Articles
Fat Kids Surgery Wake-up Call
Bariatric surgery or lap-banding is now a fairly common procedure undertaken by obese adults. Whether or not this surgery is a good idea for children and adolescents is a topic of much interest, and one with very little evidence to support it. Should we condone such surgery in our Australian children, or should parents and the health system be looking at other alternatives?
As dietitians, we often find lap-banding to be unsuccessful in many long term cases. Put simply, lap-banding is a surgery that is designed to restrict the amount and type of food that can be consumed at any one time. However, it does not restrict all unhealthy foods, such as chocolate, soft drink and ice cream, and does not prevent overeating if one is able to vomit up the stomach contents.
Lap-banding actually makes it more difficult to eat large quantities of salads and vegetables, and chicken and meat are difficult to digest.
There are individuals who do change their eating habits and keep a reasonable amount of weight off for an extended period of time. They follow the guidelines and eat healthy and do regular exercise, but unfortunately they are usually the exception. If ones obesity is not caused by over eating, but rather under exercising, then lap-band surgery will do little to help them shed the kilos.
So it seems that lap-banding, although leading to decreased overall food consumption, does little to change the mental issues that lead to obesity. So is this something we should be recommending for our children, or is it simply re-enforcing bad behaviors. The Dietitians Association of Australia (DAA) recently released a 2009 position statement on Bariatric surgery in children and teens. They consider lap-banding, or any weight loss surgery, to be an absolute last resort for severely obese children and teens. It should only be considered if all lifestyle approaches have been unsuccessful. These include education and help with healthy eating, planned physical activity and whole family interventions. DAA believe that as of yet, there is very limited evidence on the long term success. There can be complications with Bariatric surgery in children and teens.
The DAA recommendations for those considering Bariatric surgery for children and teens are as follows:
The child must have the education capacity to consent to the
surgery.
The child must go through overall screening by a number of
health professionals. Bariatric surgery should only be
considered after 6 months of lifestyle intervention with the
child and family, and only if the child meets very strict
criteria.
A dietetic assessment should be conducted to determine food
habits, family food practices and any evidence of eating
disorders.
Only reversible surgical techniques, such as lap-banding,
should be used.
Long term health professional follow-ups after surgery are
indicated to ensure the child continues to grow and develop
normally.
We must remember that all people, including children, may eat poorly because they are bored, depressed, disorganized or lack the fundamental knowledge about nutrition and food preparation. So combating these issues should be the starting point in a successful weight loss plan. Seeking help from a dietitian is the perfect place to start, as they can help with menu planning, shopping lists, advice on suitable exercise, impart knowledge about food and cooking and most of all, they will be supportive.
If someone, teenager or adult does embark on Bariatric surgery then at least make sure that they have long term follow-up, especially from a Dietitian. Surgery will never be a cure in itself; the individual must still learn to live a healthy lifestyle. Children and teenagers should be encouraged to look at every other avenue first. Healthy eating and exercise with psychological support and behaviour modification should be able to achieve weight loss goals. If the problem is approached before children develop bad habits and unhealthy routines, the battle is even easier. Lets make our next generation healthier by counseling the whole family with a team approach from doctors, dietitians and exercise physiologists.
Added to site on : Monday, 29 March 2010