ST-09: Perspectives on pediatric bariatric surgery: Identifying barriers to referral
ABSTRACT Pediatric obesity is a growing problem affecting the health of our youth. We sought to identify the barriers to pediatric bariatric referral at a tertiary referral center.
We performed a survey of pediatricians and family practitioners at a single institution to assess their perspectives on pediatric obesity.
A total of 61 physicians completed the survey (response rate 46%). All believed pediatric obesity is a major problem, and 82.0% noted an increase in the incidence during a mean period of 15 years (range 3-25). Of the 61 physicians, 88.5% used nonoperative weight loss techniques, with only 1.8% reporting satisfactory results. However, 42.6% had referred a patient (adult or pediatric) for a bariatric procedure, of whom 84.6% were satisfied with the operative outcomes. Despite the high satisfaction with bariatric procedures, 88.5% would be unlikely or would never refer a child for a bariatric procedure, and 44.3% would be somewhat or very likely to refer an adolescent.
Physicians caring for children recognize the growing problem of childhood and adolescent obesity. Despite the poor outcomes with nonoperative methods and the high satisfaction with the outcomes of bariatric procedures, physicians are still reluctant to refer children and adolescents for surgical weight loss procedures.
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ABSTRACT: The goal of this study was to evaluate trends, and outcomes of adolescents who undergo bariatric surgery. Patients younger than 21 years who underwent elective bariatric surgery between 2005 and 2007 were identified from the California Office of Statewide Health Planning and Development database. Multivariate logistic regression was used to identify factors associated with the type of surgery. Overall, 590 adolescents (aged 13-20 years) underwent bariatric surgery in 86 hospitals. White adolescents represented 28% of those who were overweight but accounted for 65% of the procedures. Rates of laparoscopic adjustable gastric banding (LAGB) increased 6.9-fold from 0.3 to 1.5 per 100,000 population (P<.01), whereas laparoscopic Roux-en-Y gastric bypass (LRYGB) rates decreased from 3.8 to 2.7 per 100 000 population (P<.01). Self-payers were more likely to undergo LAGB (relative risk [RR]: 3.51 [95% confidence interval: 2.11-5.32]) and less likely to undergo LRYGB (RR: 0.45 [95% confidence interval: 0.33-0.58]) compared with privately insured adolescents. The rate of major in-hospital complication was 1%, and no deaths were reported. Of the patients who received LAGB, 4.7% had band revision/removal. In contrast, 2.9% of those who received LRYGB required reoperations. White adolescent girls disproportionately underwent bariatric surgery. Although LAGB has not been approved by the US Food and Drug Administration for use in children, its use has increased dramatically. There was a complication rate and no deaths. Long-term studies are needed to fully assess the efficacy, safety, and health care costs of these procedures in adolescents.PEDIATRICS 10/2010; 126(4):e746-53. DOI:10.1542/peds.2010-0412 · 5.30 Impact Factor
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ABSTRACT: Expansion of the facultative parasitic plant Rhamphicarpa fistulosa as a weed of rain-fed lowland rice was studied in 2007 on a national level (Benin) by repeating a survey from 1998. Wider species' distribution was investigated in 2008. Current and potential impact and management strategies were investigated through farmer surveys and pot experiments. Out of 36 cultivated inland valleys visited across Benin, eight were found to be infested with Rhamphicarpa. Out of nine inland valleys inspected in 1998, Rhamphicarpa was found in five in 2007, compared with only three in 1998. Farmers estimated Rhamphicarpa-inflicted yield losses could exceed 60% and indicated that heavily infested fields are abandoned. In a pot experiment with a wide infestation range, the popular cultivar Gambiaka, combining resistance with sensitivity, showed a mean relative yield loss (RYL) of 63%. Parasitic Rhamphicarpa biomass (PRB), the difference between the above-ground biomass produced with and without a host, was suggested as indicator for infection level of this facultative parasite and hence as a practical measure for host resistance. Genetic variation in resistance and tolerance levels was observed among rice cultivars, but fertilizer applications significantly reduced parasite numbers, biomass and effects, cancelling out such genotypic differences. Depending on the tolerance level of the cultivars, the PRB only accounted for 3.7-38.8% of the average parasite-inflicted host biomass reductions, indicating phytotoxic effects of Rhamphicarpa infection. R. fistulosa is an apparently increasing constraint to rain-fed lowland rice in Benin, threatening rice production in the wider region. The use of resistant and tolerant cultivars, combined with fertilizer applications could reduce Rhamphicarpa infections and mitigate negative effects on rice yields.
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ABSTRACT: BACKGROUND: Bariatric surgery is 1 of the few effective treatments of morbid obesity. However, the weight loss and other health-related outcomes for this procedure in large, diverse adolescent patient populations have not been well characterized. Our objective was to analyze the prospective Bariatric Outcomes Longitudinal Database (BOLD) to determine the weight loss and health related outcomes in adolescents. The BOLD data are collected from 423 surgeons at 360 facilities in the United States. METHODS: The main outcome measures included the anthropometric and co-morbidity status at baseline (n = 890) and at 3 (n = 786), 6 (n = 541), and 12 (n = 259) months after surgery. Adolescents (75% female; 68% non-Hispanic white, 14% Hispanic, 11% non-Hispanic black, and 6% other) aged 11 to 19 years were included in the present analyses. RESULTS: The overall 1-year mean weight loss for those who underwent gastric bypass surgery was more than twice that of those who underwent adjustable gastric band surgery (48.6 versus 20 kg, P < .001). Similar results were found for all other anthropometric changes and comparisons within 1 year between surgery types (P < .001). In general, the gastric bypass patients reported more improvement than the adjustable gastric band patients in co-morbidities at 1 year after surgery. A total of 45 readmissions occurred among gastric bypass patients and 10 among adjustable gastric band patients, with 29 and 8 reoperations required, respectively. CONCLUSIONS: The weight loss at 3, 6, and 12 months after surgery is approximately double in adolescent males and females who underwent gastric bypass surgery versus those who underwent adjustable gastric band surgery. Bariatric surgery can safely and substantially reduce weight and related co-morbidities in morbidly obese adolescents for ≥1 year.Surgery for Obesity and Related Diseases 03/2012; 9(4). DOI:10.1016/j.soard.2012.03.007 · 4.94 Impact Factor