Children’s Hospital Los Angeles Launches Pediatric Bariatric Surgery Program

Children’s Hospital Los Angeles has launched a new program to provide bariatric surgery to eligible children and adolescents with obesity.

The program will significantly improve access to this care for pediatric patients in the greater Los Angeles area, including Medi-Cal beneficiaries. The team performed its first surgery Nov. 13 and has since performed more than 20 surgeries.

Bariatric surgery is offered through a partnership between Children’s Hospital Los Angeles and Keck Medicine of USC. Surgical Director Kamran Samakar, MD, has been performing these procedures for 10 years and also directs the Bariatric Surgery Program at USC.

“Bariatric surgery is a highly effective treatment for obesity, but it has not been widely available for children under 18,” says Alaina Vidmar, MD, Medical Director of Obesity Medicine and Bariatric Surgery at Children’s Hospital Los Angeles. “Many of our patients have severe obesity, and we are excited to offer this therapy for children who need it.”

Comprehensive care

The new service is part of CHLA’s comprehensive, multidisciplinary obesity program, which offers a wide variety of treatment options to patients.

The program aligns with the recently released American Academy of Pediatrics (AAP) guidelines, which recommend early, proactive interventions for the treatment of children and adolescents living with obesity—including intensive lifestyle modifications, obesity medications and surgery.

“The AAP guidelines are very clear that we can’t take a watchful waiting approach to pediatric obesity,” Dr. Vidmar says. “This is a chronic disease, and not the fault of the child or their parents. We need to use all the tools we have to prevent children from developing life-limiting complications such as diabetes, heart disease and liver disease.”

Bariatric surgery is one of those tools, although it’s not for every patient. In general, surgery can be an option for youth as young as 10-12 who meet certain body mass index (BMI) criteria as well as other factors. The decision to undergo surgery, though, is part of a comprehensive, holistic and multidisciplinary care plan that is tailored to the individual needs of each patient.

A highly effective treatment

The main operation performed is a laparoscopic sleeve gastrectomy, also called a “gastric sleeve.” In this minimally invasive procedure, surgeons remove about 75% of a patient’s stomach, creating a smaller gastric pouch shaped like a banana or “sleeve.”

“In addition to creating a smaller stomach, the surgery has hormonal effects,” Dr. Samakar explains. “Those effects help mediate hunger and appetite, as well as other metabolic issues.”

The surgery results in dramatically greater weight loss than other available treatments. Typically, patients lose 60% to 65% of excess body weight, and 20% to 25% of total body weight.

In contrast, diet and exercise might help a patient lose 5% to 10% of excess body weight, while medications can result in 10% to 15% excess weight loss.

Long-term impacts

For young people, the long-term health effects of bariatric surgery may be even greater than for adults.

A 2019 study published in The New England Journal of Medicine found that 86% of adolescents who underwent surgery saw their Type 2 diabetes go into remission—compared with 53% of adults who underwent the same surgery.

In the same study, the percentage of adolescents taking blood pressure medications fell from 57% before surgery to just 11% five years later.

“That’s a huge long-term impact on a young person’s life,” Dr. Vidmar notes. “These are teenagers who otherwise would have been on these medications for 60, 70 years.”

One barrier to more youth receiving surgical treatment has been access and availability. But there’s another obstacle, too, one that affects people of all ages: stigma.

“Many patients tell me after surgery, ‘I wish I had done this sooner, but I thought I was giving up,’” Dr. Samakar says. “We have to remove that stigma. Obesity is a chronic disease. You are not giving up when you get treatment for a disease.”

Dr. Vidmar stresses that treatment options are geared to each child and are based on the severity of the disease. Youth who pursue bariatric surgery at CHLA receive comprehensive care in medical weight management, nutritional and psychological support, imaging and sleep studies and more.

“This is not about appearance or a number on the scale. It’s about preventing the life-limiting complications of pediatric obesity,” she says. “Our goal is to give each child the best chance for a long and healthy life.”