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Surgery for Obese Children on NHS

Posted on: Saturday, 18 March 2006, 18:00 CST

By JENNY HOPE

OBESE children are to have stomach surgery on the NHS.

Experts say the drastic action is needed to save a generation of overweight youngsters from dying before their parents.

Major operations such as stomach stapling and gastric banding which carry life-threatening risks will be offered to children as young as 14.

Many are so fat their health is endangered by heart disease, diabetes and other disorders.

Doctors are also being told they should prescribe anti-obesity drugs for the worst-affected children of 12 and under even though the medication is licensed only for adults.

But some doctors condemned the controversial moves last night, saying obesity should be tackled by simply encouraging better diets and more exercise. More than a quarter of children are currently overweight, with one in seven youngsters between two and ten classed as obese.

The Government has set a target of halting the annual rise in obesity among under-11s by 2010.

Its NHS treatment watchdog, the National Institute for Health and Clinical Excellence, has now proposed the first-ever guidelines for fighting obesity in children.

Surgery would be an option for children who reach an age of 'physiological maturity', thought to be between 14 and 16.

Operations such as stomach stapling and gastric banding recently undergone by Anne Diamond cost around Pounds 10,000 at private clincs.

The weight loss drugs Xenical and Reductil may be prescribed for teenagers, and even for younger children if doctors think their lives are at risk.

Although NICE accepts the drugs are not licensed to be used on children, it says doctors are legally permitted to do so if it will benefit their patients.

Professor Colin Waine, chairman of the National Obesity Forum, said surgery and drugs must be an option for childhood obesity.

He said: 'I would accept the need for consideration of surgery when a child has achieved maximum height, there has been a failure of medical treatment and the child's risk profile is significant.

'These children are at risk of developing type 2 diabetes in later life, they have significant risk factors for premature cardiovascular disease and they are more at risk of developing cancer.' Consultants at Sheffield Children's Hospital said last year they were considering operating on obese children in their early teens as a 'last resort'.

GP Dr David Haslam, clinical director of the NOF, said childhood obesity was such an enormous problem it needed extreme solutions.

He said: 'Surgery could be lifesaving for children who are obese and already developing heart disease.

'But I believe GPs would not want to prescribe drugs to children under 12.

They should be seen in specialist centres if this course of action was being considered.' Other doctors are worried, however, that the issue of overweight children is being made into a medical problem when they should be encouraged to be more active and eat healthily.

Only around two-thirds of pupils in the state sector manage two hours of sport each week, according to government figures. About half of all sixyear- olds in state schools are not getting the recommended two hours of PE every week.

Campaigners worried about the low activity levels have condemned the lack of sport provision. Playing fields have been disappearing at the rate of almost one a day under Labour.

Dr David Kerr, of the Bournemouth Diabetes Centre, said: 'It's a sad day when we are using pharmacological treatment or surgery to tackle a problem which is basically preventable.

'This issue has become embedded with politics which is why we have only just got to the stage where children are being weighed and measured an essential first step.

'Our "ditch the fizz" scheme to encourage children not to consume fizzy drinks can be as effective as taking weight-loss drugs. When we asked 1,000 secondary schoolchildren about exercise, they said they wanted to find out more about different things they could do.

'These are much more effective ways of dealing with the problem than getting children to swallow drugs that at best have a modest benefit.' The NICE guidelines, which will now go through an eight- week consultation process, say children would have to undergo a thorough psychological, educational, family and social assessment before being considered for surgery.

NICE said anti- obesity drugs should not generally be offered to children under 12 and should be given only to teenagers with 'severe obesity-related health problems'.

But a spokesman for Abbott, which makes Reductil, said: 'It is not indicated for use in children and we do not recommend its use off licence.'

j.hope@dailymail.co.uk

Operations that carry deadly risks

GASTRIC surgery is a risky procedure even for adults which needs lifelong monitoring for potential complications.

The operations have been made popular by celebrities such as Sharon Osbourne, Roseanne Barr and most recently former TV presenter Anne Diamond, who had a gastric band fitted last September in Belgium.

In stomach stapling, the upper stomach is stapled to create a small pouch.

This reduces the stomach's capacity and the intestine's ability to absorb nutrients.

Stomach band surgery involves placing a band around the upper part of the stomach. The band can be inflated so a smaller gastric pouch is formed. This limits food consumption and creates an earlier feeling of fullness.

The device is intended to stay in place permanently but can be tightened or loosened by surgeons through a portal under the skin.

Hundreds of such gastric bypass operations are conducted every year on those classified as 'morbidly obese' where their weight puts them at severe health risk.

Up to one in 50 patients may experience a wound or internal infection. The risk of death is three in 1,000.

Unpleasant side effects of anti-fat drugs

THE two anti-obesity drugs that could be given to children work in different ways but both can have unpleasant side effects.

Xenical, which came on the market in 1998, disrupts the absorption of fat in the intestine so the body excretes it instead.

Users must stick to a low-fat diet, or face side effects including flatulence and loss of bowel control.

Although not licensed for children, the EU has given permission to manufacturer Roche to print data on the label about the drug's efficiency in treating 12 to 18-year-olds.

This followed a study in the Journal of the American Medical Association in which 539 obese adolescents were given either Xenical or a placebo, while also on a calorie-controlled diet and taking exercise. Researchers found that in a year those given Xenical cut their Body Mass Index more than those on the placebo and lost up to 16lbs.

Also known as orlistat, Xenical costs the NHS about Pounds 40 a month.

Reductil, also known as sibutramine, tricks patients' brains into making them feel 'full' by raising the metabolic rate and causes them to eat up to 20 per cent less food.

Made by Abbott Laboratories, the drug's side effects include high blood pressure, insomnia, constipation and a dry mouth. It is usually prescribed to patients between the ages of 18 and 65 who have made serious attempts to slim by other means and costs the NHS about Pounds 45 a month.

Source: Daily Mail; London (UK)

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