Surgical Management of Obesity in Adolescents

Abstract

Introduction: No doubt childhood obesity is a problem. Many have labeled it as an epidemic. In the past, the term “obesity” has only been associated with adults, but this idea has changed, as cases of child obesity are increasing every day. Studies show that childhood obesity has more than tripled in the past 30 years Obesity is a progressive, chronic, and often fatal disease, refractory to most currently available medical interventions. The terms overweight (BMI for age and gender >85th percentile), obese (BMI for age and gender >95th percentile),and extreme obesity (BMI for age and gender >99th percentile) have been used to refer to the increasing weight problem in children. The operations that have been used primarily can be classified as either purely restrictive or a combination of restriction and malabsorption the laparoscopic adjustable gastric band (AGB) and laparoscopic vertical sleeve gastrectomy (LSG) are purely restrictive procedures, and the degree of weight loss with these operations in adults has generally been satisfactory. The LSG is a relatively new operation that produces significant initial weight loss with low operative risk in both adult and pediatric studies. Because it likely does not affect micronutrient absorption, it may be a safe alternative with fewer nutritional risks than Roux-en-Ygastric bypass (RYGB), and also may avoid device-related long-term risks inherent in the AGB procedure Aim of the work :The study is conducted to review the best time for intervention, regarding physiological and pshycological maturation, the criteria of selection of the patients for surgical management which are mainly physical and psychological, the best surgical procedure and the outcome of these procedures e.g. of weight loss ,electrolyte and vitamins deficiency and effect on skeletal growth. Summary Obesity is defined as abnormal or excessive fat accumulation that may impair health. Pediatric obesity as BMI greater than the 95th percentile for age and sex. Overweight, or at risk for overweight, has been defined as a BMI > 85th percentile. Human obesity is due to a complex interaction among environmental, behavioral, developmental and genetic factors. Risk factors include lack of physical activity, watching television, family history of obesity and socio-economic status. Fat metabolism is controlled through different hormones. Leptin hormones which is produced by adipocytes reduces appetite and its deficiency decrease appetite. Also, gut hormones have important role in fat metabolism .Ghrelin which is neropeptide hormone which is produced from gastric oxyntic glands. Ghrelin is the only gut hormone known to increase our appetite. Both obesity itself and its related co morbidities are all highly heritable. For thorough obesity can be classified according to genetics into: monogenic obesity, syndromic obesity, polygenic obesity and epigenetic obesity. As the prevalence of obesity increases, complications and Co morbidities related to obesity also increases. Complications include type 2 DM, hypertension, nonalcoholic fatty liver disease, skeletal deformities and obstructive sleep apnea. Key words: Surgical Management ; Obesity ; Adolescents