Bariatric surgery for severely overweight adolescents: Concerns and recommendations
Bariatric surgery for severely overweight adolescents: Concerns and recommendations
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DOI：
10.1542/peds.114.1.217
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发表时间：
2004-07-01
期刊：
影响因子：
8
通讯作者：
Daniels, SR
中科院分区：
文献类型：
--
作者：
Inge, TH;Krebs, NF;Daniels, SR
随着肥胖和肥胖相关疾病在美国青少年中的患病率持续增加，医生越来越面临着为受影响患者确定最佳治疗策略的困境。本报告提供了一种方法，以评估青少年患者候选的减肥手术。除了人体测量和合并症的评估，许多独特的因素必须严格评估超重的年轻人。为了减少不良医疗和心理社会后果的风险，增加减肥手术后的依从性和后续监测，必须考虑青少年生长和发育的原则、患者的决策能力、家庭结构和坚持治疗的障碍。只有当青少年经历了大于或等于6个月的有组织的减肥尝试失败，并且符合一定的人体测量学、医学和心理标准时，才考虑进行减肥手术。接受减肥手术的青少年候选人应非常严重肥胖（世界卫生组织将体重指数定义为大于或等于40），已达到大部分骨骼成熟（女孩一般大于或等于13岁，男孩大于或等于15岁），并有与肥胖相关的合并症，可通过持续减肥来补救。减肥手术的潜在候选人应转介到具有多学科体重管理团队的中心，这些团队在满足超重青少年的独特需求方面具有专业知识。手术应在有能力满足严重肥胖患者三级护理需求的机构进行，并收集这些患者临床结果的长期数据。
As the prevalence of obesity and obesity-related disease among adolescents in the United States continues to increase, physicians are increasingly faced with the dilemma of determining the best treatment strategies for affected patients. This report offers an approach for the evaluation of adolescent patients' candidacy for bariatric surgery. In addition to anthropometric measurements and comorbidity assessments, a number of unique factors must be critically assessed among overweight youths. In an effort to reduce the risk of adverse medical and psychosocial outcomes and increase compliance and follow-up monitoring after bariatric surgery, principles of adolescent growth and development, the decisional capacity of the patient, family structure, and barriers to adherence must be considered. Consideration for bariatric surgery is generally warranted only when adolescents have experienced failure of greater than or equal to6 months of organized weight loss attempts and have met certain anthropometric, medical, and psychologic criteria. Adolescent candidates for bariatric surgery should be very severely obese (defined by the World Health Organization as a body mass index of greater than or equal to40), have attained a majority of skeletal maturity (generally greater than or equal to13 years of age for girls and greater than or equal to15 years of age for boys), and have comorbidities related to obesity that might be remedied with durable weight loss. Potential candidates for bariatric surgery should be referred to centers with multidisciplinary weight management teams that have expertise in meeting the unique needs of overweight adolescents. Surgery should be performed in institutions that are equipped to meet the tertiary care needs of severely obese patients and to collect long-term data on the clinical outcomes of these patients.