Severe child obesity: a potential lost tribe?
More than a quarter of children in England and Wales have overweight and, worryingly, obesity prevalence is as high as 15% (1, 2). Mark Hanson and colleagues (3) are absolutely right to highlight the desperate need for, and the persistent bureaucratic barriers to, concerted multimodal measures to actively reduce child obesity rates, not just halt their increase.
However, while we vehemently seek appropriate discussion and delivery of anti-obesogenic medicine (population-level) interventions, we must not forget about the young individuals who cannot and will not be helped by such an approach. When obesity is severe (i.e. BMI ≥40 kg/m2, or ≥120% of 95th percentile), lifestyle and pharmaceutical interventions are unsuccessful (4). These individuals get lost within, or worse, left outside of health care systems that struggle find a successful response. There is evidence that obesity will both significantly shorten the length (5) and worsen the quality (6) of these young people’s lives. With long-term evidence recently emerging supporting the efficacy of adolescent bariatric surgery in reversing and improving weight, quality of life and cardiometabolic risk factors, including type 2 diabetes, dyslipidaemia and hypertension (7-9), it is now essential that this vulnerable group is not left as a lost tribe. Instead, we must learn in the UK from lessons in Sweden (8) and the US (7,9), where adolescent bariatric surgery programmes have been developed over the past decade. Prevention and treatment are not mutually exclusive; both are essential in what will almost certainly be a ‘hundred-years war’ on child obesity.
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2. Bailey L. Child Measurement Programme for Wales 2014/2015: Public Health Wales NHS Trust; 2016.
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4. Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013;128(15):1689-712.
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6. Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. Jama. 2003;289(14):1813-9.
7. Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Helmrath MA, Brandt ML, et al. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. The New England journal of medicine. 2016;374(2):113-23.
8. Olbers T, Beamish AJ, Gronowitz E, Flodmark CE, Dahlgren J, Bruze G, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. The lancet Diabetes & endocrinology. 2017;5(3):174-83.
9. Inge TH, Jenkins TM, Xanthakos SA, Dixon JB, Daniels SR, Zeller MH, et al. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. The lancet Diabetes & endocrinology. 2017;5(3):165-73.
Competing interests: I work in the field of bariatric surgery.