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Use of Metabolic and Bariatric Surgery Among US Youth

Use of Metabolic and Bariatric Surgery Among US Youth Letters RESEARCH LETTER mbsaqip) were used. The University of Texas Health Science Center Committee for Human Subjects Protection deemed this Use of Metabolic and Bariatric Surgery cohort study exempt from review and informed consent be- Among US Youth cause it is a retrospective analysis of public, anonymized data Severe obesity (body mass ≥120% of the 95th percentile ad- sets. This study followed the Strengthening the Reporting of justed for age and sex or an index >35 [calculated as weight in Observational Studies in Epidemiology (STROBE) reporting kilograms divided by height in meters squared]) is the fastest- guideline. growing obesity subcategory in the US pediatric population. A Cochran-Armitage trend test compared MBS use in 2015- The severe obesity rate in this 2019 vs 2020-2021 (years before and after the 2019 AAP state- population rose from 5.6% in ment release) in youth aged 10 to 19 years and in adults (aged Supplemental content 2015 to 6.5% in 2018, an in- >19 years) and by racial and ethnic groups (self-reported Black, crease of approximately 4.8 million youths, with the largest Hispanic, White, and other [American Indian or Alaska Na- increase among Hispanic youth (4.1% in 1999-2000 to 10.7% tive, Asian, Native Hawaiian or Other Pacific Islander], multi- in 2017-2018), followed by non-Hispanic Black (hereafter Black) racial, or unknown or not reported). Statistical analyses were youth (from 6.7% to 10.2%, respectively) and non-Hispanic performed using SAS, version 9.4 (SAS Institute, Inc). Two- White (hereafter White) youth (from 2.6% to 4%, respectively). sided P ≤ .05 was considered significant. Pediatric obesity is associated with cardiometabolic comor- bidities, liver and kidney disease, and lower quality of life, and Results | The analysis included 1 346 468 participants (mean these associations continue into adulthood. [SD] age, 44.9 [11.9] years; 1 101 823 females [81.1%%] and Behavioral lifestyle interventions alone do not result in 254 363 males [18.9%]: 227 999 Black [16.9%], 130 601 His- long-term, clinically important weight loss among youth with panic [9.7%], and 773 292 White [57.4%] individuals and severe obesity. Metabolic and bariatric surgery (MBS) is a 214 576 individuals [15.9%] of other races and ethnicities, 2,3 safe and effective treatment. In 2019, an American Acad- multiracial, or unknown race and ethnicity). The MBS emy of Pediatrics (AAP) policy statement highlighted the completion rates in youths increased from pre-AAP statement need for increased adolescent access to MBS when medically release through 2021, overall and for each ethnic subgroup indicated. Recent AAP clinical practice guidelines have sup- (for all groups, P for trend < .001). More youths (n = 1349) ported this policy. We examined trends in MBS use among (Figure, A) and adults (n = 207 834) (Figure, B) completed US youths aged 10 to 19 years and adults before and after the MBS in 2021 than in 2020 (1135 youths and 167 119 adults), 2019 AAP statement. resulting in 18.85% and 24.36% year-to-year increases in MBS rates, respectively. In 2021, MBS completion increased from Methods |Datafrommerged2015-2021participantusefilesfrom 182 to 258 procedures in Black youths, from 179 to 273 proce- the Metabolic and Bariatric Surgery Accreditation and Qual- dures in Hispanic youths, and from 459 to 518 procedures in ity Improvement Program (MBSAQIP; asmbs.org/about/ White youths (P for trend < .001 for all). Figure. Number of Metabolic and Bariatric Surgery (MBS) Procedures Completed in US From 2015 to 2021 A Youth B Adults 1600 250 000 Total Hispanic 200 000 Black White Other 150 000 100 000 50 000 0 0 2015 2016 2017 2018 2019 2020 2021 2015 2016 2017 2018 2019 2020 2021 Year Year Number of MBS procedures among youth (A) and adults (B) overall and stratified by race and ethnicity before and after (solid vertical line) the 2019 American Academy of Pediatrics statement calling for increased MBS access for adolescents. P for trend < .001 in both age groups. jamapediatrics.com (Reprinted) JAMA Pediatrics Published online May 30, 2023 E1 No. of MBS procedures No. of MBS procedures Letters Critical revision of the manuscript for important intellectual content: Messiah, Discussion | Use of and access to MBS have increased among US Xie, de la Cruz-Munoz. youth and among most racial and ethnic groups. Compared Statistical analysis: Messiah, Xie. with 2015-2019, MBS use in youths increased significantly in Obtained funding: Messiah. 2020-2021 during the first 2 years of the COVID-19 pandemic. Administrative, technical, or material support: Messiah, Lipshultz. Supervision: Messiah. In contrast, MBS rates in adults decreased in 2020. The AAP has highlighted the need to educate pediatricians about the Conflict of Interest Disclosures: Dr Messiah reported receiving grants from the National Institute on Minority Health and Health Disparities (NIMHD) and the benefits of MBS for qualified patients. Historically, MBS has National Institute of Child Health and Human Development during the conduct of been underused in youths due to barriers, including low re- this study. Dr Xie reported receiving grants from NIMHD during the conduct of this ferral rates, limited access, and poor insurance coverage. In a study. Dr Lipshultz reported receiving grants from the US Department of Health and Human Services, National Center for Toxicological Research, National recent study, our research group reported sustained weight, Institutes of Health, Laura Coulter-Jones Foundation, Bachelor Foundation, comorbidity reductions, and low long-term complication rates Children’s Cardiomyopathy Foundation, Sofia’s Hope, Inc, Kyle John Rymiszewski a decade after MBS in patients aged 15 to 21 years. A study limi- Foundation, Children’s Hospital of Michigan Foundation, Scott Howard Fund, and tation is that the MBSAQIP data may not be representative of Michael Garil Fund. No other disclosures were reported. all MBS practices in the US. Nevertheless, results of the pres- Data Sharing Statement: See the Supplement. ent study suggest cautious optimism regarding the decreas- Additional Contributions: The authors thank the American College of Surgeons ing barriers to MBS for those US youth in need. and the American Society for Metabolic and Bariatric Surgery for use of the 2015-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participant use file for this analysis. Sarah E. Messiah, PhD 1. Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity Luyu Xie, PharmD, PhD and severe obesity prevalence in US youth and adults by sex and age, Nestor de la Cruz-Muñoz, MD 2007-2008 to 2015-2016. JAMA. 2018;319(16):1723-1725. doi:10.1001/ Steven E. Lipshultz, MD jama.2018.3060 2. Messiah SE, Xie L, Atem F, et al. Disparity between United States adolescent Author Affiliations: University of Texas Health Science Center at Houston class II and III obesity trends and bariatric surgery utilization, 2015-2018. Ann Surg. School of Public Health—Dallas Campus, Dallas (Messiah, Xie); Dewitt Daughtry 2022;276(2):324-333. doi:10.1097/SLA.0000000000004493 Family Department of Surgery, University of Miami Miller School of Medicine, 3. Armstrong SC, Bolling CF, Michalsky MP, Reichard KW; Section on Obesity, Miami, Florida (de la Cruz-Muñoz); Department of Pediatrics, University at Section on Surgery. Pediatric metabolic and bariatric surgery: evidence, barriers, Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York and best practices. Pediatrics. 2019;144(6):e20193223. doi:10.1542/ (Lipshultz). peds.2019-3223 Accepted for Publication: January 13, 2023. 4. Kelly AS, Barlow SE, Rao G, et al; American Heart Association Published Online: May 30, 2023. doi:10.1001/jamapediatrics.2023.0803 Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Open Access: This is an open access article distributed under the terms of the CC- Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical BY License. © 2023 Messiah SE et al. JAMA Pediatrics. Activity and Metabolism, and Council on Clinical Cardiology. Severe obesity in children and adolescents: identification, associated health risks, and treatment Corresponding Author: Sarah E. Messiah, PhD, University of Texas Health approaches: a scientific statement from the American Heart Association. Science Center at Houston School of Public Health—Dallas Campus, 2777 N Circulation. 2013;128(15):1689-1712. doi:10.1161/CIR.0b013e3182a5cfb3 Stemmons Fwy, Ste 8400, Dallas, TX 75207 (sarah.e.messiah@uth.tmc.edu). 5. Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the Author Contributions: Dr Messiah had full access to all of the data in the study evaluation and treatment of children and adolescents with obesity. Pediatrics. and takes responsibility for the integrity of the data and the accuracy of the data 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640 analysis. Concept and design: Messiah, de la Cruz-Munoz, Lipshultz. 6. de la Cruz-Muñoz N, Xie L, Quiroz HJ, et al. Long-term outcomes after Acquisition, analysis, or interpretation of data: Messiah, Xie, Lipshultz. adolescent bariatric surgery. J Am Coll Surg. 2022;235(4):592-602. doi:10.1097/ Drafting of the manuscript: Messiah, Xie, Lipshultz. XCS.0000000000000325 E2 JAMA Pediatrics Published online May 30, 2023 (Reprinted) jamapediatrics.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Pediatrics American Medical Association

Use of Metabolic and Bariatric Surgery Among US Youth

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Publisher
American Medical Association
Copyright
Copyright 2023 Messiah SE et al. JAMA Pediatrics.
ISSN
2168-6203
eISSN
2168-6211
DOI
10.1001/jamapediatrics.2023.0803
Publisher site
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Abstract

Letters RESEARCH LETTER mbsaqip) were used. The University of Texas Health Science Center Committee for Human Subjects Protection deemed this Use of Metabolic and Bariatric Surgery cohort study exempt from review and informed consent be- Among US Youth cause it is a retrospective analysis of public, anonymized data Severe obesity (body mass ≥120% of the 95th percentile ad- sets. This study followed the Strengthening the Reporting of justed for age and sex or an index >35 [calculated as weight in Observational Studies in Epidemiology (STROBE) reporting kilograms divided by height in meters squared]) is the fastest- guideline. growing obesity subcategory in the US pediatric population. A Cochran-Armitage trend test compared MBS use in 2015- The severe obesity rate in this 2019 vs 2020-2021 (years before and after the 2019 AAP state- population rose from 5.6% in ment release) in youth aged 10 to 19 years and in adults (aged Supplemental content 2015 to 6.5% in 2018, an in- >19 years) and by racial and ethnic groups (self-reported Black, crease of approximately 4.8 million youths, with the largest Hispanic, White, and other [American Indian or Alaska Na- increase among Hispanic youth (4.1% in 1999-2000 to 10.7% tive, Asian, Native Hawaiian or Other Pacific Islander], multi- in 2017-2018), followed by non-Hispanic Black (hereafter Black) racial, or unknown or not reported). Statistical analyses were youth (from 6.7% to 10.2%, respectively) and non-Hispanic performed using SAS, version 9.4 (SAS Institute, Inc). Two- White (hereafter White) youth (from 2.6% to 4%, respectively). sided P ≤ .05 was considered significant. Pediatric obesity is associated with cardiometabolic comor- bidities, liver and kidney disease, and lower quality of life, and Results | The analysis included 1 346 468 participants (mean these associations continue into adulthood. [SD] age, 44.9 [11.9] years; 1 101 823 females [81.1%%] and Behavioral lifestyle interventions alone do not result in 254 363 males [18.9%]: 227 999 Black [16.9%], 130 601 His- long-term, clinically important weight loss among youth with panic [9.7%], and 773 292 White [57.4%] individuals and severe obesity. Metabolic and bariatric surgery (MBS) is a 214 576 individuals [15.9%] of other races and ethnicities, 2,3 safe and effective treatment. In 2019, an American Acad- multiracial, or unknown race and ethnicity). The MBS emy of Pediatrics (AAP) policy statement highlighted the completion rates in youths increased from pre-AAP statement need for increased adolescent access to MBS when medically release through 2021, overall and for each ethnic subgroup indicated. Recent AAP clinical practice guidelines have sup- (for all groups, P for trend < .001). More youths (n = 1349) ported this policy. We examined trends in MBS use among (Figure, A) and adults (n = 207 834) (Figure, B) completed US youths aged 10 to 19 years and adults before and after the MBS in 2021 than in 2020 (1135 youths and 167 119 adults), 2019 AAP statement. resulting in 18.85% and 24.36% year-to-year increases in MBS rates, respectively. In 2021, MBS completion increased from Methods |Datafrommerged2015-2021participantusefilesfrom 182 to 258 procedures in Black youths, from 179 to 273 proce- the Metabolic and Bariatric Surgery Accreditation and Qual- dures in Hispanic youths, and from 459 to 518 procedures in ity Improvement Program (MBSAQIP; asmbs.org/about/ White youths (P for trend < .001 for all). Figure. Number of Metabolic and Bariatric Surgery (MBS) Procedures Completed in US From 2015 to 2021 A Youth B Adults 1600 250 000 Total Hispanic 200 000 Black White Other 150 000 100 000 50 000 0 0 2015 2016 2017 2018 2019 2020 2021 2015 2016 2017 2018 2019 2020 2021 Year Year Number of MBS procedures among youth (A) and adults (B) overall and stratified by race and ethnicity before and after (solid vertical line) the 2019 American Academy of Pediatrics statement calling for increased MBS access for adolescents. P for trend < .001 in both age groups. jamapediatrics.com (Reprinted) JAMA Pediatrics Published online May 30, 2023 E1 No. of MBS procedures No. of MBS procedures Letters Critical revision of the manuscript for important intellectual content: Messiah, Discussion | Use of and access to MBS have increased among US Xie, de la Cruz-Munoz. youth and among most racial and ethnic groups. Compared Statistical analysis: Messiah, Xie. with 2015-2019, MBS use in youths increased significantly in Obtained funding: Messiah. 2020-2021 during the first 2 years of the COVID-19 pandemic. Administrative, technical, or material support: Messiah, Lipshultz. Supervision: Messiah. In contrast, MBS rates in adults decreased in 2020. The AAP has highlighted the need to educate pediatricians about the Conflict of Interest Disclosures: Dr Messiah reported receiving grants from the National Institute on Minority Health and Health Disparities (NIMHD) and the benefits of MBS for qualified patients. Historically, MBS has National Institute of Child Health and Human Development during the conduct of been underused in youths due to barriers, including low re- this study. Dr Xie reported receiving grants from NIMHD during the conduct of this ferral rates, limited access, and poor insurance coverage. In a study. Dr Lipshultz reported receiving grants from the US Department of Health and Human Services, National Center for Toxicological Research, National recent study, our research group reported sustained weight, Institutes of Health, Laura Coulter-Jones Foundation, Bachelor Foundation, comorbidity reductions, and low long-term complication rates Children’s Cardiomyopathy Foundation, Sofia’s Hope, Inc, Kyle John Rymiszewski a decade after MBS in patients aged 15 to 21 years. A study limi- Foundation, Children’s Hospital of Michigan Foundation, Scott Howard Fund, and tation is that the MBSAQIP data may not be representative of Michael Garil Fund. No other disclosures were reported. all MBS practices in the US. Nevertheless, results of the pres- Data Sharing Statement: See the Supplement. ent study suggest cautious optimism regarding the decreas- Additional Contributions: The authors thank the American College of Surgeons ing barriers to MBS for those US youth in need. and the American Society for Metabolic and Bariatric Surgery for use of the 2015-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participant use file for this analysis. Sarah E. Messiah, PhD 1. Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity Luyu Xie, PharmD, PhD and severe obesity prevalence in US youth and adults by sex and age, Nestor de la Cruz-Muñoz, MD 2007-2008 to 2015-2016. JAMA. 2018;319(16):1723-1725. doi:10.1001/ Steven E. Lipshultz, MD jama.2018.3060 2. Messiah SE, Xie L, Atem F, et al. Disparity between United States adolescent Author Affiliations: University of Texas Health Science Center at Houston class II and III obesity trends and bariatric surgery utilization, 2015-2018. Ann Surg. School of Public Health—Dallas Campus, Dallas (Messiah, Xie); Dewitt Daughtry 2022;276(2):324-333. doi:10.1097/SLA.0000000000004493 Family Department of Surgery, University of Miami Miller School of Medicine, 3. Armstrong SC, Bolling CF, Michalsky MP, Reichard KW; Section on Obesity, Miami, Florida (de la Cruz-Muñoz); Department of Pediatrics, University at Section on Surgery. Pediatric metabolic and bariatric surgery: evidence, barriers, Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York and best practices. Pediatrics. 2019;144(6):e20193223. doi:10.1542/ (Lipshultz). peds.2019-3223 Accepted for Publication: January 13, 2023. 4. Kelly AS, Barlow SE, Rao G, et al; American Heart Association Published Online: May 30, 2023. doi:10.1001/jamapediatrics.2023.0803 Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Open Access: This is an open access article distributed under the terms of the CC- Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical BY License. © 2023 Messiah SE et al. JAMA Pediatrics. Activity and Metabolism, and Council on Clinical Cardiology. Severe obesity in children and adolescents: identification, associated health risks, and treatment Corresponding Author: Sarah E. Messiah, PhD, University of Texas Health approaches: a scientific statement from the American Heart Association. Science Center at Houston School of Public Health—Dallas Campus, 2777 N Circulation. 2013;128(15):1689-1712. doi:10.1161/CIR.0b013e3182a5cfb3 Stemmons Fwy, Ste 8400, Dallas, TX 75207 (sarah.e.messiah@uth.tmc.edu). 5. Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the Author Contributions: Dr Messiah had full access to all of the data in the study evaluation and treatment of children and adolescents with obesity. Pediatrics. and takes responsibility for the integrity of the data and the accuracy of the data 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640 analysis. Concept and design: Messiah, de la Cruz-Munoz, Lipshultz. 6. de la Cruz-Muñoz N, Xie L, Quiroz HJ, et al. Long-term outcomes after Acquisition, analysis, or interpretation of data: Messiah, Xie, Lipshultz. adolescent bariatric surgery. J Am Coll Surg. 2022;235(4):592-602. doi:10.1097/ Drafting of the manuscript: Messiah, Xie, Lipshultz. XCS.0000000000000325 E2 JAMA Pediatrics Published online May 30, 2023 (Reprinted) jamapediatrics.com

Journal

JAMA PediatricsAmerican Medical Association

Published: May 30, 2023

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