Marc P. Michalsky, MD: Challenges in Adolescent Bariatric Surgery

Dr. Michalsky observed challenges in pediatric bariatric surgery, specifically growing consensus on its use, the use of BMI, and access to treatment.

In the second part of an interview with HCPLive®, Marc P. Michalsky, MD, Nationwide Children's Hospital, discussed challenges in both treatment and access to treatment when it comes to pediatric bariatric surgery.

Dr. Michalsky 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.

He spoke on a potential shift in consensus on bariatric surgery, explaining the consensus is seemingly broadening, especially as more non-surgical parties and stakeholders are involved in the process.

"Twenty years ago, when you mentioned or brought up the term of bariatric surgery as a possible therapeutic intervention, it was not uncommon to get some very surprised reactions," he said.

Michlasky noted a broad uptick in public policy initiatives, as well as a larger spectrum of creating specialty care teams designed to treat excess fat more directly.

"Now, much more so, I think it has broadened in terms of its acceptance,” he explained. “There are a number of centers throughout the country now, and a much more robust interest from, tertiary care centers to establish multi disciplinary service lines that address [excess fat] in general, which has become much less stigmatized than it was 10, 20, 30 years ago.”

Additionally, he reviewed the effectiveness of BMI, noting it does aid in defining candidacy for bariatric intervention in adults and even some adolescent age groups. However, he noted that the reliability of a BMI measure may be lower when children are much younger and called to attention the lack of an age guideline when it comes to bariatric surgery.

"When it comes to BMI, and when it comes to age, I think it's very important to take a very individualized approach," Michalsky said. "We see this in the adult world, even where there has been a push to allow or administer bariatric intervention for  BMI under 35 groups. I think that that's very important, and certainly serves as a model for the pediatric population."

Lastly, Michalsky touched on issues with accessibility in care, stemming from payers lack of authorization on surgical procedures or a lack of guidelines about its utilization.

“It's not uncommon for their policies to be predicated on data that is decades old or has not really been updated in the appropriate way,” he said.  “I think that there are a number of challenges and access to care is such a multifaceted issue. It needs to be addressed, not only within the medical community itself, but within our near social safety net.”