High rate of overweight and obesity found in children having surgery; extra weight can increase complications

A very high proportion of children who are having surgery are overweight or obese, and because of the excess weight have a greater chance of experiencing problems associated with the surgery, according to a new study from the University of Michigan Health System.

Researchers looked at a database of all 6,017 pediatric surgeries at the U-M Hospital from 2000 to 2004, and they found that nearly a third of the patients – 31.5 percent – were overweight or obese. More than half of those children qualified as obese, according to the study, which appears in the new issue of the Journal of the National Medical Association.

The prevalence of overweight children having surgery presents challenges to surgeons, anesthesiologists and their teams. Overweight adult patients are more likely to have conditions such as type II diabetes, hypertension, asthma and other breathing problems, and are more likely to develop infections in their wounds after surgery. The researchers on this study say those conditions also are becoming common among overweight and obese children.

The results also suggest that children who are overweight or obese have an increased likelihood of requiring certain types of surgery. The surgeries these children were having performed most frequently included the removal of tonsils and adenoids, as well as other surgeries designed to assist with breathing problems and sleep apnea; orthopedic surgeries to fix broken bones and other ailments; and procedures designed to mend digestive and gastrointestinal issues.

“The high rates of overweight and obesity that we found among children are striking because overweight children have a higher risk of problems before, during and after surgery,” says lead author Bukky Nafiu, M.D., FRCA, a resident in the U-M Medical School Department of Anesthesiology.

“This is an important element of the childhood obesity epidemic, and one that has not received much attention,” says senior author Josephine Kasa-Vubu, M.D, MS, assistant professor in the U-M Medical School Department of Pediatrics and Communicable Diseases.

While all age ranges in the study involved high rates of overweight and obesity, the highest was in boys and girls ages 8 to 12, typically the age just before entering puberty. “This seems to indicate an age-related vulnerability to becoming overweight and needing surgery, and this is something we believe warrants further studies,” Nafiu says.

Researchers noted that many of these children are likely to remain obese as adults – indeed, some 60 to 70 percent of obese adolescents are likely to remain obese as adults. Because of that they risk problems with their overall health and well-being, as well as future problems if they need to undergo surgery.

The researchers also point out that the magnitude of the problem may reflect, in part, the fact that Michigan has one of the highest rates of obesity in the United States. There are no comparable data from other states, but the researchers say it still is likely that these rates may be similar around the country, noting that rates of overweight and obesity in children has nearly tripled in the last two decades throughout the United States.

In addition to Nafiu and Kasa-Vubu, other authors on the article about obesity and surgery were Khady S. Ndao-Brumblay, Pharm.D.; Olumuyiwa A Bamgbade, M.D., FRCA, and Michelle Morris, M.S., all of the U-M Medical School Department of Anesthesiology.

Reference: Journal of the National Medical Association, Jan. 2007, VOL. 99, NO. 1.