AAP Policy for Adolescent Bariatric Surgery: Pediatric Obesity 2017

Severe obesity estimates in the adolescent population range up to approximately 2 million patients who have physiologic or anthropomorphic qualifications to consider bariatric surgery.

Data from a decade ago consisted mostly of single institutional, relatively small cohort, retrospective, non-uniform studies.

Recent studies (Teen Labs, FAS-5, AMOS) are high-level prospective studies using uniform data reporting methodology, which is the type of data needed to develop paradigm shifts and widespread clinical application.

These prospective studies serve as the foundation for making best practice guidelines and widely accepted recommendations on treatment paradigms.

The 2004 consensus paper in Pediatrics continues to hold significant influence in the insurance industry regarding access to care for adolescent bariatric surgery.

BMI recommendations for eligibility were higher in the 2004 paper than in current recommendations.

Current BMI eligibility guidelines target around 40 kg/m² or higher, though in certain individual cases below 40 is considered reasonable.

Updated guidelines from ASMBS pediatric committee are expected within the next 12 to 18 months.

Prior to 2014, ASMBS had no specific pediatric standards in their centers of excellence designation.

MBSAQIP (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program) was formed around 2012, combining ASMBS and American College of Surgeons accreditation, and included for the first time a separate designation for centers offering bariatric surgery to individuals under age 18.

The first MBSAQIP pediatric standards were rolled out in 2014 and updated in 2016.

In a 2014 study of Teen Labs centers, 47% of adolescents achieved initial insurance authorization at original request for surgery, compared to approximately 85% in the adult population.

80% of insurance denials were approved after appeals, but required as many as 5 appeals.

11% of adolescents in the Teen Labs centers study were ultimately unable to obtain insurance authorization for bariatric surgery.

The most cited reason for insurance denial was age less than 18 years.

The most recent AHRQ report developed by Kaiser on management for obese and severely obese children makes only scant reference to bariatric surgery and largely ignores it as a consideration for this population.

The AAP policy statement is currently in draft in committee as of first quarter 2017, with peer review planned for Q1 2017 and proposed publication by end of 2017 or early 2018.

The AAP policy statement will be released around the same time as revised ASMBS best practice guidelines.

Procedural prevalence for adolescent bariatric surgery remains stable despite favorable outcomes and standardization of care.

In 2016, the AAP Section on Obesity and Section on Surgery executive committees agreed to sponsor joint policy statements on adolescent bariatric surgery.