Obésité et chirurgie bariatrique chez l’adolescent

Abstract

The prevalence of severe and morbid obesity in children and adolescents is sharply increasing. Severe obesity is defined by a body mass index>120% of BMI IOTF-30 cut off and morbid obesity by a BMI>140% of BMI IOTF-30 cut off. It concerns 5 to 10% of French obese adolescents. This condition is simple to diagnose but complex to manage. Somatic complications can be found in about half of these patients, and psychiatric symptoms such as depression and anxiety are common. These comorbidities have a real impact on the quality of life of these patients. In case of severe obesity, bariatric surgery can be indicated for adolescents once other therapeutic strategies have failed. It is an effective option when lifestyle interventions – such as nutritional, physical and behavioural care – turn out to be inefficient. The three techniques used are gastric banding, gastric bypass and sleeve gastrectomy. It has shown short-term effeciency in adolescents with severe and morbid obesity regarding weight loss, treatment of comorbidities and improvement of quality of life. However, success in surgery is not systematic and side effects can occur. Sometimes, patients require another surgery. Also, obesity in adolescence is associated with a context of psychological vulnerability. It seems wise to identify and reinforce elements of internal motivation and adaptive capacities of the young person in order to refine the demand and improve the efficiency of surgery. When a psychiatric disorder is identified, it is essential to take it into account and propose a fitting psychiatric care. Medical care has to be performed in specialized multidisciplinary centers. Multidisciplinary follow-up must be standardized and continued even into adulthood. Data regarding middle-term and long-term evolution are sparse, thus it is primordial to pursue this follow-up in order to improve knowledge of the clinical evolution of these patients and to maintain a sustainable efficacy. It is also essential to identify the factors that could be responsible of failure of bariatric surgery so that effectiveness can be improved. French recommendations regarding bariatric surgery indications and specialized multidisciplinary care have been published by the French National Health Authority (Haute Autorité de Santé) in 2016.