UK Solution to Childhood Obesity - Surgery & Drugs

In a stunning decision this week, reported in This is London, the National Health Services approved weight loss surgery for children as young as 14; those younger will be offered "anti-obesity" drugs.

They claim dramatic action is needed to save a generation from dying before their parents. More than a quarter of children are overweight or obese, with obesity rates of 14 per cent in those aged between two and 10 years.

At the same time, levels of inactivity have soared as many children no longer take part in competitive sport at school and playing fields have been closed.The Government has set a target to halt the year-on-year rise in obesity among children under 11 by 2010.

For the first time the Government's watchdog, the National Institute for Health and Clinical Excellence (NICE), has proposed guidelines for preventing and treating obesity in children.Surgery - which costs around £10,000 - would be an option for children who had reached an age of "psychological maturity", thought to be between 14 and 16 years.

Gastric surgery is a risky procedure - even for adults - which needs lifelong monitoring for potential complications.

What types of complications are we talking about subjecting these children to?

Short Term Complications (in the first 3 to 14 days)

• Bleeding Leak
• Abscess and Infection
• Pulmonary Embolus
• Death
• Severe Nausea and Vomiting
• Narrowing or ulceration of the connection between the stomach and the small bowel has been reported in one series in about 20% of all patients undergoing gastric bypass.
• Bile Reflux Gastritis occurs when bile flows back into the stomach.
• Fistulas, (an abnormal passage leading from one hollow organ to another) abscess and infection have been seen in gastric bypass operations.
• Dumping Syndrome
• Gallstones
• Adhesions, scar tissue caused by healing after surgery
• Diarrhea

Long Term Complications

• Vitamin and Mineral Deficiencies - Decreases in iron, vitamin B12, and/or Folate levels were detected eight months to eight years (median, two years) after the operation.
• Peripheral neuropathy (disorders resulting from injury to the peripheral nerves) has been reported after operation.
• Osteoporosis and Bone Loss.
• Gastric bypass procedures carry the highest risk of multiple micronutrient deficiencies, that may supervene despite close medical follow-up.
• Patients with a gastric bypass have a greater frequency of microcytosis and anemia, more frequent subnormal serum levels of vitamin B12, and impressive failure to absorb food vitamin B12.
• Gastrointestinal bleeding from a duodenal ulcer four years after having a gastric bypass procedure for obesity
• Symptomatic gallstones requiring cholecystectomy
• Abdominal Wall Hernia
• Pregnancy Complications

Oh, let's not forget the drugs!

Weight loss drugs Xenical and Reductil could also be prescribed for teenagers, and even children under 12 if doctors think their lives are at risk. NICE accepts the drugs are not licensed for use in children but says doctors are legally permitted to do so if it will benefit their patients.

Professor Colin Waine, chairman of the National Obesity Forum, said "We believe there is a small group of obese children at significant risk who could benefit, once a child has finished growing and has achieved maximum height, and where there has been a failure of medical treatment.

"We wish it wasn't necessary but the risks are so great of not helping these children that surgery has to be be an option."This is because these children are at risk of developing type 2 diabetes in later life, they have significant risk factors for premature cardiovascular disease, and they are more at risk of developing cancer."