Major obesity surgery for children will be available on the NHS

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Overweight teenagers as young as 14 could undergo major operations such as a gastric bypass, stapling and banding

Obese children are to receive potentially life-threatening stomach surgery on the NHS under controversial new guidelines out next week.

Overweight teenagers as young as 14 are set to undergo major operations such as a gastric bypass, stapling and banding in a bid to curb Britain's obesity epidemic. Gastric bypass surgery is regarded as a safer form of stomach stapling, which bypasses part of the small intestine to reduce the capacity of the stomach.

In addition children under 12 will be offered anti-obesity drugs - despite the medication being licensed only for use in adults.

Experts proposing the guidelines say these "last resort" measures should be used only when children are so fat their health is endangered by heart disease, diabetes and other weight-related disorders.

• The facts about gastric surgery

They claim dramatic action is needed to save a generation from dying before their parents. More than a quarter of children are overweight or obese, with obesity rates of 14 per cent in those aged between two and 10 years.

At the same time, levels of inactivity have soared as many children no longer take part in competitive sport at school and playing fields have been closed.

The Government has set a target to halt the year-on-year rise in obesity among children under 11 by 2010.

For the first time the Government's watchdog, the National Institute for Health and Clinical Excellence (NICE), has proposed guidelines for preventing and treating obesity in children.

Surgery - which costs around £10,000 - would be an option for children who had reached an age of "psychological maturity", thought to be between 14 and 16 years.

Consultants at Sheffield Children's Hospital last year said they were considering operating on a small number of obese children in their early teens as a "last resort".

Gastric surgery is a risky procedure - even for adults - which needs lifelong monitoring for potential complications.

Last year 22-year-old teacher Hayley Caunter, from Billericay, Essex, died after having a gastric band fitted at a private Birmingham hospital to help her slim down from 20 stones. But she developed severe stomach pains after eating a piece of chicken and doctors failed to remove it. She died four days later.

Weight loss drugs Xenical and Reductil could also be prescribed for teenagers, and even children under 12 if doctors think their lives are at risk.

NICE accepts the drugs are not licensed for use in children but says doctors are legally permitted to do so if it will benefit their patients.

The latest guidance will spark controversy as NICE last month banned the use of Alzheimer's drugs in people with 'mild' disease, saying they were not cost-effective at £2.50 a day per patient - around £1,800 a year.

The National Obesity Forum says surgery and drugs must be available for treating childhood obesity where the child's health is at risk.

Professor Colin Waine, chairman of the National Obesity Forum, said "We believe there is a small group of obese children at significant risk who could benefit, once a child has finished growing and has achieved maximum height, and where there has been a failure of medical treatment.

"We wish it wasn't necessary but the risks are so great of not helping these children that surgery has to be be an option.

"This is because these children are at risk of developing type 2 diabetes in later life, they have significant risk factors for premature cardiovascular disease, and they are more at risk of developing cancer."

Some doctors are worried the problem of overweight children is being medicalised when they should be encouraged to be more active and eat healthily.

But Dr Waine said although this approach may stop today's youngsters getting fat, children who are obese need help now.

He said "We can't just ignore these children who are obese. Surgery works, it is not more dangerous than any other operation and the results are very good.

"It is used a lot more on the Continent and in the US for overweight teenagers and adults, and I think surgeons here are waiting for the go-ahead from NICE to offer it more widely.

"The costs will be reasonable, and do not compare with the costs to the Health Service if we do nothing and these children develop type 2 diabetes and its complications" he added.

The guidelines to be issued by NICE will advise that children undergo a thorough psychological, educational, family, and social assessment before being considered for surgery.

The techniques used include stapling the stomach or fitting a gastric band but they are normally used only on obese adults.

During the surgical procedure, the size of the patient's stomach is reduced so they feel full after eating small amounts.

Although anti obesity drugs are not licensed for use in children, the Royal College of Paediatrics and Child Health says doctors are legally allowed to prescribe unlicensed medicines where there are no suitable alternatives and where the use is justified by a responsible body of professional opinion.   Campaigners worried about the low activity levels in children have condemned the lack of sport provision in schools. Playing fields have been disappearing at the rate of almost one a day under Labour - some 2,540 school and community playing field sites have disappeared since 1997. A spokesman for Abbott, which makes Reductil, said "It is not indicated for use in children and we do not recommend its use off-licence."

A spokesman for Roche, which makes Xenical, said data had been sent to drug regulatory watchdogs on a study into its use in adolescents aged 12-16 years.

She said "It is up to doctors' discretion if they want to use the drug in children."

email j.hope@dailymail.co.uk

 

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