Obesity is such a serious problem in Qatar, that the Hamad Medical Corporation has started performing bariatric surgery on children. The youngest patients so far have been teenagers aged 14 to 18, but over the next few months they plan to operate on children as young as eight years old.
The overwhelming demand for bariatric surgery has prompted the Hamad Medical Corporation (HMC), a premier non-profit health care provider affiliated with Cornell University, and the Supreme Council of Health (SCH) in Qatar to build a new center of excellence for bariatric surgery. The $5 million center is expected to open within six months.
Although the bariatric center is not yet complete, it has already started performing weight loss surgeries. The first bariatric surgery in teenagers was done some six months ago on a 16 year old who weighed 200kg (440 lbs).
Dr. Michael Gagner, clinical professor of surgery at HMC and one of the world’s foremost experts in minimally invasive surgery, originator of laparoscopic sleeve gastrectomy and first to have performed laparoscopic duodenal switch, says:
- “We started the bariatric surgery on teenagers aged 14 to 18 and by now five procedures have been done. Over the next few months, we will start the procedure for those aged between eight and 14…We have some 20 teenagers in the waiting list, and in the paediatrics, there must be same number of children. These numbers might seem small, but it is extraordinary. When we speak about need for surgery for obesity in children, then we have an obvious problem.”
Qatar, an Arab emirate in the Middle East, suffers from one of the highest rates of obesity and diabetes in the world. Studies show that 28 per cent of Qatari children are overweight and 50 per cent of Qatari boys have a BMI between 22 and 36, an indication of severe obesity.
The only bariatric surgery that will be done to children is sleeve gastrectomy, a procedure that reduces the size of the stomach. Dr. Gagner believes sleeve gastrectomy is the best procedure for this age group since it needs minimal follow-up and nutrient absorption is left intact as the intestine is not cut or shortened.
Gastric banding, which involves implanting a medical device around the top portion of the stomach to restrict eating, is not being used as is can lead to erosions and rejection of the band as well as scarring of tissues as the children grow. Revision surgery to remove the gastric band can get complicated due to altered blood supply to nearby organs.
Gastric bypass is also not being done on children due to the risk of nutritional deficiencies. The procedure, which involves bypassing a part of the intestine, requires patients to take vitamin and mineral tablets for the rest of their lift. Compliance is typically not very good in children and teenagers, causing them to become anemic, have fragile bones, and develop fractures.
Dr. Gagner admits that:
- “Bariatric surgery in children is very unusual” but that it “fills a major gap in providing care for obese children who are struggling with potentially life-threatening medical complications. This can help lose 70 percent of excess weight.”
Bariatric surgery for children under 18 remains controversial, yet even in the United States children as young as 12 years old have undergone a surgical weight loss procedure. Many doctors believe the health benefits of bariatric surgery in children and teens is worth the risk, but many others are unconvinced. Even if bariatric surgery is warranted, however, how do we determine what age is too young?