Dubai - Eating well and exercising may not help morbidly obese children, and they ?have the option to undergo bariatric surgery.
Published: Sun 24 Jul 2016, 9:24 PM
Last updated: Mon 25 Jul 2016, 8:54 AM
High prevalence of childhood obesity in the UAE is keeping parents and health officials worried. While experts advise parents to focus on eating well and exercising to keep their children healthy, morbidly obese kids have the option of undergoing bariatric surgery only after meeting certain criteria.
Health authorities in the UAE, however, are approaching the issue of bariatric surgery in children with caution despite the procedure being carried out in countries such as the US where obesity is a major health issue.
Bariatric surgery on youngest EmiratiMaha Salem is possibly the youngest girl in the world to undergo bariatric surgery at the age of four.
Dr Nadler performed the surgery on the young Emirati in 2014 after she weighed 69kg - at least 40kg more than any average four-year-old would weigh. He performed similar surgeries on three other children weighing more or less the same.
"She had a unique condition and was already showing signs of developing diabetes," said Dr Nadler. She was also withdrawn and inactive due to her weight.
Maha also had a rare genetic deficiency called homozygous MC4R that makes her prone to obesity. Prior to this point, many healthcare professionals believed obese children with this deficiency would not benefit from surgery.
A small study, published in the International Journal of Obesity, of four children (three from the UAE and one from Kuwait), showed that patients with this genetic condition experienced significant weight loss and overall health improvement following bariatric surgery.
Two of the patients, aged four and eight, had their surgery at Children's National, while the others had surgery in the UAE. The surgery, known as vertical sleeve gastrostomy (VSG) permanently reduces the size of the stomach by 80 per cent or more.
Three of the four children, who, prior to surgery, were profoundly obese with a series of ailments related to the disease, have made significant weight loss and overall health improvements.
One of those, who was eight-year-old, was over 350 pounds (158kg), and so debilitated that she was wheelchair bound.
"Before the surgery, the four-year-old already had signs of diabetes, and if we waited and did not intervene, she may have been in the situation of the eight-year-old," said Dr Nadler. "I wasn't willing to watch her go through the same evolution."
"Now the older child no longer needs a wheelchair to move around, and the four-year-old is basically a completely different person, being very active. This surgery was just transformational," he added.
Maha's mother told Khaleej Times that she sleeps well now as compared to earlier when she couldn't even eat well.
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Childhood obesity can lead to hypertension, type 2 diabetes, orthopaedic complications, sleep apnoea and psychosocial difficulties. It can also cause abnormal amount of cholesterol and fat in the blood, leading to heart and liver disease.
According to studies, approximately a third of all children in UAE are overweight or obese. Statistics released for 2014-15 by Dubai Health Authority's (DHA) Schools and Educational Institutions Unit last week show that 33 per cent of school children from kindergarten to grade 12 across 176 private schools are either overweight or obese.
Of these, 14 to 16 per cent are obese.
The health authority recently released Dubai standards for bariatric surgery for morbidly obese adults and is in the process of developing separate standards for children.
The regulation applies to all procedures including: advanced laparoscopic procedure, bariatric surgery, basic laparoscopy, biliopancreatic diversion, duodenal switch, endo barrier, gastrointestinal liner, gastric bypass, intra-gastric balloon etc.
Dr Layla Al Marzouqi, Director of Health Regulation at the authority said that only 18 years and older can opt for this procedure.
"Adolescent patients (12-18 years of age), shall be referred to health facilities with multidisciplinary obesity management teams," she said.
"These teams shall include specialists in paediatrics/adolescent obesity evaluation and management, such as bariatric surgeons, psychologists, nutritionists and physical activity instructors."
"The criteria for undergoing bariatric procedures in adolescents has particular risks and benefits that must be accounted for when considering this approach," she said, adding that the unique psychological and emotional needs of adolescent patients make patient selection criteria and perioperative management substantially different from those of adult patients.
Other medical experts say that bariatric surgery is recommended when a patient suffers from a weight-related illness that has not been successfully managed through diet modifications or medication.
"Bariatric surgery for children and adolescents can help them defeat obesity," Dr Evan Nadler, co-director at Children's National Obesity Institute, Children's National Medical Centre, Washington DC, USA told Khaleej Times in an interview.
How to keep children healthy· Children should be provided healthy foods from a young age and fast-foods should be limited.
· Children and teens should never be placed on a weight reduction diet without the consultation of a healthcare provider.
· Parents should cut out the unhealthy fats and sweets and they should prepare their children's favourite meals in a healthier manner.
· Parents should cut out juices and other unnecessary sources of sugar from their children's diet and they should replace it with complex carbohydrates and natural sugars.
· They should provide children lean sources of meat and limit portion sizes.
· Children's lunch boxes should have healthy nutritious meals.
· Parents need to adopt a healthy lifestyle because children mirror what they see.
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"The surgery not only helps the patient lose weight, but it also corrects obesity-related illnesses that may afflict the patient," he added.
"Diabetes is an example of a disease that almost always goes away after weight loss surgery in children and adolescents. Still the long-term success rates of any bariatric surgery procedure rely heavily on the patient committing to changing their lifestyle and eating habits," he said.
Dr Ali Khammas, consultant, general surgery at Rashid Hospital, said the department has performed 1,400 surgeries - mostly on Emiratis aged between 15 and 20 years - since 2009 at its dedicated bariatric surgery unit.
The heaviest person operated upon was a young Emirati weighing 267kg.
But the unit does not perform surgeries on children.
No longer controversial
"Bariatric surgery in children is no longer a controversial procedure," he said. "Especially if it is under strict guidance and done with a good follow up," said the doctor who is also the president of the UAE Bariatric Society.
He said surgeries on children should not be performed until clear guidelines are followed. "Surgeons should exhaust all other weight loss options before recommending children for such surgeries."
In cases where surgeries have to be performed, strict follow-ups should be maintained. "Doctors should check that the patient is complying with medicines and supplements after the surgery. We cannot end one disease of obesity and start another of malnutrition," he explained.
However, Dr Nadler said that such surgeries are in need in the UAE where childhood obesity is high. "Children's health has never been in the forefront worldwide when it should be," said the doctor who works closely with the Abu Dhabi's Imperial College of London Diabetes Centre (ICLDC).
He said that despite surgeries being performed on children for nearly 20 years, the procedure remains under debate.
"It is ok to perform such surgeries on children when it can help reverse disease." However, surgeons have to keep in mind that the nutritional status of the child is not affected and also the age as children are likely to go through puberty.
"In cases where, for example, a child has developed diabetes due to obesity, there is no medical reason to wait," he said, adding that obesity is a real disease and is not linked to bad parenting.
"It is for their health, not vanity," said the doctor who has performed hundreds of such surgeries in the US.
The surgery is normally performed on children with BMI more than 35. However, a strict routine has to be maintained after the surgery failing which lost weight can be regained over time.
asmaalizain@khaleejtimes.com
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