Bariatric surgery may help teens, but insurers often exclude them

As obesity among young people continues to rise, a growing number of clinicians and researchers say that weight-loss surgery may be their best chance to take off significant weight and either correct or avoid such conditions as diabetes and heart disease, which often go hand-in-hand with obesity. But although health plans frequently cover bariatric surgery in adults, coverage for the procedure in patients younger than age 18 is spotty.

Experts in pediatric obesity say that caution is warranted and that insurers shouldn’t just rubber-stamp such surgery in adolescents. But they say emerging research may lead to more coverage for young people.

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• Insurers often exclude teens from bariatric surgery

Americans generally are getting fatter; more than a third of adults qualify as obese, with a body mass index of 30 or higher, according to the Centers for Disease Control and Prevention. But kids are putting on the pounds even faster than adults. Between 1980 and 2008, while the rate of obesity doubled in adults, it tripled for children, and 17 percent of them are now obese.

Bariatric surgery has found growing acceptance as an effective weight-loss strategy for adults. About 220,000 people had weight-loss surgery in 2009, according to the American Society for Metabolic & Bariatric Surgery. Three-quarters of companies with more than 20,000 employees cover the procedure for qualified patients. At firms with fewer than 1,000 workers, the figure is lower but still substantial: 46 percent, according to a 2011 survey by human resources consultant Mercer. Almost all Medicaid programs cover it.

But coverage for the procedures often excludes teenagers. “It’s harder to get teens covered,” says Robin Blackstone, a bariatric surgeon who is president of the ASMBS. “Plans just say they cover people 18 and over.”

Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry trade group, said she did not believe there was a consensus among physicians on how appropriate bariatric procedures are for teens. “There are also concerns about whether adolescents are mature enough to agree to surgery that will require behavior modifications for the rest of their lives.”

A smaller stomach

The most common weight-loss surgeries involve either placing an adjustable silicone band around the stomach to make it smaller or shrinking the stomach and reattaching it to the intestine so that it bypasses a portion of the digestive tract, thus reducing the absorption of calories and nutrients. Although generally considered safe, long-term complications such as malnutrition, low blood sugar and bowel obstruction may occur.

To qualify for surgery, adults generally must have a BMI of 40 or more, or a BMI of 30 to 35 with a weight-related disease. Before surgery is approved, prospective patients typically must have attempted to lose weight through diet and exercise for at least six months, among other criteria.

Similar or even more conservative guidelines are usually applied to adolescents. But bariatric surgery is still very rare in this group; according to one estimate, no more than 1 percent of surgeries involve patients younger than 18.