Revisiting childhood obesity: persistent underutilization of surgical intervention?

Over the last two decades, the prevalence of obesity in children ages 6 to 11 years has almost tripled, and more than tripled in teenagers. The purpose of this study is to define the characteristics of hospitalized obese children and utilization of bariatric surgery. Analysis of the 1998 to 2007 Healthcare Cost and Utilization Project Nationwide Inpatient Sample was conducted with years 2000, 2003, and 2006 substituted with the Kids' Inpatient Database dataset. Records with diagnosis of obesity were included in the analysis with major comorbidities defined as the presence of hypertension, obstructive sleep apnea, diabetes mellitus, or coronary artery disease. National estimates over a 10-year period were calculated using sampling weights. Approximately 223,700 children met the inclusion criteria, of which 20 per cent were morbidly obese, with an overall 20 per cent incidence of major comorbidity. Comorbidities were found to be significantly higher among Asian/Pacific Islander (28.3%), African-American (27.2%), and Hispanic (19.1%; P < 0.001) compared with white (15.6%) children. Only 2 per cent of morbidly obese children with major comorbidity underwent a bariatric procedure. Obesity remains a growing childhood epidemic with a disproportionate ethnic burden of comorbidities. Bariatric surgery remains a viable option and a structured guideline in children may provide equitable access across different ethnic and socioeconomic groups.