Pediatrician calls for more weight loss programs to treat severely obese teens

07/01/04

Bariatric surgery should be last option, says Saint Louis University doctor

ST. LOUIS --- If behavior-based weight management programs were more available to adolescents, bariatric surgery could become the treatment of last resort for severely obese teens, says Sarah Barlow, M.D., MPH, assistant professor of pediatrics at Saint Louis University School of Medicine.

Dr. Barlow wrote a commentary in the July issue of Pediatrics in response to a report from an expert panel about the appropriate use of bariatric surgery in obese adolescents.

The panel members urge extreme caution in deciding who would be a good candidate for the procedure. Among the criterion: adolescents should have failed at least six months of organized weight loss attempts.

That's a tough standard to meet, Dr. Barlow says, because high quality behavior management weight loss programs are rare and when they are available, they're too expensive for some families.

"Adolescents deserve the best chance possible to avoid surgery by initial participation in high-quality weight-control programs," says Dr. Barlow, a pediatric gastroenterologist who specializes in pediatric obesity at SSM Cardinal Glennon's Children's Hospital.

"Programs such as these will cost money, but bariatric surgery, which insurance may cover, costs $25,000 on average; that amount of money would go far in supporting high-quality, behavior-based weight-control programs."

Organized comprehensive weight loss programs would reduce the number of adolescents who need bariatric surgery and teach those who would benefit from bariatric surgery how to maintain a healthier weight after their procedure, Dr. Barlow says.

"If families, physicians, payers, and society now recognize that the crisis of childhood obesity means that life-altering surgery is an appropriate intervention, surely now is the time to insist on the availability of the best possible non-surgical weight-management programs," she says.

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