P2.P312: Obesity Prevalence and Trends in the Pediatric General Surgery Population at a Tertiary Referral Center

Background: Childhood obesity is a significant public health issue that can lead to devastating complications. In recent years, there has been increased utilization of metabolic and bariatric surgery for the management of severe obesity in children and a growth in the amount of literature supporting this practice. In fact, the American Academy of Pediatrics in 2023 recommended all children 13 years and older with severe obesity be referred for bariatric surgery evaluation. The aim of this study was to evaluate our institution’s experience by studying the trend in obesity rates and number of patients who would be considered for bariatric surgery per society guidelines.

Methods: A retrospective review of children admitted to the pediatric surgery service at a single pediatric tertiary referral hospital from November 2005 and December 2022 was performed. To screen for obesity, children less than 18 years old who underwent laparoscopic or open cholecystectomy or appendectomy were included if their chart had sufficient information to calculate BMI-for-age percentiles based on CDC growth charts. Demographics, BMI, BMI percentile, and comorbidities were compared between two cohorts differentiated by operation timing (on or before [n=1135] vs. after [n=1135] October 30, 2014). The proportion of patients who qualified for bariatric surgery per society guidelines was also evaluated (120% of the 95th BMI percentile [class 2 obesity] and ≥1 BMI-related comorbidity or 140% of the 95th BMI percentile [class 3 obesity]). Parametric testing using t-tests was performed. Statistical significance was defined as p< 0.05.

Results: Of the 2270 patients, 496 (21.8%) were characterized as obese (BMI≥95th percentile), and 64 (2.8%) met criteria for severe obesity (BMI ≥120% of the 95th percentile). Median age at time of operation was 11 years. When comparing the cohorts, mean BMI (20.2±5.8 vs. 21.1±6.4; p=0.0003), mean BMI percentile (64.7±30.9 vs. 67.1±30.6, p=0.0336), and the number of patients with BMI-related comorbidities (2.3% vs. 5.3%; p=0.0003) were significantly higher in after October 2014. The proportion of patients with class 2 obesity and a comorbidity also increased from 0.7% to 1.5% but was not found to be significant (p=0.068). There was no difference between cohorts in class 3 obesity rates (2.3% vs. 2.1%; p=0.745) or the total proportion who qualify for bariatric surgery (3% vs. 3.6%; p=0.424).

Conclusion: We found that obesity rates have increased over the past decade in children who underwent appendectomy or cholecystectomy in our region. At least 3% of this population may benefit from bariatric surgery. Assessing these data for other regions may support the need to build capacity for metabolic and bariatric surgery capacity in our pediatric population.