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Obese minority children less likely to have weight-loss surgery

[September 16, 2017] By Carolyn Crist

(Reuters Health) - Obese white teens in the U.S. are much more likely obese black or Hispanic teens to be treated with weight loss surgery, according to a recent study.

That's despite the fact that minority kids are disproportionately affected by rising childhood obesity rates in the U.S.

Bariatric surgery, which includes several approaches to shrinking the stomach so patients eat less, has been shown to help with weight loss and reversing health conditions that come with obesity, such as diabetes and high blood pressure. Current guidelines recommend the procedure for adolescents with serious or severe obesity who haven’t been able to lose weight with other treatments.

While 4.5 million children and adolescents in the U.S. are obese, few teens undergo bariatric surgery, the study team reports in Journal of Adolescent Health. And white teens are more than twice as likely as their minority counterparts to have the procedure.

“We’ve known for a long time that health disparities exist in adults, but people don’t think about it with children and teens,” said senior author Dr. Kanika Bowen-Jallow, a pediatric surgeon at University of Texas Medical Branch in Galveston.

“You wouldn’t suspect it because we have coverage for children through their parent’s insurance or Medicaid, so 90 percent of kids should be covered,” she told Reuters Health in a phone interview. “But in reality, there is a difference.”

Pediatric obesity rates are on the rise, with 33 percent of children considered overweight and 9 percent considered severely obese, according to the Centers for Disease Control and Prevention.

Childhood obesity is associated with type 2 diabetes, hypertension, sleep apnea, liver disease and reflux problems, the authors write. Bariatric surgery is an option for teens with severe obesity who can’t lose weight after six months of behavioral and medical treatments.

“For parents and doctors, it’s hard to have that conversation that a child is overweight,” Bowen-Jallow said. “But it’s something that will follow children into adulthood.”

Bowen-Jallow and colleagues analyzed national data on obesity rates to identify how many teens would be candidates for bariatric surgery. They also examined records for bariatric surgery cases in the U.S. between 2007 and 2014 to understand what characteristics were associated with teens who got the surgery.

They found that 1,539 adolescents between ages 12 and 19 underwent bariatric surgery during the study period.

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After surgery, weight loss and improvements in obesity-related health conditions didn’t differ based on race or sex, researchers found.

“Childhood obesity is an epidemic that disproportionately affects minorities,” Bowen-Jallow said. “It’s important to realize your cultural background has a profound effect on treatment.”

Researchers don’t yet know why exactly this is the case, said Dr. Leslie Heinberg of the Cleveland Clinic in Ohio, who wasn’t involved in the study.

“Do doctors suggest bariatric surgery when they see obese women or obese Caucasians more?” she said in a phone interview. “Or is there a self-referral or cultural difference?”

Future research should look at the behavior, psychology and adherence patterns of patients to better understand the referral patterns and success of weight-loss surgery among different groups, Heinberg said.

“Behavioral factors can help predict which people will lose weight and who will keep it off,” she noted. “For adolescents, we’re not just thinking 10 to 20 years down the road, but a lifetime.”

“One piece of good news was that minority patients were more likely to receive gastric bypass surgery, which is among the most effective procedures for weight loss,” said Dr. Lauren Hersch Nicholas of Johns Hopkins University in Baltimore, who wasn’t involved in the study.

In some states, Medicaid doesn’t cover bariatric surgery, and some insurance companies don’t cover patients until they are 18, Heinberg added, which can further limit options no matter the patient's race or ethnicity.

“Bariatric surgery can be an option for the right adolescent,” she said. “It is a lifelong decision with lifelong consequences. Patients and parents should carefully prepare and find the right place with the right care,” she said by email.

SOURCE: http://bit.ly/2wd2XGn Journal of Adolescent Health, online September 1, 2017.

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