."

"The manuscript clearly demonstrates that the surgical management of adolescents with CI/DD should not differ from patients with 'typical' development," she said. "In a structured, surgical weight loss program, adolescent patients have the ability to have similar outcomes regardless of CI/DD."

"Even though bariatric surgery has well-established benefits, it remains an underutilized option in obese adolescents," Dr. Bowen-Jallow added.

SOURCE: http://bit.ly/2UjNKuf

Pediatrics 2019.

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