In 2023, the American Academy of Pediatrics published its “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity.” The guideline recommends that metabolic and bariatric surgery (MBS) be considered for obesity when medical or lifestyle treatments are not sufficient for youth with class 3 obesity (BMI ≥ 140% of the 95th percentile or BMI ≥ 40 kg/m2) or class 2 obesity (BMI ≥ 120 to 140% of the 95th percentile or BMI ≥ 35 kg/m2) with a comorbidity including obstructive sleep apnea, type 2 diabetes, idiopathic intracranial hypertension, gastroesophageal reflux, or hypertension.
Are children and teens who qualify for MBS receiving it? Shapiro et al. (10.1542/peds.2023-063916) share with us an analysis of a multicenter retrospective cohort of over 603,000 adolescents (ages 13–17 years) enrolled in the Kaiser Permanente Southern California between 2018 and 2021 to see how many met the criteria for MBS and received it.
Overall, 4.4% of all the adolescents in the study qualified for MBS. This implies that 1 out of 23 adolescents met criteria for MBS. To put this in perspective, that means that about 1 million teens in the US would be eligible for MBS, yet only 1,700 are done annually. Most adolescents who are eligible for MBS treatment are not receiving it.
The authors also find important differences in likelihood of being eligible for MBS and receiving such care. For example, more males qualified for MBS and yet the authors note more youths who are female are currently receiving MBS than males. While national data suggests that non-Hispanic White youth are getting this surgery, in this study the groups that had the highest numbers eligible were non-Hispanic Black and Hispanic adolescents, and yet they are not receiving this surgery at rates higher than non-Hispanic White youth. In addition, teens living in neighborhoods with highest neighborhood deprivation (meaning high in social drivers of poorer health such as food insecurity) are currently the least likely to receive MBS surgery.
So, what can be done about these findings suggesting there are more eligible adolescents who could benefit from MBS than are actually receiving it? To help understand what we can do to ensure that patients eligible for MBS are offered it, we invited a commentary from pediatric surgeons Dr. Marc Michalsky from Nationwide Children’s Hospital and Dr. Janey Pratt from Stanford University (10.1542/peds.2023-064375). They note the importance of recognizing disparities in receipt of MBS. Drs. Michalsky and Pratt call for raised awareness of MBS eligibility criteria by primary care pediatricians as well as a need for more MBS centers with adequate payment by insurers. Without recognizing who would benefit from MBS and access to MBS programs, we will not reduce the disparities, and many will not benefit from this potentially lifesaving intervention. Review these concerning findings and next steps we can all take to equitably improve MBS referrals by linking to this important study and commentary.
