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AAP guidelines promote access to pediatric metabolism, bariatric surgery



NEW ORLEAN – The new AAP policy statement offers a way for pediatricians to increase access to metabolic and bariatric surgery for pediatric and adolescent patients who are eligible for this procedure.

The AAP also suggests steps that can be taken by the government, medical centers and medical academics, as well as public and private insurance.

"Children with severe obesity develop health problems earlier than those with lower obesity rates, including diabetes, high blood pressure, fatty liver disease and sleep apnea," Sarah Armstrong, MD, FAAP, lead author of the policy statement and member of the AAP Section's executive committee on Obesity, said in a news release.

"The last decade of evidence has shown surgery is safe and effective when performed in high-quality centers, with pediatricians and primary care families in the joint decision-making process. Unfortunately, we see a significant difference in which patients have access to bariatric surgery. Surgery needs to be an option for all eligible patients, regardless of race, ethnicity or income. "

This recommendation focuses on increasing provider knowledge about indications for procedures – including having a BMI of 35 or higher or weighing 120% or higher than the 95th percentile for age and sex – the importance of helping families with decision-making based on risks, and benefits intervention and collaboration with multidisciplinary teams to identify the best treatment options and optimize care before and after surgery.

Photos of doctors at the hospital performing surgeries surrounded by health monitors

Source: Adobe Stock

The AAP also urges pediatricians to advocate for increased access to metabolic and bariatric surgery for all eligible patients, regardless of race, ethnicity or socioeconomic background.

According to the authors, contraindications to surgery include causes of obesity that can be corrected medically; current or improperly controlled drug abuse or substance abuse in the previous year; presence of medical, psychiatric, psychosocial or cognitive conditions that can affect adherence to diet plans and postoperative treatment; and the current pregnancy or pregnancy is planned for 12 to 18 months after the procedure.

According to Armstrong and colleagues, medical centers must use best practices related to metabolic and bariatric operations, including multidisciplinary care, which is age-adjusted according to family values ​​and preferences, to ensure safe and effective care. There is no lower age limit for this procedure, so the authors suggest that these centers consider the potential health benefits and individual care for patients and families. Furthermore, they recommend that the center increase the number of multidisciplinary centers that focus on metabolic and bariatric operations, ensuring access to these centers for all adolescents who meet the criteria for this procedure.

The AAP recommends that private and public insurance companies pay for multidisciplinary pre and post-operative care, the operation itself and ongoing care for patients who meet the criteria for metabolic and bariatric surgery. Operational constraints, such as inadequate payments, limited access, baseless exclusion criteria and delays in the bureaucracy in approval for operations, must also be reduced.

The policy statement is accompanied by a technical report that provides details and supporting evidence.

"The decision to undergo metabolic and bariatric surgery must be based on the health and needs of each patient," Mark Michalsky, MD, FACS, FAAP, FASMBS, professor of clinical and pediatric surgery at the Ohio State University School of Medicine and director of surgery for the Center for Weight and Nutrition Health at Nationwide Children's Hospital, said in its release. "This must be a wise and collaborative decision made between patients, their parents and their medical and surgical team, based on their body mass index, other health conditions and quality of life." – by Katherine Bortz

Reference:

Armstrong SC, et al. Pediatrics. 2019; doi: 10.1542 / peds.2019-3223.

Bolling CF, et al. Pediatrics. 2019; doi: 10.1542 / peds.2019-3224.

Disclosures: Armstrong reports on the research relationship with AstraZeneca. All other authors report no relevant financial disclosures.

NEW ORLEAN – The new AAP policy statement offers a way for pediatricians to increase access to metabolic and bariatric surgery for pediatric and adolescent patients who are eligible for this procedure.

The AAP also suggests steps that can be taken by the government, medical centers and medical academics, as well as public and private insurance.

"Children with severe obesity develop health problems earlier than those with lower obesity rates, including diabetes, high blood pressure, fatty liver disease and sleep apnea," Sarah Armstrong, MD, FAAP, lead author of the policy statement and member of the AAP Section's executive committee on Obesity, said in a news release.

"The last decade of evidence has shown surgery is safe and effective when performed in high-quality centers, with pediatricians and primary care families in the joint decision-making process. Unfortunately, we see a significant difference in which patients have access to bariatric surgery. Surgery needs to be an option for all eligible patients, regardless of race, ethnicity or income. "

This recommendation focuses on increasing provider knowledge about indications for procedures – including having a BMI of 35 or higher or weighing 120% or higher than the 95th percentile for age and sex – the importance of helping families with decision-making based on risks, and benefits intervention and collaboration with multidisciplinary teams to identify the best treatment options and optimize care before and after surgery.

Photos of doctors at the hospital performing surgeries surrounded by health monitors

Source: Adobe Stock

The AAP also urges pediatricians to advocate for increased access to metabolic and bariatric surgery for all eligible patients, regardless of race, ethnicity or socioeconomic background.

According to the authors, contraindications to surgery include causes of obesity that can be corrected medically; current or improperly controlled drug abuse or substance abuse in the previous year; presence of medical, psychiatric, psychosocial or cognitive conditions that can affect adherence to diet plans and postoperative treatment; and the current pregnancy or pregnancy is planned for 12 to 18 months after the procedure.

According to Armstrong and colleagues, medical centers must use best practices related to metabolic and bariatric operations, including multidisciplinary care, which is age-adjusted according to family values ​​and preferences, to ensure safe and effective care. There is no lower age limit for this procedure, so the authors suggest that these centers consider the potential health benefits and individual care for patients and families. Furthermore, they recommend that the center increase the number of multidisciplinary centers that focus on metabolic and bariatric operations, ensuring access to these centers for all adolescents who meet the criteria for this procedure.

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The AAP recommends that private and public insurance companies pay for multidisciplinary pre and post-operative care, the operation itself and ongoing care for patients who meet the criteria for metabolic and bariatric surgery. Operational constraints, such as inadequate payments, limited access, baseless exclusion criteria and delays in the bureaucracy in approval for operations, must also be reduced.

The policy statement is accompanied by a technical report that provides details and supporting evidence.

"The decision to undergo metabolic and bariatric surgery must be based on the health and needs of each patient," Mark Michalsky, MD, FACS, FAAP, FASMBS, professor of clinical and pediatric surgery at the Ohio State University School of Medicine and director of surgery for the Center for Weight and Nutrition Health at Nationwide Children's Hospital, said in its release. "This must be a wise and collaborative decision made between patients, their parents and their medical and surgical team, based on their body mass index, other health conditions and quality of life." – by Katherine Bortz

Reference:

Armstrong SC, et al. Pediatrics. 2019; doi: 10.1542 / peds.2019-3223.

Bolling CF, et al. Pediatrics. 2019; doi: 10.1542 / peds.2019-3224.

Disclosures: Armstrong reports on the research relationship with AstraZeneca. All other authors report no relevant financial disclosures.


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