Marc P. Michalsky, MD: Expanding Use of Bariatric Surgery in Pediatrics


Dr. Michalsky discusses the utility of bariatric surgical options in patients with a high body mass index.

Expanding data on the use of bariatric surgery has led to an expansion in the pediatric population, but some primary care practitioners may still question its ultimate utility.

In an interview with HCPLive®, Marc P. Michalsky, MD, Nationwide Children's Hospital, spoke on the lag in clinical application of bariatric surgery, nothing a need for updated guidelines to help grow the use in the primary care space.

Dr. Michalsky recently presented a talk entitled "Adolescent Bariatric Surgery - What Every Pediatrician Needs to Know: Research, Consensus Guidelines, Accreditation and Ongoing Challenges," at the 2021 American Academy of Pediatrics Virtual Meeting.

"The more important part of the challenge is to actually help shepherd recommendations and consensus guidelines into the primary care consciousness in order to help providers understand that bariatric surgery is a important tool to help treat the pediatric population that is suffering from the most severe forms of body mass," Michalsky said.

Additionally, Michalsky pointed to a multiplicity of comorbid conditions stemming from high body mass index (BMI) and a reduction in these conditions following bariatric surgery.

He noted the legitimacy of questioning the implications of surgery at a more vulnerable timeframe in patients, but explained the growing body of data in support of pediatric bariatric surgery.

"I circle back to this issue of reversal of comorbid condition and the likelihood that a patient is going to no longer be hypertensive or no longer have diabetes," he said. "When we compare that, or those measures to matched adult groups, we see that the pediatric patients are actually doing better."

Michalsky also discussed outcomes of pediatric patients with a severe high BMI measure, observing that diet and excercise or behavior modification are not guaranteed results in losing excess fat.

"When you're looking at individuals that are dealing with a BMI of 35 or higher, the likelihood of being able to maintain a significant amount of reduction is very low," Michalsky said. "The short term and even long term success in terms of body mass loss durability is much more impressive than non-surgical techniques.

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