Surgical Intervention for Childhood Obesity by Dr. Mark Holterman

Pediatric Surgeon Dr. Mark Holterman Tackles Childhood Obesity

According to the U.S. Centers for Disease Control, childhood obesity rates in the u.S. have increased by more than 300 percent since 1970. Consequently, one-in-five children between the ages of 6–19 currently suffers from obesity. While prevention of obesity should be a top priority for healthcare professionals and society at large, medical interventions are necessary for children who already have the condition. The emotional challenges of adolescence make behavior modification particularly difficult for this age group, but experts have recently identified more effective approaches to treating obesity in young patients.


What is Childhood Obesity?


Obesity is not the same as being overweight. While both terms describe an excess of body fat in proportion to a person’s height, age, and sex, obesity implies a more immediate health threat. Body mass index, or BMI, is the common standard used for diagnosing obesity in children who are still growing. Children with a BMI that falls within the 85-94 percentiles of their peers of the same height, age and gender are considered overweight. If their BMI is at the 95th percentile or higher, they have obesity.


How Obesity Affects Children


Obesity can have a lasting impact on a child’s physical and emotional well-being ( Obesity puts children at a higher risk for the following health conditions:

– Asthma

– Bone and joint issue

– Diabetes

– Heart disease

– Sleep apnea


Obese children are also more prone to bullying, which leaves them vulnerable to social isolation and depression. Many obese children remain obese into adulthood, and the risks of such health complications compound with age.

What Causes Childhood Obesity?


The causes of the sudden spike in childhood obesity rates are poorly understood by the public. While many people mistakenly believe that sedentary lifestyles are to blame, obesity often results from a number of factors including:

– Genetics

– Individual metabolism

– Diet

– Physical activity

– Psychological and environmental factors


Overeating and lack of exercise certainly contribute to obesity, but genetic predispositions and individual biology have a greater impact on weight management than most people realize. Psychological and social factors also play a role. For example, depression and anxiety can increase cortisol production in the body, which makes weight loss more difficult. The types of foods that children have access to depends largely on their parents and poor dietary habits instilled at a young age can have lifelong consequences.


A nutritious diet limited in sugars and solid fats coupled with at least an hour of daily exercise offers the best defense against childhood obesity. Unfortunately, children with slower metabolism gain weight faster than their peers, and they have a harder time losing weight.


How to Help Children with Obesity


Obesity can also affect a young person’s performance in school. Research has shown that obese students typically miss more days of class than their peers due to health issues or to avoid bullying. Health experts view our public schools as crucial to the fight against childhood obesity, which has led to moderate improvements in cafeteria offerings and more opportunities for physical recreation.


While such school-based interventions have been effective at preventing obesity in young children, research on teenagers is less promising because older teens have more choices over what they eat and how they spend their time. While obesity prevention should be a goal for middle school and high school educators, behavior modification efforts have proven ineffective at treating obesity in this age group. Thankfully, research has identified a better option: bariatric surgery.

Weight Loss Surgery for Children


Bariatric surgery refers to a number of procedures designed to help obese people lose weight. While they remain somewhat controversial in the court of public opinion, surgical interventions for childhood obesity are safe and effective according to pediatric surgeon Dr. Mark Holterman. In 2011, Holterman and his colleagues at the University of Illinois College of Medicine authored a report making the case for such procedures.


“Weight management clinics that offer a surgical treatment option have been effective at achieving sustained weight loss and resolution of weight-related comorbidities,” Dr. Mark Holterman explains in his report. In the U.S., adolescents currently account for between 1,500-2,000 surgical weight loss patients each year.


Dr. Holterman’s interest in obesity stretches back decades. After graduating from Yale University with a degree in biology, Holterman obtained his Ph.D. and MD from the University of Virginia where he completed a residency in general surgery before accepting a pediatric surgery fellowship at the University of Washington. He also worked as an attending pediatric surgeon at Rush University Medical Center in Chicago.


In addition to teaching at the University of Illinois, Dr. Holterman is a practicing pediatric surgeon at the Advocate Christ Children’s Hospital, where he previously served as surgeon-in-chief and the Children’s Hospital of Illinois (Doctor.WebMD). His professional memberships include the American College of Surgeons and the American Academy of Pediatrics. Aside from obesity treatment, Dr. Holterman also studies regenerative medicine and stem cell therapies.

Dr. Marc Michalsky agrees with Holterman that bariatric surgeries for obese children are “a good idea, despite many misconceptions.” In an editorial, Michalsky cautions that bariatric surgery and similar procedures come with lifelong consequences, so they shouldn’t be taken lightly.


“Most importantly,” Michalsky notes, “it is critical to understand that the decision to move ahead with bariatric surgery is supported by an increasing number of studies showing that such operations are safe and effective.


Types of Surgical Treatment for Obesity


“Choosing a weight loss surgical strategy for children and adolescents should be patient specific and based on their age, the severity of comorbidities and their BMI,” Dr. Holterman claims. Any weight loss intervention must begin with a professional assessment of the child’s dietary habits, activity level, and overall health.


Bariatric surgery has proven to help adult patients lose weight and, more importantly, lower their risk for weight-related health issues. Research on children is scarce, but all of the available data indicates that bariatric procedures are more effective than behavior modification plans. Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and vertical sleeve gastrectomy are all examples of such procedures that are commonly performed on youth.


Bariatric surgery comes with risks, but so does childhood obesity. Therefore, kids and their parents should have access to all available treatments. Hopefully, more research will convince the public that such surgeries are safe for young patients.




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