The intricacies of obesity: for overweight children they want to allow surgery
Russia may allow surgical intervention in the treatment of obesity in children. This concerns, in particular, bypass surgery and gastric resection. A new standard of care for minors has been developed by the Ministry of Health. In some cases, obesity becomes a serious threat to the health and life of a young patient, so that without surgical intervention can not do without, experts believe. However, before that, it is still worth trying conservative methods of treatment. Is it dangerous to conduct bariatric surgery at an early age - in the material "Izvestia".
New approach
Standards of medical care for children with obesity may change from January 1, 2025. The corresponding draft order prepared by the Ministry of Health of the Russian Federation. The document is published on the portal of normative legal acts.
The Ministry plans to add several types of surgical interventions to the list. It is about resection and laparoscopic gastric bypass.
In general, assistance to children with obesity will consist of diagnosis, inpatient and outpatient treatment and dispensary monitoring.
It follows from the annex to the order that the list will also add primary consultation of a nutritionist and otorhinolaryngologist.
Another standard of the Ministry of Health provides for:
- examinations by a geneticist, neurologist and pediatric endocrinologist;
- several types of blood tests (including hormone tests);
- ultrasound examination of the abdominal cavity organs;
- MRI of the brain;
- determination of the percentage of water, muscle and fat tissue;
- study of basic metabolic parameters;
- cardiorespiratory monitoring.
During inpatient treatment, the child will be examined daily by a surgeon and an endocrinologist.
In addition, the standard assumes that children attend a special school for patients with overweight and obesity. The use of drugs of peripheral action is allowed. Nutrition is provided by the basic version of the standard diet.
Acute problem
Obesity is one of the most common chronic diseases in the world. It is manifested by excessive deposits of fat in the subcutaneous tissue, around the organs and even inside them.
In Russia, this problem is quite acute. According to Rosstat, only in 2022, 419 thousand new cases of obesity among Russians were detected. In total, endocrine system diseases, eating disorders and metabolic disorders were observed in 13.05 million Russians in the same year.
Medical professionals are alarmed by the fact that obesity is rapidly getting younger. Among children under 14 years of age 108 thousand in 2022 were diagnosed with this disease. At the same time 12 years ago the number of diagnosed cases amounted to 69 thousand.
In May of this year, Antonina Starodubova, the chief nutritionist of the Moscow Department of Health, noted that in total about 27% of children in Russia have a body weight above the norm. Of these, 18% are diagnosed overweight, and 9% are obese.
Radical methods
Surgical intervention can help when obesity begins to significantly limit the patient and threaten his life, warns pediatric proctologic surgeon Irina Romadova. In such cases, the child's musculoskeletal system suffers, which interferes with the growth and development of the body.
- Too much strain on the heart can lead to heart failure, in such situations it is necessary to resort to bariatric surgery. This will effectively reduce body weight and save the young patient from a lot of problems and even death," the doctor believes.
It is important that the decision to perform the operation should be made jointly with medical specialists, including pediatricians, nutritionists and psychotherapists, believes pediatrician, family doctor Anna Pykhantseva.
- They can assess the child's general health and readiness for surgery. It is also important for parents to be actively involved in the process, supporting the child at every stage," emphasizes the Izvestia interlocutor.
The Ministry of Health order refers to two types of surgical intervention. Resection is an operation in which a part of the stomach is removed. Bypass is a procedure during which the stomach and the 12-intestine are disconnected from the main gastrointestinal tract and an anastomosis (communication between vessels, organs and cavities) is created between the esophagus, the "gastric pouch" and the jejunum, explains Alexander Umnov, a lecturer at the Department of Surgery of the Medical Faculty of the State University of Education, a surgeon.
By reducing the stomach, it is possible to reduce the daily amount of calories consumed, notes Romadova. This is largely because after resection, the production of the hunger hormone ghrelin is reduced, which helps to reduce appetite.
Gastric bypass surgery is indicated in extremely obese (BMI 40-50 kg/m2). It is recommended for people who, in addition to obesity, have other health problems, such as diabetes, hypercholesterolemia, arterial hypertension and so on, explains Umnov.
- The advantage of this method is that hormones, enzymes and gastric juice are still produced and involved in digestion, but the portion becomes small and the body mass index decreases, Romadova points out.
Treatment with consequences
Nevertheless, any surgical intervention is traumatic and associated with serious complications and limitations in the postoperative period, warns pediatrician of the highest category Svetlana Tsvetkova.
Among the early complications that can arise after such operations, the doctor singles out inflammation of the abdominal cavity, which occurs due to the rupture of sutures on the intestine or stomach. They also include bleeding, bacterial complications, deep vein or pulmonary artery thrombosis and death (occurs in 0.3-0.5% of cases).
Among the late complications after bypass surgery, pediatricians name gastric ulcer, deficiency of iron, vitamin B12, calcium and vitamin D, diarrhea when eating certain foods and dumping syndrome (food passes quickly through the stomach and immediately enters the small intestine, leading to a spike in blood sugar). In addition, gallstones, bowel obstruction and constipation can occur after surgery.
It is important to pay attention to the age of the child, believes Alexander Umnov. At 6-8 years old, in particular, they are dangerous, because the body needs food for growth and development.
- At 15-17 years of age, the needs for growth and development of organs gradually decrease. At this age, it is possible to perform these procedures. However, do not forget about the dangers of the effect of anesthesia on the body - this is a separate unit that can make adjustments, - cautions the surgeon.
In addition, it is important to remember that after surgery, children will need to follow strict dietary recommendations and regularly visit the doctor to monitor their health. Without it, the risk of weight regain remains high, says Anna Pykhantseva.
- Surgical treatment can help some children to get rid of excess weight, but this decision should be made taking into account all factors and only after a thorough assessment of the state of health, - convinced pediatrician.
Consequences of obesity
Excess body weight is extremely dangerous for children's bodies, as it increases the risk of diabetes mellitus, provokes cardiovascular disorders, including adolescent hypertension, causes problems with the spine and joints, flat feet, menstrual disorders and reproductive problems in girls and late puberty in boys, lists Svetlana Tsvetkova.
Against the background of obesity often increases the level of cholesterol in the blood, adds Irina Romadova.
- This leads to atherosclerosis and damage to the vascular bed. In today's world, strokes and heart attacks are very young thanks to the early development of atherosclerosis, - states the doctor.
In addition, patients with excess body weight develop fatty liver disease, which leads to a violation of metabolic processes in the body.
To the most common causes of obesity Tsvetkova attributes excessive calorie intake with food, lack of physical activity, improper daily regimen, lack of sleep, metabolic disorders, endocrine pathologies and taking certain medications.
In the treatment of obesity in children, first of all, you should try to reduce body weight by conservative means, convinced Irina Romadova.
- It is necessary to work with a nutritionist and psychologist to change eating behavior and build a proper balanced diet, which in most cases helps to reduce body weight - says the surgeon.
When losing weight, in particular, it is necessary to eat animal protein (meat, fish, eggs, dairy products, legumes), fats (nuts, vegetable oils, egg yolk, fatty varieties of fish), include vegetables and fruits in the diet, as well as limit the intake of fast carbohydrates (sweets, pastries and fast food), recommends Tsvetkova.
Also to maintain a healthy body weight, according to the pediatrician, it is necessary to exercise regularly.
Helping underage children lose weight requires a delicate approach and careful attention to their physical and emotional state, Anna Pykhantseva points out. In addition to sports and proper nutrition, a supportive environment, education and awareness, avoidance of strict diets that can negatively affect growth and development, consultation with professionals and psychological support can help the child.
The final choice of treatment methodology is left to the doctor, Romadova emphasizes. However, bariatric surgeries can also be effective in the practice of treating children, the doctor is sure.
- A child's body adapts to new living conditions much more easily, weight will be quickly reduced, and further development and growth of the body will take place in favorable conditions," summarizes the surgeon.
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