According to a recent case report published in the International Journal of Surgery, a two year old toddler became one of the youngest patients to undergo weight loss surgery at a hospital in Riyadh, Saudi Arabia. He underwent a laparoscopic sleeve gastrectomy surgery, wherein two thirds of the stomach was surgically removed. The report has been published 2 years after the surgery was conducted and the child has lost about 10 kg in 24 months (an average of 0.4 kg per month).
Over the last one week, this report has been widely publicized in tabloids across the world and has generated a lot of media frenzy. In the last few months there have been a few cases in India also, where laparoscopic sleeve gastrectomy surgery has been performed on children as young as 4 years. 2 years back, an 11 months old baby underwent the same surgery in Mumbai.
Although all these cases were presumably done as life-saving procedures; what is worrisome, is the overzealous media hype around them. This overenthusiastic excitement borders on unreasonably coercing bariatric surgery as being a standard of care for obese toddlers, even in the absence of any hard evidence. These cases raise a lot of pertinent questions, not only about the future medical and psychosocial outcomes in these children, but also about medical ethics and moral accountability.
It is a well known fact that sleeve gastrectomy is an irreversible procedure in which outer two-thirds of the stomach is removed permanently. The removed portion of the stomach is the primary site from where the hormone ‘Ghrelin’ is secreted in the human body. It has been proven that ‘Ghrelin’ plays a significant role in secretion of the growth hormone and is an important link connecting growth and body composition with metabolism. This irreversible removal of the Ghrelin containing part of the stomach can have unknown repercussions on the growth of any child who undergoes this surgery.
Bariatric surgery is also known to cause bone loss and osteoporosis in children. Nutritional deficiencies are known to occur after surgery, and to expect lifelong commitment in terms of nutritional supplementation from a 2 year old is a bit too much to ask for. The implications on future reproductive health and pregnancy outcomes are also unknown. For all we know, the child may lose weight in the short term, but may grow up to be a cripple in his adulthood.
Direct extrapolation of adult results to pediatric population has never worked in the past. Moreover, an average weight loss of half a kg per month, as in this case, could possibly have also been achieved by implementation of a strict medically supervised lifestyle modification. These children are too immature to understand the gravity of the surgery being performed on them. For many years to come, they will not be able to apprehend the demands and exigencies of an irreversible procedure such as a sleeve gastrectomy surgery. Long term results of this surgery are unknown even in adults and it seems foolhardy to perform this on children, who may be at risk of experiencing unanticipated negative consequences several years into the future.
So, are we really justified in surgically modifying the healthy organ of an innocent toddler in absence of any clear evidence regarding safety and future outcomes?
Another question that arises here is, ‘Who exactly are we treating?’
It is expected that parents would act in the best interest of their children, and usually, they are the ones who take the decision and give consent for surgery. Poor parental food choices are a significant contributing factor leading to a rise in childhood obesity. More often than not, in such cases, we are probably actually treating the parental guilt rather than the health of the children in question. Surgery may be just a convenient solution to what may be perceived as parental failure.
As parents and doctors, we have a huge responsibility when it comes to the future of our children. Extreme caution is warranted while treating such cases. Cutting into a child’s healthy organ as a quick-fix must be avoided at all cost; and doctors and hospitals must refrain from generating unwarranted media hype around these cases, just to satisfy vested interests.
Children’s talent to endure stems from their ignorance of alternatives. – Maya Angelou
The innocence and ignorance of these children should not be wrongly exploited to expose them to potentially harmful treatment, which can thrust them into a future full of darkness. The voices of dissent must become stronger. It is high time that the right perspective is brought to the forefront.