The bariatric surgery program at UF Health, led by Kfir Ben-David, M.D., director of bariatric surgery and an associate professor at UF Health, recently received accreditation from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program as a “Comprehensive Center with Adolescent Qualifications.”
Only 34 institutions nationwide have an accreditation that covers adolescent bariatric surgery from this group. The group was created to be the national accrediting body for bariatric surgery programs when the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery combined their respective national bariatric surgery accreditation programs into one program.
Though UF Health’s accreditation from the MBSAQIP is relatively new, its adolescent bariatric surgery program is not. Ben-David has been performing bariatric surgery for qualified adolescent patients since 2007. He and UF Health pediatric endocrinologist Janet Silverstein, M.D., a professor and chief of the division of endocrinology in the department of pediatrics, were part of the Centers for Medicare and Medicaid Services committee that formulated Florida guidelines on adolescent bariatric surgery in 2008.
Ben-David also noted that the nursing support staff for bariatric surgery has received special training in dealing with adolescent patients. The adolescent bariatric surgery program at UF Health follows a formalized team approach to evaluating potential patients. Doing so helps ensure high-quality outcomes for patients by allowing only those with adequate family support and those deemed physically, mentally and psychologically ready for weight-loss surgery to undergo it.
“All the patients get referred to our program and we go through a pretty stringent workup for these patients,” Ben-David said.
The team that assesses teenage candidates for surgery and meets monthly to discuss potential patients includes Ben-David, Silverstein, a child psychiatrist, a nutritionist, a pediatrician and the surgical coordinators and nurse coordinator for the bariatric surgery program.
To qualify for surgery, patients must be at least 16 years old and free of underlying endocrine disorders, metabolic disorders or psychiatric conditions that contribute to their morbid obesity, as well as genetic predispositions to overeating.
Teens who do have endocrine or metabolic problems causing their morbid obesity must work with UF Health physicians to correct those problems before they are considered eligible for weight-loss surgery. Ben-David and the team also look at more intangible factors.
“I want them to show me that they’re motivated, so they have to do well in school. They have to be disciplined at home. They have to make sure that they’re losing weight before the surgery to show me that they actually are able to do it,” Ben-David said. “We have to make sure that the parents are involved in the care. Unfortunately, the 16-year-old’s not going food shopping. It’s the parents that are going food shopping. We just have to make sure that this is a team effort to take care of these children.”
Ben-David, who performs all of the bariatric surgeries for adolescent patients, estimated he does a maximum of 15 such surgeries per year. He only performs them when school is out, so as not to interfere with a patient’s education.
And, though he emphasized that preventing morbid obesity is always the best route, he advocates bariatric surgery as an important tool for some adolescents whose lives are gravely affected by their extreme weight.
“Most of these kids are morbidly obese, but they also have significant medical problems,” Ben-David said.
He listed sleep apnea, hypertension, diabetes, high cholesterol and arthritis as common problems he sees in teen patients. Silverstein, the pediatric endocrinologist, concurred.
“Some of the patients are in their early teens and weigh more than 200 pounds; some more than 300 pounds and have no ability to do any physical activity at all,” she said. “They are sedentary, are often home-schooled because they are bullied in the public schools and have abnormal blood sugar levels, high blood pressure, high cholesterol and fatty livers, all before the age of 20. They are at great risk for early heart attacks or strokes unless they can lose adequate weight to restore normal metabolism. Although we don’t recommend surgery as a weight loss tool often (for adolescents), there is a group of patients for whom this is their only option for a healthy, normal life.”