Tonsillectomy increases risk of pediatric obesity

Tonsillectomy is the most common major surgical procedure performed in children. Children who undergo the surgical removal of their tonsils (tonsillectomy), with or without the removal of their adenoids (adenoidectomy), are at increased risk for becoming overweight after surgery, according to new research published in the February 2011 issue of Otolaryngology - Head and Neck Surgery.

Pediatric obesity has increased overwhelmingly over the last 20 years, with recent data suggesting that as many as 33 percent of American children are overweight and 17 percent obese. Obese children are at increased risk of becoming obese adults, thus making them susceptible to cardiovascular disease and diabetes.

The study sample included 795 children aged 0 to 18 years old, described as normal weight or overweight and who had tonsillectomy or adenotonsillectomy surgery. In 47.7 percent of patients, the primary reason for surgery was sleep-disordered breathing. The first group included three studies involving 127 children, whose body mass index (BMI) increased by 5.5-8.2%. The second group included three studies involving 419 patients, in whom the standardized weight scores increased in 46-100% patients. The third group included three studies with 249 patients, in whom 50 - 75% of the patients gained weight after adenoidectomy. Each study was designed with different definitions of overweight and a range of follow-up periods

"There may have been a variety of proposed mechanisms for the weight gain following adenoidectomy," writes author Anita Jeyakumar, MD. "Children with chronic tonsillitis may have dysphagia or odynophagia that may lead to a reduced calorie intake. When the diseased tonsils are removed, the child then is able to consume additional calories. Parents may also feel impelled to over-feed their child when recovering from chronic illness or surgery, further adding to caloric intake and weight gain."

Based on these findings, the authors recommend that dietary and lifestyle advice be given to parents whose children are undergoing tonsillectomy. Growth monitoring after surgery is key to ensure that catch-up growth occurs within healthy limits.

January's edition of the journal featured a supplement on tonsillectomies, "Clinical Practice Guideline: Tonsillectomy in Children," which has been mentioned in several news outlets. You can view that guideline here, http://www.entnet.org/Practice/clinicalPracticeguidelines.cfm.